Abstract
Objective:
Congenital hypothyroidism (CH) with delayed thyroid-stimulating hormone (TSH) elevation is a common form of thyroid dysfunction among premature infants. Routine newborn screening (NBS) may miss infants with CH with delayed TSH elevation. The objective of the study is to determine the prevalence of CH with delayed TSH elevation in premature infants and to identify associated risk factors.
Study Design:
Retrospective analysis of serum thyroid function screening (TFS) at day of life 30 in premature infants <30 weeks gestation, admitted to University of Iowa Neonatal Intensive Care Unit between 1 July 2012 to 30 June 2015. Serum free thyroxine and TSH levels were obtained in premature infants <30 weeks gestation on day of life 30. Follow-up testing and pediatric endocrinology consultation were done according to the institutional protocol.
Result:
In total, 286 infants were included. All infants underwent routine NBS and 280 patients underwent TFS. Twenty-six patients (9.1%) were diagnosed with thyroid dysfunction. NBS identified only three patients. CH with delayed TSH elevation was diagnosed in 20 patients (6.9%) and was significantly associated with multiple gestation, lower birth weight, higher gestational age and lower 5 min APGAR score.
Conclusion:
Thyroid dysfunction is common among premature infants born before 30 weeks gestation. The majority of cases with thyroid dysfunction had CH with delayed TSH elevation, which was not detected by NBS. We recommend measurement of serum TSH and free T4 levels on day of life 30 in premature infants born at <30 weeks gestation to identify patients with CH with delayed TSH elevation.
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References
Stoll BJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shankaran S et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA 2015; 314: 1039–1051.
Rysavy MA, Li L, Bell EF, Das A, Hintz SR, Stoll BJ et al. Between-hospital variation in treatment and outcomes in extremely preterm infants. N Engl J Med 2015; 372: 1801–1811.
Fisher DA . Thyroid system immaturities in very low birth weight premature infants. Semin Perinatol 2008; 32: 387–397.
LaFranchi SH . Screening preterm infants for congenital hypothyroidism: better the second time around. J Pediatr 2014; 164: 1259–1261.
Wassner AJ, Brown RS . Congenital hypothyroidism: recent advances. Curr Opin Endocrinol Diabetes Obes 2015; 22: 407–412.
Hunter MK, Mandel SH, Sesser DE, Miyahira RS, Rien L, Skeels MR et al. Follow-up of newborns with low thyroxine and non-elevated thyroid-stimulating hormone-screening concentrations: results of the 20-year experience in the Northwest Regional Newborn Screening Program. J Pediatr 1998; 132: 70–74.
Mandel SJ, Hermos RJ, Larson CA, Prigozhin AB, Rojas DA, Mitchell ML . Atypical hypothyroidism and the very low birthweight infant. Thyroid 2000; 10: 693–695.
Larson C, Hermos R, Delaney A, Daley D, Mitchell M . Risk factors associated with delayed thyrotropin elevations in congenital hypothyroidism. J Pediatr 2003; 143: 587–591.
Wiley V, Bijarnia S, Wikcken B . Screening for hypothyroidism in very low birth weight babies. Rev Invest Clin 2009; 61 (Supp 1): 31.
Woo HC, Lizarda A, Tucker R, Mitchell ML, Vohr B, Oh W et al. Congenital hypothyroidism with a delayed thyroid stimulating hormone elevation in very premature infants: incidence and growth and developmental outcomes. J Pediatr 2011; 158: 538–542.
Mitchell ML, Hsu HW, Sahai I . The increased incidence of congenital hypothyroidism: fact or fancy? Clin Endocrinol 2011; 75: 806–810.
LaFranchi SH . Newborn screening strategies for congenital hypothyroidism: an update. J Inherit Metab Dis 2010; 33: S225–S233.
Papile LA, Burstein J, Burstein R, Koffler H . Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92: 529–534.
De Vries LS, Eken P, Dubowitz LM . The spectrum of leukomalacia using cranial ultrasound. Behav Brain Res 1992; 49: 1–6.
Bell MJ, Ternberg JL, Feigin RD, Marshall R, Barton L et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187: 1–7.
International Committee for the Classification of Retinopathy of Prematurity. The international classification of retinopathy of prematurity revisited. Arch Ophthalmol 2005; 123: 991–999.
Lee JH, Kim SW, Jeon GW, Sin JB . Thyroid dysfunction in very low birth weight preterm infants. Korean J Pediatr 2015; 58: 224–229.
Hinton CF, Harris KB, Borgfeld L, Drummond-Borg M, Eaton R, Lorey F et al. Trends in incidence rates of congenital hypothyroidism related to select demographic factors: data from the United States, California, Massachusetts, New York, and Texas. Pediatrics 2010; 125: S37–S47.
Léger J, Olivieri A, Donaldson M, Torresani T, Krude H, van Vliet G et al. European Society for Paediatric Endocrinology consensus guidelines on screening, diagnosis, and management of congenital hypothyroidism. J Clin Endocrinol Metab 2014; 99: 363–384.
Vigone MC, Daiulo S, Di Frenna M, Ghirardello S, Corbetta C, Mosca F et al. Evolution of thyroid function in preterm infants detected by screening for congenital hypothyroidism. J Pediatr 2014; 164: 1296–1302.
Van Wassenaer AG, Kok JH, de Vijlder JJ, Briet JM, Smit BJ, Tamminga P et al. Effects of thyroxine supplementation on neurologic development in infants born at less than 30 weeks' gestation. N Engl J Med 1997; 336: 21–26.
Filippi L, Pezzati M, Cecchi A, Poggi C . Dopamine infusion: a possible cause of undiagnosed congenital hypothyroidism in preterm infants. Pediatr Crit Care Med 2006; 7: 249–251.
Filippi L, Pezzati M, Pogi C, Rossi S, Cecchi A, Santoro C . Dopamine versus dobutamine in very low birthweight infants: endocrine effects. Arch Dis Child Fetal Neonatal Ed 2007; 92: F367–F371.
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DK designed the study, drafted the project proposal, collected data, drafted and approved final manuscript as submitted. TTC was involved in designing of the study, did the data analysis, drafted and approved final manuscript as submitted. LMP and MT were involved in designing of the study, reviewed and approved final manuscript as submitted. JMK was involved in designing of the study, coordinated with IRB, reviewed and approved final manuscript as submitted.
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Kaluarachchi, D., Colaizy, T., Pesce, L. et al. Congenital hypothyroidism with delayed thyroid-stimulating hormone elevation in premature infants born at less than 30 weeks gestation. J Perinatol 37, 277–282 (2017). https://doi.org/10.1038/jp.2016.213
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DOI: https://doi.org/10.1038/jp.2016.213
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