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Thyroid dysfunction in preterm infants born before 32 gestational weeks.

ABSTRACT: BACKGROUND:Thyroid hormones are critical for growth and brain development during the newborn period and infancy. Because of delayed maturation of the hypothalamic-pituitary-thyroid axis in preterm infants, thyroid dysfunction is common, and thyroid stimulating hormone (TSH) elevation is often delayed in preterm infants. The objective of this study was to determine the incidence of thyroid dysfunction requiring levothyroxine treatment and to identify its risk factors in preterm infants. METHODS:A retrospective cohort study was performed on preterm infants who were born before 32 gestational weeks and admitted to a single tertiary academic center for more than 8?weeks between January 2008 and December 2014. In these infants, serial thyroid function tests (TFTs) measuring serum TSH and free thyroxine (fT4) were routinely performed at 1, 3, and 6?weeks of postnatal age. RESULTS:Of the 220 preterm infants enrolled, 180 infants underwent TFTs at 1, 3, and 6?weeks of postnatal age and were included in the study. Of the 180 infants, 35 infants (19.4%) were started on levothyroxine treatment based on the results of serial TFTs. Among the 35 infants who were treated with levothyroxine, 16 infants (45.7%) had normal results on the initial TFT. Three of these 16 infants continued to have normal results on the second TFT. Thyroid dysfunction requiring levothyroxine treatment was significantly associated with maternal pregnancy-induced hypertension (adjusted odds ratio 2.64, 95% confidence interval 1.02-6.81). CONCLUSIONS:Thyroid dysfunction requiring levothyroxine treatment occurred in nearly one-fifth of preterm infants born before 32 gestational weeks. Nearly half of the preterm infants who were treated with levothyroxine had normal TSH and fT4 levels at 1 week of postnatal age. The findings of the present study suggest that serial TFTs is important to find preterm infants who require levothyroxine treatment.

SUBMITTER: Kim HR

PROVIDER: S-EPMC6819381 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Thyroid dysfunction in preterm infants born before 32 gestational weeks.

Kim Hye-Rim HR Jung Young Hwa YH Choi Chang Won CW Chung Hye Rim HR Kang Min-Jae MJ Kim Beyong Il BI

BMC pediatrics 20191029 1

<h4>Background</h4>Thyroid hormones are critical for growth and brain development during the newborn period and infancy. Because of delayed maturation of the hypothalamic-pituitary-thyroid axis in preterm infants, thyroid dysfunction is common, and thyroid stimulating hormone (TSH) elevation is often delayed in preterm infants. The objective of this study was to determine the incidence of thyroid dysfunction requiring levothyroxine treatment and to identify its risk factors in preterm infants.<h ...[more]

PMID: 31664954

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Project description:BackgroundAt present, the relationship between thyrotropin (TSH) and free thyroxine (FT4) in relation to postmenstrual age (PMA) in preterm infants is still unclear, and there is no reliable standard thyroid hormone reference ranges, resulting in different diagnostic criteria for congenital hypothyroidism been used by different newborn screening programs and different countries.ObjectivesTo investigate the relationship between TSH/FT4 and PMA in very preterm infants (VPIs) born with gestational age (GA) <32 weeks and to derive thyroid function reference charts based on PMA.MethodsA prospective cohort study was performed on VPIs born with GA<32 weeks and born in or transferred to the 27 neonatal intensive care units from January 1, 2019 to December 31, 2019. Serial TSH and FT4 values were measured at the end of each week during the first month after birth and also at PMA36 weeks, PMA40 weeks and at discharge, respectively. The 2.5th, 5th, 50th, 95th, and 97.5th percentiles of TSH and FT4 of different PMA groups were calculated to draw the percentile charts based on PMA.Results1,093 preterm infants were included in this study. The percentile charts of TSH and FT4 levels based on PMA were drawn respectively, and the result indicated that the percentile charts of TSH values were gradually increased initially and then decreased with increasing PMA. The 97.5th percentile chart reached the peak at PMA30 weeks (17.38μIU/ml), and then decreased gradually, reaching the same level as full-term infants (9.07μIU/ml) at PMA38-40 weeks. The 2.5th percentile chart of FT4 was at its lowest point at PMA26-27 weeks (5.23pmol/L), then increased slowly with PMA and reached the same level as full-term infants at PMA38-40 weeks (10.87pmol/L). At PMA36 weeks, the reference intervals of the 2.5th to 97.5th percentiles of TSH and FT4 were 1.18-12.3μIU/ml and 8.59-25.98pmol/L, respectively.ConclusionThe percentile charts of TSH and FT4 in VPIs showed characteristic change with PMA. The results prompt that age-related cutoffs, instead of a single reference range, might be more useful to explain the thyroid function of VPIs. And repeated screening is necessary for preterm infants.

Project description:ImportanceNasal continuous positive airway pressure (nCPAP) is a well-established treatment of respiratory distress syndrome in preterm infants. Suboptimal weaning from nCPAP may be associated with lung injury, pulmonary morbidity, and infant weight gain. To our knowledge, the best weaning strategy from nCPAP is unknown.ObjectiveTo compare the effect of sudden wean and pressure wean from nCPAP in very preterm infants.Design, setting, and participantsA randomized, clinical, open-label, multicenter trial was conducted at 6 neonatal intensive care units in Denmark from September 2012 to December 2016 and included infants born before 32 weeks of gestation.InterventionsSudden wean with discontinuation of nCPAP without a prior reduction in pressure. Pressure wean with gradual pressure reduction prior to the discontinuation of nCPAP.Main outcome and measuresThe primary outcome was weight gain velocity from randomization to postmenstrual age 40 weeks. Secondary outcomes included other measures of growth, nCPAP and the duration of oxygen supplementation, postmenstrual age at successful wean and at discharge, successful wean at the first attempt, the number of attempts to wean, and the length of the hospital stay. Prespecified subgroup analyses by gestational age were performed.ResultsOf the 372 randomized infants, 185 (49.7%) were randomized to sudden wean and 187 infants (50.3%) to pressure wean. A total of 177 infants in both groups completed the trial (median gestational age for sudden and pressure wean, 30 weeks [interquartile range, 29-31]; male: sudden wean, 89 [50%]; pressure wean, 96 [54%]). There was no difference in mean [SD] weight gain velocity from randomization to 40 weeks postmenstrual age between the 2 groups (22 [6] g/kg/day). No difference was found in any of the secondary outcomes. More infants born before 28 weeks of gestation were successfully weaned from nCPAP during the first attempt in the pressure wean group compared with the sudden wean group (risk difference, 31%; 95% CI, 13%-50%), but there was no difference in the duration of nCPAP and oxygen supplementation.Conclusions and relevanceOverall, we found no difference in weight gain velocity or any of the secondary outcomes between very preterm infants who were randomized to sudden wean or pressure wean from nCPAP. However, among infants born before 28 weeks' gestation, infants from the pressure wean group were more often successfully weaned during the first attempt without a longer total duration of nCPAP treatment.Trial registrationClinicalTrials.gov Identifier: NCT01721629.

Project description:To estimate the incidence of respiratory syncytial virus (RSV) disease as a function of chronologic age and exposure to young children in US preterm infants.In the RSV Respiratory Events among Preterm Infants Outcomes and Risk Tracking (REPORT) study, preterm infants born at 32-35 weeks gestational age (wGA) were enrolled from 188 US clinics and followed September-May of 2009-2010 or 2010-2011. Infants with medically-attended acute respiratory illness had nasal/pharyngeal swabs collected for viral testing. Results of RSV tests conducted during routine clinical care were also collected. Event rates during November-March were modeled as a function of chronologic age and birth month using Poisson regression and adjusting for other covariates. Rates were calculated overall and for infants with and without exposure to young siblings or daycare attendance. Of 3317 infants screened, 1646 were enrolled as a consecutive sample. Infants with chronic lung disease of prematurity, hemodynamically significant congenital heart disease, life expectancy <6 months, or receiving or being considered for RSV immunoprophylaxis were excluded. 84% of patients completed the study. Demographics of the enrolled cohort were generally similar to those of US infants born at 32-35 wGA; infants 32-34 wGA, Hispanic infants, and infants of less-educated mothers were under-represented.Among 1642 evaluable infants, outpatient RSV lower respiratory illness incidence was highest at older ages, whereas RSV hospitalization and intensive care unit (ICU) admission were highest at younger ages. In all instances, young child exposure was associated with higher RSV incidence. The highest RSV hospitalization and ICU rates occurred among February-born infants with young child exposure, at 19.0 (95% CI, 13.5-27.0) and 6.5 (95% CI, 5.6-7.6) per 100 infant-seasons, respectively.Preterm infants have a substantially elevated risk of RSV disease. Young age and exposure to other young children identify those at greatest risk of severe RSV disease.Clinicaltrials.gov: NCT00983606.

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Thyroid dysfunction in preterm infants born before 32 gestational weeks.

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Thyroid dysfunction in preterm infants born before 32 gestational weeks.

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