Chen L.-W.a· Chu C.-H.b· Lin Y.-C.a· Chen H.-J.c· Kao S.-M.c· Huang C.-C.a,d

Author affiliations

aDepartment of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
bDepartment of Statistics, Tunghai University, Taichung, Taiwan
cThe Chinese Foundation of Health, Neonatal Screening Center, Taipei, Taiwan
dDepartment of Pediatrics, College of Medicine, Taipei Medical University, Taipei, Taiwan

Log in to MyKarger to check if you already have access to this content.

Buy FullText & PDF Unlimited re-access via MyKarger Unrestricted printing, no saving restrictions for personal use read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.

Save over 20% compared to the individual article price.

Learn more

Rent via DeepDyve Unlimited fulltext viewing of this article Organize, annotate and mark up articles Printing and downloading restrictions apply

Start free trial

Subscribe Access to all articles of the subscribed year(s) guaranteed for 5 years Unlimited re-access via Subscriber Login or MyKarger Unrestricted printing, no saving restrictions for personal use read more

Subcription rates

Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview

Received: September 11, 2022
Accepted: December 18, 2022
Published online: February 13, 2023

Number of Print Pages: 8
Number of Figures: 1
Number of Tables: 4

ISSN: 1661-7800 (Print)
eISSN: 1661-7819 (Online)

For additional information: https://www.karger.com/NEO

Abstract

Introduction: High-end cutoffs of thyroid-stimulating hormone (TSH) have been emphasized for hypothyroidism therapy in extremely preterm infants, but the significance of low TSH levels remains unknown. This study hypothesized that the spectrum of TSH levels by newborn screening after birth signifies specific morbidities in extremely preterm neonates. Methods: The multicenter population cohort analyzed 434 extremely preterm neonates receiving TSH screening at 24–96 h of age in 2008–2019. Neonates were categorized by blood TSH levels into group 1: TSH <0.5 µU/mL, group 2: 0.5 ≤ TSH <2 µU/mL, group 3: 2 ≤ TSH <4 µU/mL, and group 4: TSH ≥4 µU/mL. Neonatal morbidities were categorized using the modified Neonatal Therapeutic Intervention Scoring System. Results: The four groups differed in gestational age, birth weight, and the postnatal age at blood sampling so did the proportions of mechanical ventilation usage (p = 0.01), hypoxic respiratory failure (p = 0.005), high-grade intraventricular hemorrhage (p = 0.007), and periventricular leukomalacia (p = 0.048). Group 1 had higher severity scores for respiratory distress syndrome (RDS; effect size 0.39 [95% confidence interval [CI]: 0.18–0.59]) and brain injury (0.36 [0.15–0.57]) than group 2, which remained significant after adjusting for gestational age, birth weight, dopamine usage, and the postnatal age at TSH screening (RDS: mean + 0.45 points [95% CI: 0.11–0.79]; brain injury: +0.32 [0.11–0.54]). Conclusions: Low TSH levels in extremely preterm neonates are associated with severe RDS and brain injuries. Studies recruiting more neonates with complete thyroid function data are necessary to understand central-peripheral interactions of the hypothalamic-pituitary-thyroid axis.

© 2023 S. Karger AG, Basel

References Mansour C, Ouarezki Y, Jones J, Fitch M, Smith S, Mason A, et al. Trends in Scottish newborn screening programme for congenital hypothyroidism 1980–2014: strategies for reducing age at notification after initial and repeat sampling. Arch Dis Child. 2017 Oct;102(10):936–41. Weiner A, Oberfield S, Vuguin P. The laboratory features of congenital hypothyroidism and approach to therapy. Neoreviews. 2020 Jan;21(1):e37–44. Cavarzere P, Camilot M, Popa FI, Lauriola S, Teofoli F, Gaudino R, et al. Congenital hypothyroidism with delayed TSH elevation in low-birth-weight infants: incidence, diagnosis and management. Eur J Endocrinol. 2016 Nov;175(5):395–402. Zdraveska N, Kocova M. Thyroid function and dysfunction in preterm infants: challenges in evaluation, diagnosis and therapy. Clin Endocrinol. 2021 Oct;95(4):556–70. Williams FLR, Ogston SA, van Toor H, Visser TJ, Hume R. Serum thyroid hormones in preterm infants: associations with postnatal illnesses and drug usage. J Clin Endocrinol Metab. 2005 Nov;90(11):5954–63. Fisher DA. Thyroid system immaturities in very low birth weight premature infants. Semin Perinatol. 2008 Dec;32(6):387–97. Biswas S, Buffery J, Enoch H, Bland JM, Walters D, Markiewicz M. A longitudinal assessment of thyroid hormone concentrations in preterm infants younger than 30 weeks’ gestation during the first 2 weeks of life and their relationship to outcome. Pediatrics. 2002 Feb;109(2):222–7. Simpson J, Williams FLR, Delahunty C, van Toor H, Wu SY, Ogston SA, et al. Serum thyroid hormones in preterm infants and relationships to indices of severity of intercurrent illness. J Clin Endocrinol Metab. 2005 Mar;90(3):1271–9. Yilmaz A, Ozer Y, Kaya N, Turan H, Acar HC, Ercan O, et al. The factors associated with transient hypothyroxinemia of prematurity. BMC Pediatr. 2021 Aug 14;21(1):344. Lim DJ, Herring MK, Leef KH, Getchell J, Bartoshesky LE, Paul DA. Hypothyroxinemia in mechanically ventilated term infants is associated with increased use of rescue therapies. Pediatrics. 2005 Feb;115(2):406–10. Ryckman KK, Spracklen CN, Dagle JM, Murray JC. Maternal factors and complications of preterm birth associated with neonatal thyroid stimulating hormone. J Pediatr Endocrinol Metab. 2014 Sep;27(9–10):929–38. Kaluarachchi DC, Allen DB, Eickhoff JC, Dawe SJ, Baker MW. Thyroid-stimulating hormone reference ranges for preterm infants. Pediatrics. 2019 Aug;144(2):e20190290. Gray JE, Richardson DK, McCormick MC, Workman-Daniels K, Goldmann DA. Neonatal therapeutic intervention scoring system: a therapy-based severity-of-illness index. Pediatrics. 1992 Oct;90(4):561–7. Hervé M, Hervé MM. Package “RVAideMemoire.” [updated 2022 February 21; cited 2022 July 22]. Parle JV, Maisonneuve P, Sheppard MC, Boyle P, Franklyn JA. Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: a 10-year cohort study. Lancet. 2001 Sep 15;358(9285):861–5. Jacobs A, Derese I, Vander Perre S, van Puffelen E, Verstraete S, Pauwels L, et al. Non-thyroidal illness syndrome in critically ill children: prognostic value and impact of nutritional management. Thyroid. 2019 Apr;29(4):480–92. Langouche L, Jacobs A, Van den Berghe G. Nonthyroidal illness syndrome across the ages. J Endocr Soc. 2019 Oct 16;3(12):2313–25. Schneider HJ, Kreitschmann-Andermahr I, Ghigo E, Stalla GK, Agha A. Hypothalamopituitary dysfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a systematic review. JAMA. 2007 Sep 26;298(12):1429–38. Mele C, Pingue V, Caputo M, Zavattaro M, Pagano L, Prodam F, et al. Neuroinflammation and hypothalamo-pituitary dysfunction: focus of traumatic brain injury. Int J Mol Sci. 2021 Mar 7;22(5):2686. Fekete C, Lechan RM. Central regulation of hypothalamic-pituitary-thyroid axis under physiological and pathophysiological conditions. Endocr Rev. 2014 Apr;35(2):159–94. Heuer JF, Pelosi P, Hermann P, Perske C, Crozier TA, Brück W, et al. Acute effects of intracranial hypertension and ARDS on pulmonary and neuronal damage: a randomized experimental study in pigs. Intensive Care Med. 2011 Jul;37(7):1182–91. Robba C, Poole D, McNett M, Asehnoune K, Bösel J, Bruder N, et al. Mechanical ventilation in patients with acute brain injury: recommendations of the European Society of Intensive Care Medicine consensus. Intensive Care Med. 2020 Dec;46(12):2397–410. Ziaka M, Exadaktylos A. Brain-lung interactions and mechanical ventilation in patients with isolated brain injury. Crit Care. 2021 Oct 13;25(1):358. Barca-Mayo O, Liao XH, DiCosmo C, Dumitrescu A, Moreno-Vinasco L, Wade MS, et al. Role of type 2 deiodinase in response to acute lung injury (ALI) in mice. Proc Natl Acad Sci U S A. 2011 Dec 6;108(49):E1321–9. Bello G, Pennisi MA, Montini L, Silva S, Maviglia R, Cavallaro F, et al. Nonthyroidal illness syndrome and prolonged mechanical ventilation in patients admitted to the ICU. Chest. 2009 Jun;135(6):1448–54. Filippi L, Cecchi A, Tronchin M, Dani C, Pezzati M, Seminara S, et al. Dopamine infusion and hypothyroxinaemia in very low birth weight preterm infants. Eur J Pediatr. 2004 Jan;163(1):7–13. Filippi L, Pezzati M, Poggi C, Rossi S, Cecchi A, Santoro C. Dopamine versus dobutamine in very low birthweight infants: endocrine effects. Arch Dis Child Fetal Neonatal Ed. 2007 Sep;92(5):F367–71. Bouissou A, Rakza T, Klosowski S, Tourneux P, Vanderborght M, Storme L. Hypotension in preterm infants with significant patent ductus arteriosus: effects of dopamine. J Pediatr. 2008 Dec;153(6):790–4. Eriksen VR, Hahn GH, Greisen G. Dopamine therapy is associated with impaired cerebral autoregulation in preterm infants. Acta Paediatr. 2014 Dec;103(12):1221–6. Goldsmith JP, Keels E. Recognition and management of cardiovascular insufficiency in the very low birth weight newborn. Pediatrics. 2022 Mar 1;149(3):e2021056051. Filippi L, Pezzati M, Cecchi A, Serafini L, Poggi C, Dani C, et al. Dopamine infusion and anterior pituitary gland function in very low birth weight infants. Biol Neonate. 2006;89(4):274–80. Morgan AS, Mendonça M, Thiele N, David AL. Management and outcomes of extreme preterm birth. BMJ. 2022 Jan 10;376:e055924. Article / Publication Details

First-Page Preview

Received: September 11, 2022
Accepted: December 18, 2022
Published online: February 13, 2023

Number of Print Pages: 8
Number of Figures: 1
Number of Tables: 4

ISSN: 1661-7800 (Print)
eISSN: 1661-7819 (Online)

For additional information: https://www.karger.com/NEO

Copyright / Drug Dosage / Disclaimer Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.