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Chen LW, Chu CH, Lin YC, Huang CC. The Quartile Levels of Thyroid-Stimulating Hormone by Newborn Screening Stratified Risks of Neurodevelopmental Impairment in Extremely Preterm Infants - A Population Cohort Study. J Epidemiol 2024:JE20230253. [PMID: 38191177 DOI: 10.2188/jea.je20230253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND To evaluate whether thyroid-stimulating hormone (TSH) by newborn screening (NBS) at birth and at discharge can be surrogate markers for neurodevelopmental impairment (NDI) in extremely preterm infants. METHODS The population cohort enrolled infants born <29 weeks' gestation in 2008 - 2020 in southern Taiwan. Infants with a maternal history of thyroid disorders and infants who required thyroxine supplementation during hospitalization were excluded. TSH levels by NBS at birth and at term-equivalent age (TEA)/discharge were respectively categorized into the lowest quartile, the interquartile range, and the highest quartile, which were correlated to NDI outcomes. RESULTS Among 392 patients with paired TSH data, 358 (91%) were prospectively followed until corrected age 24 months. At birth, infants with lowest-quartile TSH had higher NDI risks (OR 2.3, 95% CI 1.3 - 4.1, P = 0.004) compared to infants with interquartile-range TSH. Conversely, by TEA/discharge, infants with highest-quartile TSH had increased NDI (OR 1.9, 1.0 - 3.4, P = 0.03). By paired TSH categories, infants persistently in the lowest TSH quartile (48%, aOR 4.4, 1.4 - 14.5, P = 0.01) and those with a shift from interquartile range to the highest quartile (32%, aOR 2.7, 1.0 - 7.4, P = 0.046) had increased NDI risks compared with the reference with consistent interquartile-range TSH. CONCLUSIONS Extremely preterm infants persistently in the lowest-quartile TSH level at birth and at discharge had the highest NDI risk. TSH quartile levels by NBS may serve as a population surrogate biomarker for assessing NDI risks in infants born extremely preterm.
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Affiliation(s)
- Li-Wen Chen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | | | - Yung-Chieh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | - Chao-Ching Huang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
- Department of Pediatrics, College of Medicine, Taipei Medical University
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Grob F. Approaching the diagnosis of thyroid disorders in preterm infants. Pediatr Res 2022; 91:1021-1022. [PMID: 35079111 DOI: 10.1038/s41390-022-01951-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/19/2021] [Indexed: 02/01/2023]
Affiliation(s)
- Francisca Grob
- Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. .,Murdoch children's research institute (MCRI), Melbourne, Australia.
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Montaner-Ramón A, Hernández-Pérez S, Campos-Martorell A, Ballesta-Anguiano M, Clemente-León M, Castillo-Salinas F. Thyroid function in < 32 weeks gestation preterm infants. An Pediatr (Barc) 2022; 96:130-137. [DOI: 10.1016/j.anpede.2020.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/29/2020] [Indexed: 10/19/2022] Open
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Mikołajczak A, Kufel K, Bokiniec R. Correlation Between Thyroid Hormone Concentrations and Ultrasound Thyroid Volume in Preterm Infants Born Before 33 Weeks of Gestation. Front Endocrinol (Lausanne) 2022; 13:860716. [PMID: 35620396 PMCID: PMC9128814 DOI: 10.3389/fendo.2022.860716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/11/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Thyroid disorders are commonly concomitant with premature birth; however, indications to start therapy remain unclear due to a lack of gestational age (GA)-specific reference ranges. We aimed to evaluate the age-specific thyroid-stimulating hormone (TSH), free thyroxine (FT4) levels and the correlation between TSH and FT4 serum levels and ultrasound thyroid volume in preterm infants. MATERIALS AND METHODS This was an observational, prospective, single-center study of 98 preterm infants born before 33 weeks GA. The infants were divided into the 24-28 weeks and 29-32 weeks GA groups. TSH and FT4 serum levels were measured at two time points: at postnatal age (PNA) 2 weeks and at postmenstrual age (PMA) 32 weeks; the results were compared between groups at two consecutive time points. RESULTS There was a statistically significant between-group difference in FT4 concentration. There was a positive correlation between FT4 and GA at both screening times. FT4 in the 24-28 weeks GA group was significantly lower than in the 29-32 weeks GA group. The mean (standard deviation [SD]) FT4 at PNA 2 weeks was 11.72 ± 2.16 pmol/l for the 24-28 weeks GA group vs. 13.33 ± 1.80 pmol/l for the 29-32 weeks GA group (p<0.001). The mean (SD) FT4 at PMA 32 weeks was 11.96 ± 1.98 pmo/l for the 24-28 weeks GA group vs. 13.33 ± 1.80 pmol/l for the 29-32 weeks GA group (p=0.001). Our results reflect a slow and gradual upward trend of FT4 in the 24-28 weeks GA. It is of interest that the correlation between thyroid volume and FT4 was statistically significant (rho=0.25, p=0.019) for all studied preterm infants. The correlation between thyroid volume and weight was statistically significant for the entire study group (rho=0.37, p<0.001). We did not find statistically significant differences in TSH and FT4 values between consecutive time points at 24-28 weeks GA. The thyroid volume was not significantly different between both groups. The total thyroid volume was 0.26 vs. 0.27 ml for the 24-28 and 29-32 weeks GA groups, respectively. CONCLUSION The results of this study indicate that preterm infants require lower FT4 values depending on GA. Moreover, ultrasound thyroid imaging may facilitate the evaluation of questionable thyroid disorders.
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Affiliation(s)
| | - Katarzyna Kufel
- Neonatal and Intensive Care Department, Medical University of Warsaw, Warsaw, Poland
| | - Renata Bokiniec
- Neonatal and Intensive Care Department, Medical University of Warsaw, Warsaw, Poland
- *Correspondence: Renata Bokiniec, ;
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Kaluarachchi DC, Colaizy TT, Lasarev MR, Allen DB, Klein JM. Hypothyroxinemia Detected at 4 Weeks of Life in Preterm Infants Born at Less than 30 Weeks of Gestation. Am J Perinatol 2021; 38:1271-1276. [PMID: 32498093 DOI: 10.1055/s-0040-1712168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Data on free thyroxine (FT4) concentrations beyond first 2 weeks of preterm infants are limited. This study was aimed to describe the association between perinatal characteristics and FT4 concentrations and the incidence of hypothyroxinemia at 4 weeks. STUDY DESIGN Retrospective analysis of serum thyroid function tests at 4 weeks in preterm infants <30 weeks of gestation. Association between FT4 at 4 weeks of life and perinatal characteristics were determined by bivariate analysis and multivariable regression. Incidence of hypothyroxinemia was determined using a gestational age adjusted definition based on in utero levels at the equivalent postmenstrual age. RESULTS The study cohort consisted of 280 infants. FT4 concentrations at 4 weeks of life were significantly associated with gestational age, birth weight, gender, and maternal history of thyroid disease. Hypothyroxinemia was found in 32.8% of the study cohort. CONCLUSION Perinatal characteristics are associated with FT4 concentrations at 4 weeks of life. Nearly one-third of infants born <30 weeks had hypothyroxinemia at 4 weeks of life when compared with in utero levels at the equivalent postmenstrual age.
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Affiliation(s)
| | - Tarah T Colaizy
- Department of Pediatrics, University of Iowa, Iowa City, Iowa
| | - Michael R Lasarev
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin
| | - David B Allen
- Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin
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Zdraveska N, Kocova M. Thyroid function and dysfunction in preterm infants-Challenges in evaluation, diagnosis and therapy. Clin Endocrinol (Oxf) 2021; 95:556-570. [PMID: 33864279 DOI: 10.1111/cen.14481] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 11/30/2022]
Abstract
Thyroid hormone levels have a crucial role for optimal brain development from gestation through the first 2 postnatal years. However, thyroid hormones vary with gestational age, and their levels vary between term and preterm infants. Preterm newborns are prone to thyroid dysfunction which is now more frequently observed with the advances of neonatal care and improved survival of extremely premature infants. Thus, hypothyroxinaemia of prematurity associated with delayed TSH elevation is very common in low birth weight premature infants most likely due to the immaturity of the hypothalamic-pituitary thyroid axis. Furthermore, postnatal illness, medications and iodine status may contribute to the thyroid dysfunction or affect the interpretation of the thyroid function tests. Despite available guidelines, timing of screening and optimal treatment of thyroid dysfunction in premature infants remains controversial. Furthermore, it is unknown whether untreated thyroid dysfunction in premature babies affects neurodevelopmental outcome. In the vast majority of preterm infants, hypothyroxinaemia is transient; however, permanent hypothyroidism due to thyroid dysgenesis or enzyme defects might also occur. Therefore, careful monitoring of thyroid function and long-term follow-up is needed to assess an appropriate therapeutic approach. This article reviews thyroid physiology in preterm infants, the influences of gestation and other neonatal conditions on thyroid function tests, optimal timing of screening and possible predictors to differentiate transient hypothyroxinaemia from permanent hypothyroidism.
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Affiliation(s)
- Nikolina Zdraveska
- Medical Faculty, University Ss. Cyril and Methodius Skopje, University Children's Hospital, Skopje, Macedonia
| | - Mirjana Kocova
- Medical Faculty, University Ss. Cyril and Methodius Skopje, University Children's Hospital, Skopje, Macedonia
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Rai R, Singh DK, Bhakhri BK. Transient hypothyroxinemia of prematurity and its risk factors in an extramural neonatal intensive care unit. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:723-729. [PMID: 33909379 PMCID: PMC10065390 DOI: 10.20945/2359-3997000000360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective Thyroid functions in preterm newborns may be altered in the first week of life. Hypothyroxinemia has been commonly reported in these babies, which could be due to the immaturity of the hypothalamic pituitary thyroid axis or acute illness. It could have a long-term impact on the developing brain of these babies. We conducted this study to estimate the incidence of transient hypothyroxinemia of prematurity (THOP) and to determine its risk factors. Methods We analyzed thyroid stimulating hormone (TSH) and free T4 levels of 64 preterm neonates admitted in the neonatal intensive care unit. TSH and free T4 levels were measured in the first week and then at 14-21 days of life to estimate the incidence of THOP and determine its risk factors. We also estimated the incidence of congenital hypothyroidism (CH) and delayed TSH elevation in CH. Risk analysis was conducted using simple and multiple logistic regression, and numerical data was compared using the Mann Whitney U test and t test. Results THOP was seen in 25% of the preterm babies. Caesarean delivery, presence of one or more morbidities, mechanical ventilation, birth weight ≥ 1,500 g, and gestational age ≥ 32 weeks were identified as risk factors for THOP based on simple logistic regression. In multiple regression, mechanical ventilation and gestational age ≥ 32 weeks were significantly associated with THOP. CH was seen in 2 (3.1%) babies, and 1 of these cases had delayed TSH elevation. Conclusion Thyroid abnormalities are common in preterm admitted neonates. Mechanical ventilation is an independent risk factor for development of THOP.
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Affiliation(s)
- Ruchi Rai
- Department of Neonatology (Maternal Reproductive Health), Super Speciality Pediatric Hospital and Postgraduate Teaching Institute, Noida, UP, India,
| | - Dharmendra Kumar Singh
- Department of Pediatrics, Super Speciality Pediatric Hospital and Postgraduate Teaching Institute, Noida, UP, India
| | - Bhanu Kiran Bhakhri
- Department of Pediatrics, Super Speciality Pediatric Hospital and Postgraduate Teaching Institute, Noida, UP, India
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Postnatal Serum Total Thyroxine of Very Preterm Infants and Long-Term Neurodevelopmental Outcome. Nutrients 2021; 13:nu13041055. [PMID: 33805038 PMCID: PMC8064055 DOI: 10.3390/nu13041055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/12/2021] [Accepted: 03/20/2021] [Indexed: 11/26/2022] Open
Abstract
Primary congenital hypothyroidism is a disease associated with low serum thyroxine and elevated thyroid-stimulating hormone (TSH) levels. The processes of screening and treating congenital hypothyroidism, in order to prevent neurodevelopmental impairment (NDI) in newborns, have been well investigated. Unlike term infants, very preterm infants (VPIs) may experience low thyroxine with normal TSH levels (<10.0 μIU/mL) during long-stay hospitalization. In the current literature, thyroxine treatment has been evaluated only for TSH-elevated VPIs. However, the long-term impact of low thyroxine levels in certain VPIs with normal TSH levels deserves more research. Since July 2007, VPIs of this study unit received screenings at 1 month postnatal age (PNA) for serum TSH levels and total thyroxine (TT4), in addition to two national TSH screenings scheduled at 3–5 days PNA and at term equivalent age. This study aimed to establish the correlation between postnatal 1-month-old TT4 concentration and long-term NDI at 24 months corrected age among VPIs with serial normal TSH levels. VPIs born in August 2007–July 2016 were enrolled. Perinatal demography, hospitalization morbidities, and thyroid function profiles were analyzed, and we excluded those with congenital anomalies, brain injuries, elevated TSH levels, or a history of thyroxine treatments. In total, 334 VPIs were analyzed and 302 (90.4%) VPIs were followed-up. The postnatal TT4 concentration was not associated with NDI after multivariate adjustment (odd ratios 1.131, 95% confidence interval 0.969–1.32). To attribute the NDI of TSH-normal VPIs to a single postnatal TT4 concentration measurement may require more research.
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Montaner-Ramón A, Hernández-Pérez S, Campos-Martorell A, Ballesta-Anguiano M, Clemente-León M, Castillo-Salinas F. [Thyroid function in < 32 weeks gestation preterm infants]. An Pediatr (Barc) 2020; 96:S1695-4033(20)30485-9. [PMID: 33358353 DOI: 10.1016/j.anpedi.2020.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/29/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Preterm newborns (PN) have a higher risk of thyroid dysfunction than term newborns (TN). This condition may go unnoticed in neonatal screening due to a late elevation of thyrotropin (TSH) in these patients. OBJECTIVE Evaluate thyroid function in the second week of life in PN of < 32 weeks gestation (WG), and to identify factors associated to its alteration. PATIENTS AND METHODS A retrospective study was performed in neonates of < 32 weeks gestation (WG), in whom thyroid function was determined. An analysis was performed on thyroxine (T4L) and TSH levels, as well as their association with perinatal and neonatal outcomes. RESULTS The study included a total of 358 patients with mean gestational age (GA) of 29.3 weeks, and mean birth weight (BW) 1127 grams. A linear correlation was found between T4L and BW (correlation coefficient (R) 0.356; p < 0.001) and GA (R = 0.442; p < 0.001). TSH values were associated with small for gestational age (SGA 5.3 mU/L [1.5-37]; non-SGA 2.89 mU/L [0.2-19.5]; p < 0.001), inotropic support (Yes 3.98 mU/L [0.6-22.9]; No 3.16 mU/L [0.2-37]; p = 0.019) and BW (R = -0.249; p < 0.001). Nine (2.5%) patients were treated with levothyroxine, of whom six were SGA. CONCLUSIONS Thyroid function analysis in the second week of life helps to identify asymptomatic newborns with risk of thyroid dysfunction. SGA newborns are at higher risk of thyroid function alterations.
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Affiliation(s)
- Alicia Montaner-Ramón
- Servicio de Neonatología, Hospital Universitario Materno-Infantil Vall d'Hebron, Barcelona, España.
| | - Susana Hernández-Pérez
- Servicio de Neonatología, Hospital Universitario Materno-Infantil Vall d'Hebron, Barcelona, España
| | - Ariadna Campos-Martorell
- Unidad de Endocrinología Pediátrica, Hospital Universitario Materno-Infantil Vall d'Hebron, Barcelona, España
| | | | - María Clemente-León
- Unidad de Endocrinología Pediátrica, Hospital Universitario Materno-Infantil Vall d'Hebron, Barcelona, España
| | - Félix Castillo-Salinas
- Servicio de Neonatología, Hospital Universitario Materno-Infantil Vall d'Hebron, Barcelona, España
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Zhang H, Cui YP, Han TY, Tong XM, Jia Q, Zhou Y, Jiang YN. [A clinical analysis of hypothyroidism in very low birth weight/extremely low birth weight infants]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:1073-1078. [PMID: 33059803 PMCID: PMC7569004 DOI: 10.7499/j.issn.1008-8830.2005085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To study the risk factors and treatment outcome of hypothyroidism in very low birth weight/extremely low birth weight (VLBW/ELBW) infants. METHODS The VLBW/ELBW infants who were diagnosed with hypothyroidism from September 2018 to December 2019 were enrolled as the case group (n=29). The children with normal thyroid function, matched at a ratio of 1 : 3, were enrolled as the control group (n=87). Clinical features were compared between the two groups. The correlation of thyroid function with gestational age and birth weight and the risk factors for hypothyroidism were analyzed. RESULTS A total of 162 VLBW/ELBW infants who met the inclusion criteria were enrolled, with 29 infants in the case group (an incidence rate of hypothyroidism of 17.9%). The lower the birth weight, the higher the incidence rate of hypothyroidism (P<0.05). Triiodothyronine (T3) and free T3 were positively correlated with gestational age (P<0.05). T3 and free thyroxine were positively correlated with birth weight (P<0.05). Small for gestational age, multiple birth, maternal age ≥ 35 years, and use of dopamine were independent risk factors for hypothyroidism (P<0.05). In the case group, 16 infants were treated with levothyroxine (5-10 μg/kg daily), and the thyroid function returned to normal after 2 weeks of treatment. CONCLUSIONS There is a high incidence rate of hypothyroidism in VLBW/ELBW infants. Small for gestational age, multiple birth, advanced maternal age, and use of dopamine are risk factors for hypothyroidism. The infants treated with levothyroxine should be followed up regularly to ensure an appropriate dose.
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Affiliation(s)
- Hui Zhang
- Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China.
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Goel D, Luig M, Maheshwari R, D'Cruz D, Goyen TA. General Movement assessment and neurodevelopmental trajectory in extremely preterm infants with hypothyroxinaemia of prematurity (THOP). Early Hum Dev 2020; 144:104886. [PMID: 31668678 DOI: 10.1016/j.earlhumdev.2019.104886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/06/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Transient hypothyroxinaemia of prematurity (THOP) has been associated with neurodevelopmental deficits with a paucity of literature leading to variable practice. AIM Evaluation of the relationship between free T4 (fT4) levels at 2 weeks after birth and early markers of neurodevelopmental outcome. STUDY DESIGN A retrospective study of prospectively collected data from infants born <29 weeks' gestation, admitted to NICU between January 2012 and December 2014. The primary outcomes were the relationship between fT4 levels at 2 weeks, Prechtl General Movement Assessment (GMA) at 36 weeks and 3 months postterm age, and Bayley Scales of Infant Development (BSID-III) at 2 years postterm age. Secondary outcomes were survival free of disability and other neonatal morbidities. RESULTS Of 122 infants, 101 infants had normal fT4 levels (No-THOP) and 21 had fT4 levels >1SD below the mean (THOP group). There was increased frequency of abnormal GMA in the No-THOP group compared with the THOP group at 36 weeks (abnormal writhing GMs: 43% vs 21%, p = 0.15) and 3 months corrected age (absent fidgety GMs: 7.6% vs 0%, p = 0.36), though not statistically significant. The neurodevelopmental outcome was worse in the No-THOP group compared with the THOP group with significantly lower mean cognitive and motor scores at 2 year of corrected age (90 ± 13.8 vs 100 ± 8.3, p = 0.01 and 91 ± 15.2 vs 100 ± 13.2, p = 0.04 respectively). CONCLUSIONS This is the first report describing General Movements (GMs) in preterm infants with THOP. We found worse neurodevelopmental outcome in No-THOP infants reflected by significantly worse cognitive and motor outcomes at 2 years corrected age.
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Affiliation(s)
- Dimple Goel
- Westmead Hospital, Sydney, Australia; University of Sydney, Sydney, Australia.
| | | | - Rajesh Maheshwari
- Westmead Hospital, Sydney, Australia; University of Sydney, Sydney, Australia
| | - Daphne D'Cruz
- Westmead Hospital, Sydney, Australia; University of Sydney, Sydney, Australia
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Jaruratanasirikul S, Janjindamai W, Sriplung H. Congenital hypothyroidism in preterm infants: a 3- to 8-year longitudinal study in southern Thailand. J Pediatr Endocrinol Metab 2019; 32:1275-1282. [PMID: 31465294 DOI: 10.1515/jpem-2019-0054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 06/18/2019] [Indexed: 11/15/2022]
Abstract
Background Preterm infants are at high risk of developing congenital hypothyroidism (CH) due to the immaturity of the hypothalamic-pituitary-thyroid (HPT) axis, loss of iodine supply from the mother and preterm health problems. Objectives To study the incidence and etiologies of CH in preterm infants who were born or admitted in our institute during 2010-2015. Methods The medical records of preterm infants diagnosed with CH as defined by the thyroid-stimulating hormone (TSH) level at the time of the first or second screening >10 mU/L and/or free T4 < 1.00 ng/dL were reviewed. Results Of 2777 preterm infants, 73 cases (2.6%) were diagnosed as CH. The average TSH levels at the first and second screenings were 20.85 and 15.42 mU/L, respectively. The patients were treated with thyroxine at an average initial dosage of 15 μg/kg/day. At 2-3 years of age, after thyroxine discontinuation for 6-10 weeks and regular thyroid function tests for 2 years, 58 patients (79.5%) were diagnosed as having transient CH and 15 patients (20.5%) were diagnosed as having permanent CH. We found no clinical or laboratory parameters in the neonatal period that could differentiate permanent from transient CH. Thyroid scintigraphy (99 m pertechnetate) revealed two patients (13.3%) with ectopic thyroid, one with thyroid hypoplasia (6.7%), eight with normal thyroid (53.3%) and four with enlarged thyroid (26.7%). Conclusions CH was common in preterm infants with an estimated incidence of 2.6%. Thyroxine should be given to preterm infants with higher initial values of TSH >10 mU/L in order to prevent delayed treatment of permanent CH that could be confirmed later.
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Affiliation(s)
- Somchit Jaruratanasirikul
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Waricha Janjindamai
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Hutcha Sriplung
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Kim HR, Jung YH, Choi CW, Chung HR, Kang MJ, Kim BI. Thyroid dysfunction in preterm infants born before 32 gestational weeks. BMC Pediatr 2019; 19:391. [PMID: 31664954 PMCID: PMC6819381 DOI: 10.1186/s12887-019-1792-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 10/17/2019] [Indexed: 11/23/2022] Open
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.
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Affiliation(s)
- Hye-Rim Kim
- Department of Pediatrics, Bundang CHA Medical Center, CHA University, Seongnam, Republic of Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Hwa Jung
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Department of Pediatrics, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea.
| | - Chang Won Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Pediatrics, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
| | - Hye Rim Chung
- Department of Pediatrics, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
| | - Min-Jae Kang
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Beyong Il Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Pediatrics, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
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Tan LO, Tan MG, Poon WB. Lack of association between hypothyroxinemia of prematurity and transient thyroid abnormalities with adverse long term neurodevelopmental outcome in very low birth weight infants. PLoS One 2019; 14:e0222018. [PMID: 31513612 PMCID: PMC6742353 DOI: 10.1371/journal.pone.0222018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/20/2019] [Indexed: 01/25/2023] Open
Abstract
Introduction The association between hypothyroxinemia of prematurity with neurodevelopment was controversial. Objectives To compare 5 year neurodevelopmental outcomes of very low birth weight (VLBW) infants with hypothyroxinemia of prematurity against those without. Methods Retrospective cohort study in a single tertiary neonatal centre of VLBW infants born between the year 2008 to 2011. Comparisons were made between all abnormal and normal thyroid function controls using cord thyroid function tests, thyroid function tests during admission and pre-discharge thyroid function test done at term equivalent age. At 2 years corrected age, Bayley scales of infant and toddler development–third edition and Vineland II adaptive behaviour scales (VABS) were collected. At 5 years, Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III), Bracken School Readiness Assessment, VABS and Beery Test of Visual-Motor Integration were collected. Results 110 subjects were studied at 2 years corrected age and 80 subjects at 5 years old. 29 infants had abnormal thyroid function test (10 infants with hypothyroxinemia of prematurity and 19 infants with transient thyroid abnormalities). There were no significant difference in the 2 years and 5 years developmental outcome between infants with and without hypothyroxinemia of prematurity (p-value>0.05); and between infants with and without transient thyroid abnormalities (p-value>0.05). There were no significant difference in neurological, visual and hearing impairment between infants with or without hypothyroxinemia of prematurity (p-value>0.05). Conclusions Hypothyroxinemia of prematurity or transient thyroid abnormalities in VLBW infants were not associated with poorer neurodevelopment and did not support the need for levothyroxine supplementation.
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Affiliation(s)
- Lay Ong Tan
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
- Department of Neonatal & Developmental Medicine, Singapore General Hospital, Singapore, Singapore
- * E-mail:
| | - Mary Grace Tan
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Woei Bing Poon
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
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Eerdekens A, Langouche L, Van den Berghe G, Verhaeghe J, Naulaers G, Vanhole C. Review shows that thyroid hormone substitution could benefit transient hypothyroxinaemia of prematurity but treatment strategies need to be clarified. Acta Paediatr 2019; 108:792-805. [PMID: 30537292 DOI: 10.1111/apa.14685] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 10/16/2018] [Accepted: 12/04/2018] [Indexed: 01/06/2023]
Abstract
AIM Thyroid hormones are crucial for foetal and neonatal brain development. This paper provides an overview of the normal role of thyroid hormones in foetal brain development and the pathophysiology of transient hypothyroxinaemia of prematurity (THOP). It also discusses the diagnostic and therapeutic controversies around THOP and looks at directions for future research. METHODS We used the PubMed and Embase databases to identify papers published in English from 1969 to June 2018. This identified 20 papers about the impact of THOP on neurodevelopment and seven randomised controlled trials about therapeutic approaches from 1981-2016. RESULTS THOP has been researched for more than three decades. The impact of temporarily low thyroxine levels, without any increase in pituitary-secreted thyroid-stimulating hormone at a critical timeframe in an infant's brain development, is still debated. Heterogeneity in THOP definitions, difficulties with thyroid hormone assessment, identifying patients at risk and a clear lack of sufficiently powered studies add to the current controversy. There are indications that thyroid hormone substitution might be useful in extremely low gestational age neonates with THOP. CONCLUSION Some preterm infants could benefit from THOP treatment, but more studies are needed to clarify further treatment strategies, including the optimal timing of initiation and duration.
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Affiliation(s)
- An Eerdekens
- Department of Neonatology University Hospitals Leuven KU Leuven Leuven Belgium
| | - Lies Langouche
- Department of Cellular and Molecular Medicine Clinical Division and Laboratory of Intensive Care Medicine KU Leuven Leuven Belgium
| | - Greet Van den Berghe
- Department of Cellular and Molecular Medicine Clinical Division and Laboratory of Intensive Care Medicine KU Leuven Leuven Belgium
| | - Johan Verhaeghe
- Department of Obstetrics & Gynaecology University Hospitals Leuven KU Leuven Leuven Belgium
| | - Gunnar Naulaers
- Department of Neonatology University Hospitals Leuven KU Leuven Leuven Belgium
| | - Christine Vanhole
- Department of Neonatology University Hospitals Leuven KU Leuven Leuven Belgium
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Chung HR. Screening and management of thyroid dysfunction in preterm infants. Ann Pediatr Endocrinol Metab 2019; 24:15-21. [PMID: 30943675 PMCID: PMC6449615 DOI: 10.6065/apem.2019.24.1.15] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/15/2019] [Indexed: 12/18/2022] Open
Abstract
Preterm infants can suffer various thyroid dysfunctions associated with developmental immaturity of the hypothalamic-pituitary-thyroid axis, postnatal illness, medications, or iodine supply. The incidence of thyroid dysfunction among preterm infants is higher than that among term infants and has been increasing with improvement in the survival of preterm infants. Hypothyroxinemia is frequently observed during the first week of life in extreme preterm neonates, and the incidence of delayed thyrotropin elevation is high at the age of 2-6 weeks. Although the necessity of routine rescreening remains controversial, recent guidelines on screening for congenital hypothyroidism have recommended rescreening of all preterm neonates. Thyroid hormone replacement is recommended for persistent thyrotropin elevation with or without hypothyroxinemia. Hypothyroxinemia without thyrotropin elevation does not require treatment, and some potential risks of levothyroxine supplementation have been reported. Although most thyroid dysfunctions are transient, careful follow-up after discontinuation of levothyroxine is considered so as to avoid missing persistent hypothyroidism.
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Affiliation(s)
- Hye Rim Chung
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea,Address for correspondence: Hye Rim Chung, MD Department of Pediatrics, Seoul National Universit y Bundang Hospital, 82, Gumi-ro 173 Beongil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7289 Fax: +82-31-787-4054 E-mail:
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17
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Walsh V, Brown JVE, McGuire W. Iodine supplementation for the prevention of mortality and adverse neurodevelopmental outcomes in preterm infants. Cochrane Database Syst Rev 2019; 2:CD005253. [PMID: 30802939 PMCID: PMC6389353 DOI: 10.1002/14651858.cd005253.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Parenteral nutrition solutions, artificial formulas, and human breast milk contain insufficient iodine to meet recommended intakes for preterm infants. Iodine deficiency may exacerbate transient hypothyroxinaemia in preterm infants and this may be associated with adverse neonatal and longer-term outcomes. OBJECTIVES To assess the evidence from randomised controlled trials that dietary supplementation with iodine reduces mortality and morbidity in preterm infants. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2018, Issue 1), Ovid MEDLINE, Ovid Embase, Ovid Maternity & Infant Care Database, and CINAHL to February 2018. We searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA Randomised or quasi-randomised controlled trials that compared supplementing enteral or parenteral feeds with iodine (as iodide salt) versus placebo or no supplementation in preterm infants. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial eligibility and risk of bias, and extracted data. We analysed treatment effects as described in the individual trials and reported risk ratios (RR) and risk differences for dichotomous data, and mean differences (MD) for continuous data, with 95% confidence intervals (CI). We used a fixed-effect model in meta-analyses and planned to explore potential causes of heterogeneity in sensitivity analyses. We used the GRADE approach to assess the quality of evidence. MAIN RESULTS Two randomised controlled trials fulfilled the eligibility criteria. Both trials used methods to limit bias including allocation concealment and blinding of clinicians and investigators to the allocated intervention. The trials enrolled 1394 infants. One trial recruited 1273 participants. Most participants were born very preterm (less than 32 weeks' gestation) and about one-third were extremely preterm (less than 28 weeks' gestation). Analyses found no effect of iodine supplementation on mortality before hospital discharge (typical RR 1.01, 95% CI 0.72 to 1.42; 2 studies, 1380 infants) or on neurodevelopmental assessments at two years post-term (Bayley Scales of Infant and Toddler Development, Third Edition main domain composite scores: cognitive: MD -0.30, 95% CI -2.44 to 1.84; motor: MD 0.20, 95% CI -2.15 to 2.55; language: MD -0.10, 95% CI -2.50 to 2.30; 1 study, 1259 infants). There were no differences in the proportion of infants who died or had a composite score less than 85 in any main Bayley domain (RR 1.05, 95% CI 0.94 to 1.17; 1 study, 1259 infants), or had visual impairment (RR 0.63, 95% CI 0.28 to 1.45; 1 study, 1092 infants) or auditory impairment (RR 1.05, 95% CI 0.51 to 2.16; 1 study, 1093 infants). Using GRADE methods, we assessed the evidence for the effects on mortality and neurodevelopment outcomes as high-certainty. AUTHORS' CONCLUSIONS The available trial data, predominantly from one large, high-quality multicentre study published in 2017, do not show any evidence of beneficial effects of iodine supplementation for preterm infants. Given the high certainty of these estimates of effect, further trials of this intervention in this population are unlikely to be considered research priorities.
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Affiliation(s)
- Verena Walsh
- University of YorkCentre for Reviews and DisseminationYorkUKY010 5DD
| | | | - William McGuire
- University of YorkCentre for Reviews and DisseminationYorkUKY010 5DD
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Finch-Edmondson M, Morgan C, Hunt RW, Novak I. Emergent Prophylactic, Reparative and Restorative Brain Interventions for Infants Born Preterm With Cerebral Palsy. Front Physiol 2019; 10:15. [PMID: 30745876 PMCID: PMC6360173 DOI: 10.3389/fphys.2019.00015] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/08/2019] [Indexed: 12/13/2022] Open
Abstract
Worldwide, an estimated 15 million babies are born preterm (<37 weeks' gestation) every year. Despite significant improvements in survival rates, preterm infants often face a lifetime of neurodevelopmental disability including cognitive, behavioral, and motor impairments. Indeed, prematurity remains the largest risk factor for the development of cerebral palsy. The developing brain of the preterm infant is particularly fragile; preterm babies exhibit varying severities of cerebral palsy arising from reductions in both cerebral white and gray matter volumes, as well as altered brain microstructure and connectivity. Current intensive care therapies aim to optimize cardiovascular and respiratory function to protect the brain from injury by preserving oxygenation and blood flow. If a brain injury does occur, definitive diagnosis of cerebral palsy in the first few hours and weeks of life is difficult, especially when the lesions are subtle and not apparent on cranial ultrasound. However, early diagnosis of mildly affected infants is critical, because these are the patients most likely to respond to emergent treatments inducing neuroplasticity via high-intensity motor training programs and regenerative therapies involving stem cells. A current controversy is whether to test universal treatment in all infants at risk of brain injury, accepting that some patients never required treatment, because the perceived potential benefits outweigh the risk of harm. Versus, waiting for a diagnosis before commencing targeted treatment for infants with a brain injury, and potentially missing the therapeutic window. In this review, we discuss the emerging prophylactic, reparative, and restorative brain interventions for infants born preterm, who are at high risk of developing cerebral palsy. We examine the current evidence, considering the timing of the intervention with relation to the proposed mechanism/s of action. Finally, we consider the development of novel markers of preterm brain injury, which will undoubtedly lead to improved diagnostic and prognostic capability, and more accurate instruments to assess the efficacy of emerging interventions for this most vulnerable group of infants.
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Affiliation(s)
- Megan Finch-Edmondson
- The Discipline of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, The University of Sydney Medical School, Sydney, NSW, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Catherine Morgan
- The Discipline of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, The University of Sydney Medical School, Sydney, NSW, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, NSW, Australia
| | - Rod W. Hunt
- Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Iona Novak
- The Discipline of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, The University of Sydney Medical School, Sydney, NSW, Australia
- Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, NSW, Australia
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19
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Abrantes MA, Valencia AM, Bany-Mohammed F, Aranda JV, Beharry KD. Dose response effects of postnatal hydrocortisone on growth and growth factors in the neonatal rat. Steroids 2018; 140:1-10. [PMID: 30142369 DOI: 10.1016/j.steroids.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/08/2018] [Accepted: 08/13/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Hydrocortisone (HC), at different dosages, is used in critically ill newborns for lung stability, blood pressure support, and prevention of chronic lung disease (CLD). Its long-term effects on postnatal growth are not well studied. We hypothesized that early exposure to high doses of HC adversely affects growth, growth factors, metabolic hormones, and neurological outcomes, persisting in adulthood. EXPERIMENTAL DESIGN Rat pups received a single daily intramuscular dose of HC (1 mg/kg/day, 5 mg/kg/day, or 10 mg/kg/day on days 3, 4 & 5 postnatal age (P3, P4, P5). Age-matched controls received equivalent volume saline. Body weight, linear growth, and neurological outcomes were monitored. Animals were sacrificed at P21, P45, and P70 for blood glucose, insulin, IGF-I, GH, leptin, and corticosterone levels. Liver mRNA expression of IGFs and IGFBPs were determined at P21 and P70. Memory and learning abilities were tested using the Morris water maze test at P70. RESULTS HC suppressed body weight and length at P12, P21 and P45, but by P70 there was catchup overgrowth in the 5 and 10 mg/kg/day groups. At P70 blood insulin, IGF-I, GH, and leptin levels were low, whereas blood glucose, and liver IGFs and IGFBPs were high in the high dose groups. High HC also caused delayed memory and learning abilities at P70. CONCLUSIONS These data demonstrate that while higher doses of HC may be required for hemodynamic stability and prevention of CLD, these doses may result in growth deficits, as well as neurological and metabolic sequelae in adulthood.
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Affiliation(s)
- Maria A Abrantes
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Long Beach Memorial Medical Center, Long Beach, CA 90806, USA; Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of California, Irvine Medical Center, Orange, CA 92868, USA; Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Kaiser Permanente, Anaheim, CA 92806, USA
| | - Arwin M Valencia
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Long Beach Memorial Medical Center, Long Beach, CA 90806, USA; Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of California, Irvine Medical Center, Orange, CA 92868, USA; Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Saddleback Memorial Medical Center, Laguna Hills, CA 92653, USA
| | - Fayez Bany-Mohammed
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of California, Irvine Medical Center, Orange, CA 92868, USA.
| | - Jacob V Aranda
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA; Department of Ophthalmology, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA.
| | - Kay D Beharry
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Long Beach Memorial Medical Center, Long Beach, CA 90806, USA; Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of California, Irvine Medical Center, Orange, CA 92868, USA; Department of Pediatrics, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA; Department of Ophthalmology, Division of Neonatal-Perinatal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA.
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20
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Howe CG, Eckel SP, Habre R, Girguis MS, Gao L, Lurmann FW, Gilliland FD, Breton CV. Association of Prenatal Exposure to Ambient and Traffic-Related Air Pollution With Newborn Thyroid Function: Findings From the Children's Health Study. JAMA Netw Open 2018; 1:e182172. [PMID: 30646156 PMCID: PMC6324507 DOI: 10.1001/jamanetworkopen.2018.2172] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Thyroid hormones are critical for fetal growth and development. Prenatal particulate matter (PM) air pollution exposure has been associated with altered newborn thyroid function, but other air pollutants have not been evaluated, and critical windows of exposure are unknown. OBJECTIVES To investigate the association of prenatal exposure to ambient and traffic-related air pollutants with newborn thyroid function and identify critical windows of exposure. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from 2050 participants in the Children's Health Study. Statistical analyses were conducted from 2017 to 2018 using pregnancy and birth data from 1994 to 1997 for a subset of participants recruited from schools in 13 southern California communities in 2002 to 2003 when participants were 5 to 7 years of age. Participants were included in statistical analyses if they could be linked to their newborn blood spot and had complete monthly exposure measures for at least 1 air pollutant across pregnancy. EXPOSURES Prenatal monthly averages of ambient (PM diameter <2.5 μm [PM2.5] or <10 μm [PM10], nitrogen dioxide, and ozone) and traffic-related (freeway, nonfreeway, and total nitrogen oxides) air pollutant exposures were determined using inverse distance-squared weighting of central monitoring data and the California Line Source Dispersion model, respectively. MAIN OUTCOMES AND MEASURES Newborn heel-stick blood spot total thyroxine (TT4) measures were acquired retrospectively from the California Department of Public Health. RESULTS Participants included 2050 newborns (50.5% male), with a median (interquartile range) age of 20 (15-29) hours. The majority of newborns were Hispanic white (1202 [58.6%]) or non-Hispanic white (638 [31.1%]). Sixty-six (3.2%) were black and 144 (7.0%) were from other racial/ethnic groups. The mean (SD) newborn TT4 measure was 16.2 (4.3) μg/dL. A 2-SD increase in prenatal PM2.5 (16.3 μg/m3) and PM10 (22.2 μg/m3) was associated with a 1.2-μg/dL (95% CI, 0.5-1.8 μg/dL) and 1.5-μg/dL (95% CI, 0.9-2.1 μg/dL) higher TT4 measure, respectively, in covariate-adjusted linear regression models. Other pollutants were not consistently associated with newborn TT4. Distributed lag models revealed that PM2.5 exposure during months 3 to 7 of pregnancy and PM10 exposure during months 1 to 8 of pregnancy were associated with significantly higher newborn TT4 concentrations (P < .05). CONCLUSIONS AND RELEVANCE Prenatal PM exposure, particularly in early pregnancy and midpregnancy, is associated with higher newborn TT4 concentrations. Future studies should assess the health implications of PM-associated differences in newborn TT4 concentrations.
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Affiliation(s)
- Caitlin G. Howe
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Sandrah P. Eckel
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Rima Habre
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Mariam S. Girguis
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Lu Gao
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | | | - Frank D. Gilliland
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Carrie V. Breton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
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Eerdekens A, Langouche L, Güiza F, Verhaeghe J, Naulaers G, Vanhole C, Van den Berghe G. Maternal and placental responses before preterm birth: adaptations to increase fetal thyroid hormone availability? J Matern Fetal Neonatal Med 2018; 32:2746-2757. [DOI: 10.1080/14767058.2018.1449199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- An Eerdekens
- Department of Neonatology, University Hospitals Leuven, KU Leuven, Belgium
| | - Lies Langouche
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Belgium
| | - Fabian Güiza
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Belgium
| | - Johan Verhaeghe
- Department of Obstetrics and Gynecology, University Hospitals Leuven, KU Leuven, Belgium
| | - Gunnar Naulaers
- Department of Neonatology, University Hospitals Leuven, KU Leuven, Belgium
| | - Christine Vanhole
- Department of Neonatology, University Hospitals Leuven, KU Leuven, Belgium
| | - Greet Van den Berghe
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Belgium
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Iijima S. Current knowledge of transient hypothyroxinemia of prematurity: to treat or not to treat? J Matern Fetal Neonatal Med 2018; 32:2591-2597. [PMID: 29447027 DOI: 10.1080/14767058.2018.1441277] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Thyroid hormones (THs) play a critical role in normal maturation of the developing brain in the fetus and infant. Continuing advances in neonatal medicine have contributed to an increased survival of extremely premature infants with neonatal morbidities. In these infants, thyroid system immaturities, as well as morbidity-related thyroid dysfunction, contribute to transient hypothyroxinemia of prematurity (THOP), which is characterized by very low total and free thyroxine and normal or low thyroid-stimulating hormone (TSH) levels. REVIEW Undoubtedly, low levels of THs with elevated TSH are associated with poor neurodevelopmental outcome. However, continuing debate exists regarding whether THOP is harmful to the developing brain. Moreover, no clear effects of TH treatment on neurodevelopmental outcome in preterm infants with THOP have been demonstrated. THs could have unpredictable effects if given unnecessarily. CONCLUSION The current recommendation is to treat THOP with TH only if THOP is accompanied with TSH elevation.
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Affiliation(s)
- Shigeo Iijima
- a Department of Pediatrics , Hamamatsu University School of Medicine , Hamamatsu , Japan
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23
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Retinopathy of prematurity: inflammation, choroidal degeneration, and novel promising therapeutic strategies. J Neuroinflammation 2017; 14:165. [PMID: 28830469 PMCID: PMC5567917 DOI: 10.1186/s12974-017-0943-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 08/14/2017] [Indexed: 01/08/2023] Open
Abstract
Retinopathy of prematurity (ROP) is an important cause of childhood blindness globally, and the incidence is rising. The disease is characterized by initial arrested retinal vascularization followed by neovascularization and ensuing retinal detachment causing permanent visual loss. Although neovascularization can be effectively treated via retinal laser ablation, it is unknown which children are at risk of entering this vision-threatening phase of the disease. Laser ablation may itself induce visual field deficits, and there is therefore a need to identify targets for novel and less destructive treatments of ROP. Inflammation is considered a key contributor to the pathogenesis of ROP. A large proportion of preterm infants with ROP will have residual visual loss linked to loss of photoreceptor (PR) and the integrity of the retinal pigment epithelium (RPE) in the macular region. Recent studies using animal models of ROP suggest that choroidal degeneration may be associated with a loss of integrity of the outer retina, a phenomenon so far largely undescribed in ROP pathogenesis. In this review, we highlight inflammatory and neuron-derived factors related to ROP progression, as well, potential targets for new treatment strategies. We also introduce choroidal degeneration as a significant cause of residual visual loss following ROP. We propose that ROP should no longer be considered an inner retinal vasculopathy only, but also a disease of choroidal degeneration affecting both retinal pigment epithelium and photoreceptor integrity.
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Abstract
Thyroid hormone has important physiologic functions in nearly every organ system. The critical role of thyroid hormone in growth and in physical and neurologic development lends particular importance to the prompt diagnosis and appropriate treatment of hypothyroidism in infants and children. Congenital hypothyroidism is common and has potentially devastating neurologic consequences. While the approach to diagnosis and treatment of severe congenital hypothyroidism is well established, data continue to emerge about the genetic causes, clinical significance, and prognosis of the milder forms of congenital hypothyroidism that are increasingly being diagnosed by newborn screening. Similarly, the diagnosis and treatment of severe acquired hypothyroidism is straightforward and clearly of clinical benefit, but uncertainty remains about the optimal management of mild subclinical hypothyroidism. This review summarizes current knowledge of the causes, clinical manifestations, diagnosis, treatment, and prognosis of hypothyroidism in infants and children, with a focus on recent developments and areas of uncertainty in this field.
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25
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Naud A, Schmitt E, Wirth M, Hascoet JM. Determinants of Indices of Cerebral Volume in Former Very Premature Infants at Term Equivalent Age. PLoS One 2017; 12:e0170797. [PMID: 28125676 PMCID: PMC5268368 DOI: 10.1371/journal.pone.0170797] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 01/11/2017] [Indexed: 01/07/2023] Open
Abstract
Conventional magnetic resonance imaging (MRI) at term equivalent age (TEA) is suggested to be a reliable tool to predict the outcome of very premature infants. The objective of this study was to determine simple reproducible MRI indices, in premature infants and to analyze their neonatal determinants at TEA. A cohort of infants born before 32 weeks gestational age (GA) underwent a MRI at TEA in our center. Two axial images (T2 weighted), were chosen to realize nine measures. We defined 4 linear indices (MAfhlv: thickness of lateral ventricle; CSI: cortex-skull index; VCI: ventricular-cortex index; BOI: bi occipital index) and 1 surface index (VS.A: volume slice area). Perinatal data were recorded. Sixty-nine infants had a GA (median (interquartile range)) of 30.0 weeks GA (27.0; 30.0) and a birth weight of 1240 grams (986; 1477). MRI was done at 41.0 (40.0; 42.0) weeks post menstrual age (PMA). The inter-investigator reproducibility was good. Twenty one MRI (30.5%) were quoted abnormal. We observed an association with retinopathy of prematurity (OR [95CI] = 4.205 [1.231-14.368]; p = 0.017), surgery for patent ductus arteriosus (OR = 4.688 [1.01-21.89]; p = 0.036), early onset infection (OR = 4.688 [1.004-21.889]; p = 0.036) and neonatal treatment by cefotaxime (OR = 3.222 [1.093-9.497]; p = 0.03). There was a difference for VCI between normal and abnormal MRI (0.412 (0.388; 0.429) vs. 0.432 (0.418; 0.449); p = 0,019); BOI was higher when fossa posterior lesions were observed; VS.A seems to be the best surrogate for cerebral volume, 80% of VS.As' variance being explained by a multiple linear regression model including 7 variables (head circumference at birth and at TEA, PMA, dopamine, ibuprofen treatment, blood and platelets transfusions). These indices, easily and rapidly achievable, seem to be useful but need to be validated in a large population to allow generalization for diagnosis and follow-up of former premature infants.
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Affiliation(s)
- Aurelie Naud
- Department of Neonatology, Maternité Régionale, CHRU NANCY, France
| | | | - Maelle Wirth
- EA 3450 - DevAH, Université de Lorraine, Nancy, France
| | - Jean-Michel Hascoet
- Department of Neonatology, Maternité Régionale, CHRU NANCY, France
- EA 3450 - DevAH, Université de Lorraine, Nancy, France
- * E-mail:
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26
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Abstract
PURPOSE OF REVIEW This review summarizes significant recent advances in the epidemiology, pathophysiology, and treatment of congenital hypothyroidism. RECENT FINDINGS The apparent incidence of congenital hypothyroidism has more than doubled in recent years because of several factors, including more inclusive diagnostic criteria, shifting demographics, and increasing survival of preterm infants. The greatest increase has occurred in mildly affected patients, many of whom have a eutopic thyroid gland. Congenital hypothyroidism may be transient or persistent, but the natural history cannot be predicted by severity at diagnosis. In premature infants, who are especially vulnerable to hypothyroidism, the rise in thyroid-stimulating hormone may be delayed and therefore detected only by routine follow-up screening. Recent studies of defects in thyroid hormone synthesis have focused on the role of mutations in the dual oxidase system and of a novel apical iodide transporter, anoctamin 1. Finally, emerging data suggest that exposure to excess thyroid hormone may be as harmful as hypothyroidism to long-term cognitive development. SUMMARY Although newborn screening has virtually eradicated mental retardation due to congenital hypothyroidism in parts of the world, new information continues to accumulate and new questions to arise about the diagnosis, physiology, and optimal management of this disorder.
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Affiliation(s)
- Ari J Wassner
- Division of Endocrinology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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27
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Korzeniewski SJ, Soto-Rivera CL, Fichorova RN, Allred E, Kuban KCK, O’Shea TM, Paneth N, Agus M, Dammann O, Leviton A. Are preterm newborns who have relative hyperthyrotropinemia at increased risk of brain damage? J Pediatr Endocrinol Metab 2014; 27:1077-88. [PMID: 24897395 PMCID: PMC4317282 DOI: 10.1515/jpem-2014-0059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 04/30/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND We sought to disentangle the contributions of hyperthyrotropinemia (an indicator of thyroid dysfunction) (HTT) and intermittent or sustained systemic inflammation (ISSI) to structural and functional indicators of brain damage. METHODS We measured the concentrations of thyroid-stimulating hormone (TSH) on day 14 and of 25 inflammation-related proteins in blood collected during the first 2 postnatal weeks from 786 infants born before the 28th week of gestation who were not considered to have hypothyroidism. We defined hyperthyrotropinemia (HTT) as a TSH concentration in the highest quartile for gestational age on postnatal day 14 and ISSI was defined as a concentration in the top quartile for gestational age of a specific inflammation-related protein on 2 separate days a week apart during the first 2 postnatal weeks. We first assessed the risk of brain damage indicators by comparing 1) neonates who had HTT to those without (regardless of ISSI) and 2) neonates with HTT only, ISSI only, or HTT+ISSI to those who were exposed to neither HTT nor ISSI. RESULTS In univariable models that compared those with HTT to those without, HTT was not significantly associated with any indicator of brain damage. In models that compared HTT only, ISSI only, and HTT+ISSI to those with neither, children with ISSI only or with HTT+ISSI were at significantly higher risk of ventriculomegaly [odds ratios (ORs) 2-6], whereas those with HTT only were at significantly reduced risk of a hypoechoic lesion (ORs 0.2-0.4). Children with HTT only had a higher risk of quadriparesis and those with ISSI alone had a higher risk of hemiparesis (ORs 1.6-2.4). Elevated risk of a very low mental development score was associated with both ISSI only and HTT+ISSI, whereas a very low motor development score and microcephaly were associated with HTT+ISSI. CONCLUSIONS The association of HTT with increased or decreased risk of indicators of brain damage depends on the presence or absence of ISSI.
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Affiliation(s)
- Steven J. Korzeniewski
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
| | - Carmen L. Soto-Rivera
- Division of Endocrinology, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Raina N. Fichorova
- Departments of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School
| | - Elizabeth Allred
- Neurology Departments, Boston Children’s Hospital, and Harvard Medical School, Boston, MA
| | - Karl C. K. Kuban
- Departments of Pediatrics, Boston Medical Center and Boston University, Boston, MA
| | | | - Nigel Paneth
- Department of Epidemiology, Michigan State University, East Lansing, MI
| | - Michael Agus
- Division of Endocrinology, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Olaf Dammann
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA
- Neuroepidemiology Unit, Hannover School of Medicine, Hannover, Germany
| | - Alan Leviton
- Neurology Departments, Boston Children’s Hospital, and Harvard Medical School, Boston, MA
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Chung HR. Adrenal and thyroid function in the fetus and preterm infant. KOREAN JOURNAL OF PEDIATRICS 2014; 57:425-33. [PMID: 25379042 PMCID: PMC4219944 DOI: 10.3345/kjp.2014.57.10.425] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/14/2014] [Indexed: 02/04/2023]
Abstract
Adrenal and thyroid hormones are essential for the regulation of intrauterine homeostasis, and for the timely differentiation and maturation of fetal organs. These hormones play complex roles during fetal life, and are believed to underlie the cellular communication that coordinates maternal-fetal interactions. They serve to modulate the functional adaptation for extrauterine life during the perinatal period. The pathophysiology of systemic vasopressor-resistant hypotension is associated with low levels of circulating cortisol, a result of immaturity of hypothalamic-pituitary-adrenal axis in preterm infants under stress. Over the past few decades, studies in preterm infants have shown abnormal clinical findings that suggest adrenal or thyroid dysfunction, yet the criteria used to diagnose adrenal insufficiency in preterm infants continue to be arbitrary. In addition, although hypothyroidism is frequently observed in extremely low gestational age infants, the benefits of thyroid hormone replacement therapy remain controversial. Screening methods for congenital hypothyroidism or congenital adrenal hyperplasia in the preterm neonate are inconclusive. Thus, further understanding of fetal and perinatal adrenal and thyroid function will provide an insight into the management of adrenal and thyroid function in the preterm infant.
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Affiliation(s)
- Hye Rim Chung
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
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29
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Schang AL, Gressens P, Fleiss B. Revisiting thyroid hormone treatment to prevent brain damage of prematurity. J Neurosci Res 2014; 92:1609-10. [DOI: 10.1002/jnr.23441] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 06/03/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Anne-Laure Schang
- Inserm, U1141; Paris France
- Université Paris Diderot, Faculté de Médecine; Paris France
- PremUP; Paris France
| | - Pierre Gressens
- Inserm, U1141; Paris France
- Université Paris Diderot, Faculté de Médecine; Paris France
- PremUP; Paris France
- Department of Perinatal Imaging and Health, Department of Division of Imaging Sciences and Biomedical Engineering; King's College London, King's Health Partners, St. Thomas' Hospital; London United Kingdom
| | - Bobbi Fleiss
- Inserm, U1141; Paris France
- Université Paris Diderot, Faculté de Médecine; Paris France
- PremUP; Paris France
- Department of Perinatal Imaging and Health, Department of Division of Imaging Sciences and Biomedical Engineering; King's College London, King's Health Partners, St. Thomas' Hospital; London United Kingdom
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