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Català L, Casas J, Yeh S, Josa-Eritja M, Tirado-Capistros M, Moliner E, Carreras G. Unusual congenital goiter due to maternal Hashimoto thyroiditis: a case report. Front Pediatr 2024; 12:1348431. [PMID: 38840805 PMCID: PMC11150639 DOI: 10.3389/fped.2024.1348431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/29/2024] [Indexed: 06/07/2024] Open
Abstract
Congenital hypothyroidism (CH) is the most common cause of endocrinopathy in the newborn Its incidence lies between 1 in 3,000 and 1 in 2,000, However, congenital goiter is a rare form of presentation. Hypothyroidism secondary to autoimmune etiology is extremely rare, with an incidence of 1:84.700-1:31.000 newborns. Anti-thyroid peroxidase antibodies (TPOAb) are able to cross the placenta but rarely induce hypothyroidism in the newborn, much less goiter. A case of congenital goiter in a male newborn secondary to maternal high TPOAb levels is reported. The mother was diagnosed of Hashimoto thyroiditis prior to the pregnancy. At birth, a grade 3 goiter was detected in the newborn. Laboratory testings revealed hypothyroidism with free thyroxine of 7.6 pmol/L, thyroid-stimulating hormone of 108 mUI/L and high TPOAb levels. Treatment with Levothyroxine was started the second day of life with progressive thyroid function normalization. Neurological development has been normal until the date.
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Affiliation(s)
- Laura Català
- Department of Pediatrics, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Judit Casas
- Department of Pediatrics, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Sean Yeh
- Department of Pediatrics, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Maria Josa-Eritja
- Department of Pediatrics, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut de Recerca Biomèdica - IIB Sant Pau, Barcelona, Spain
- Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Mireia Tirado-Capistros
- Department of Pediatrics, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut de Recerca Biomèdica - IIB Sant Pau, Barcelona, Spain
- Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Elisenda Moliner
- Department of Pediatrics, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut de Recerca Biomèdica - IIB Sant Pau, Barcelona, Spain
- Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Gemma Carreras
- Department of Pediatrics, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut de Recerca Biomèdica - IIB Sant Pau, Barcelona, Spain
- Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine and Public Health, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Yang M, Cao Z, Zhu W, Feng X, Zhou J, Liu J, Zhong Y, Zhou Y, Mei H, Cai X, Hu L, Zhou A, Xiao H. Associations between OGTT results during pregnancy and offspring TSH levels: a birth cohort study. BMC Pregnancy Childbirth 2024; 24:375. [PMID: 38760653 PMCID: PMC11100047 DOI: 10.1186/s12884-024-06554-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/29/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Limited evidence exists regarding the association between gestational diabetes mellitus (GDM) and elevated levels of thyroid-stimulating hormone (TSH) in newborns. Therefore, this study aimed to investigate the potential risk of elevated TSH levels in infants exposed to maternal GDM, considering the type and number of abnormal values obtained from the 75-gram oral glucose tolerance test (OGTT). METHODS A population-based, prospective birth cohort study was conducted in Wuhan, China. The study included women who underwent GDM screening using a 75-g OGTT. Neonatal TSH levels were measured via a time-resolved immunofluorescence assay. We estimated and stratified the overall risk (adjusted Risk Ratio [RR]) of elevated TSH levels (defined as TSH > 10 mIU/L or > 20 mIU/L) in offspring based on the type and number of abnormal OGTT values. RESULTS Out of 15,236 eligible mother-offspring pairs, 11.5% (1,753) of mothers were diagnosed with GDM. Offspring born to women diagnosed with GDM demonstrated a statistically significant elevation in TSH levels when compared to offspring of non-GDM mothers, with a mean difference of 0.20 [95% CI: 0.04-0.36]. The incidence of elevated TSH levels (TSH > 10 mIU/L) in offspring of non-GDM women was 6.3 per 1,000 live births. Newborns exposed to mothers with three abnormal OGTT values displayed an almost five-fold increased risk of elevated TSH levels (adjusted RR 4.77 [95% CI 1.64-13.96]). Maternal fasting blood glucose was independently and positively correlated with neonatal TSH levels and elevated TSH status (TSH > 20 mIU/L). CONCLUSIONS For newborns of women with GDM, personalized risk assessment for elevated TSH levels can be predicated on the type and number of abnormal OGTT values. Furthermore, fasting blood glucose emerges as a critical predictive marker for elevated neonatal TSH status.
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Affiliation(s)
- Meng Yang
- Institute of Maternal and Child Health, Tongji Medical College, Wuhan Children's Hospital (Wuhan Maternal and Child Health care Hospital, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Zhongqiang Cao
- Institute of Maternal and Child Health, Tongji Medical College, Wuhan Children's Hospital (Wuhan Maternal and Child Health care Hospital, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Wanting Zhu
- Department of Obstetrics, Tongji Medical College, Wuhan Children's Hospital (Wuhan Maternal and Child Health care Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyuan Feng
- Department of echocardiography, Tongji Medical College, Wuhan Children's Hospital (Wuhan Maternal and Child Health care Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jieqiong Zhou
- Department of Obstetrics, Tongji Medical College, Wuhan Children's Hospital (Wuhan Maternal and Child Health care Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jiuying Liu
- Department of Obstetrics, Tongji Medical College, Wuhan Children's Hospital (Wuhan Maternal and Child Health care Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanyuan Zhong
- Department of Obstetrics, Tongji Medical College, Wuhan Children's Hospital (Wuhan Maternal and Child Health care Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Zhou
- Department of Obstetrics, Tongji Medical College, Wuhan Children's Hospital (Wuhan Maternal and Child Health care Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Mei
- Institute of Maternal and Child Health, Tongji Medical College, Wuhan Children's Hospital (Wuhan Maternal and Child Health care Hospital, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Xiaonan Cai
- Institute of Maternal and Child Health, Tongji Medical College, Wuhan Children's Hospital (Wuhan Maternal and Child Health care Hospital, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Liqin Hu
- Institute of Maternal and Child Health, Tongji Medical College, Wuhan Children's Hospital (Wuhan Maternal and Child Health care Hospital, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Aifen Zhou
- Institute of Maternal and Child Health, Tongji Medical College, Wuhan Children's Hospital (Wuhan Maternal and Child Health care Hospital, Huazhong University of Science and Technology, Wuhan, 430000, China.
| | - Han Xiao
- Institute of Maternal and Child Health, Tongji Medical College, Wuhan Children's Hospital (Wuhan Maternal and Child Health care Hospital, Huazhong University of Science and Technology, Wuhan, 430000, China.
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Sosova I, Archibald A, Rosolowsky EW, Rathwell S, Christian S, Rosolowsky ET. Evaluation of the First Three Years of Treatment of Children with Congenital Hypothyroidism Identified through the Alberta Newborn Screening Program. Int J Neonatal Screen 2024; 10:35. [PMID: 38804357 PMCID: PMC11130861 DOI: 10.3390/ijns10020035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
The effectiveness of newborn screening (NBS) for congenital hypothyroidism (CH) relies on timely screening, confirmation of diagnosis, and initiation and ongoing monitoring of treatment. The objective of this study was to ascertain the extent to which infants with CH have received timely and appropriate management within the first 3 years of life, following diagnosis through NBS in Alberta, Canada. Deidentified laboratory data were extracted between 1 April 2014 and 31 March 2019 from Alberta Health administrative databases for infants born in this time frame. Time to lab collection was anchored from date of birth. Timeliness was assessed as the frequency of monitoring of Thyroid Stimulating Hormone (TSH) and appropriateness as the frequency of children maintaining biochemical euthyroidism. Among 160 term infants, 95% had confirmation of diagnosis by 16 days of age. The cohort had a median of 2 (range 0-5) TSH measurements performed in the time interval from 0 to 1 month, 4 (0-12) from 1 to 6 months, 2 (0-10) from 6 to 12 months, and 7 (0-21) from 12 to 36 months. Approximately half were still biochemically hypothyroid (TSH > 7 mU/L) at 1 month of age. After becoming euthyroid, at least some period of hypo- (60%) or hyperthyroidism (TSH < 0.2 mU/L) (39%) was experienced. More work needs to be performed to discern factors contributing to prolonged periods of hypothyroidism or infrequent lab monitoring.
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Affiliation(s)
- Iveta Sosova
- Department of Laboratory Medicine and Pathology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada;
- Genetics and Genomics, Alberta Precision Laboratories, Edmonton, AB T6G 2B7, Canada;
| | - Alyssa Archibald
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada;
| | - Erik W. Rosolowsky
- Department of Physics, Faculty of Science, University of Alberta, Edmonton, AB T6G 2E1, Canada;
| | - Sarah Rathwell
- Women & Children’s Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada;
| | - Susan Christian
- Genetics and Genomics, Alberta Precision Laboratories, Edmonton, AB T6G 2B7, Canada;
| | - Elizabeth T. Rosolowsky
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada;
- Women & Children’s Health Research Institute, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada;
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Pulungan AB, Puteri HA, Faizi M, Hofman PL, Utari A, Chanoine JP. Experiences and Challenges with Congenital Hypothyroidism Newborn Screening in Indonesia: A National Cross-Sectional Survey. Int J Neonatal Screen 2024; 10:8. [PMID: 38390972 PMCID: PMC10885017 DOI: 10.3390/ijns10010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 02/24/2024] Open
Abstract
The expansion of newborn screening (NBS) for congenital hypothyroidism (CH) is essential to reducing the number of preventable intellectual disabilities in children. Because of logistical issues, including geographic extremes, distinct cultures, and 4.8 million births annually, Indonesia has struggled to achieve universal NBS coverage. A national cross-sectional electronic survey was conducted to explore challenges in CH NBS. Responses from 423 healthcare professionals and program administrators across 30 provinces in Indonesia were collected. The major challenges reported were refusal from families (39.2%), newborns being discharged <24 h (38.3%), and limited availability of filter paper (35.9%). The respondents considered refusal from families to be due to fear, while others did not understand the necessity of CH NBS. The vast majority of respondents believed that parents do not have sufficient understanding regarding CH NBS (96.5%). Our study found that only 38.5% of respondents had received formal CH NBS training, with pediatric endocrinologists being the only profession in which all respondents had been trained. Concerted efforts are needed to improve the access to and availability of resources, increase the capacity for sample collection and analysis, empower healthcare professionals, and develop educational resources to promote understanding and acceptance of NBS amongst families.
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Affiliation(s)
- Aman Bhakti Pulungan
- Department of Child Health, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
- Global Pediatric Endocrinology and Diabetes, Vancouver, BC V5Z 4R3, Canada; (A.U.); (J.-P.C.)
- Indonesian Pediatric Society, Jakarta 10430, Indonesia;
- Global Child Health Foundation, Jakarta 10430, Indonesia;
| | - Helena Arnetta Puteri
- Global Child Health Foundation, Jakarta 10430, Indonesia;
- Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Muhammad Faizi
- Indonesian Pediatric Society, Jakarta 10430, Indonesia;
- Department of Child Health, Faculty of Medicine, Universitas Airlangga—Dr. Soetomo General Hospital, Surabaya 60286, Indonesia
| | | | - Agustini Utari
- Global Pediatric Endocrinology and Diabetes, Vancouver, BC V5Z 4R3, Canada; (A.U.); (J.-P.C.)
- Indonesian Pediatric Society, Jakarta 10430, Indonesia;
- Department of Child Health, Faculty of Medicine, Universitas Diponegoro, Semarang 50275, Indonesia
| | - Jean-Pierre Chanoine
- Global Pediatric Endocrinology and Diabetes, Vancouver, BC V5Z 4R3, Canada; (A.U.); (J.-P.C.)
- Endocrinology and Diabetes Unit, British Columbia Children’s Hospital, Vancouver, BC V6H 3N1, Canada
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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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Panda SK, Sahoo M, Pradhan DD. Central Hypothyroidism with Cytomegalovirus Infection in an Extremely Preterm Infant. Indian J Pediatr 2023; 90:1268. [PMID: 37498503 DOI: 10.1007/s12098-023-04783-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/13/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Santosh Kumar Panda
- Department of Pediatrics, Kalinga Institute of Medical Sciences (KIMS), KIIT DU, Bhubaneswar, Odisha, India.
| | - Manaswinee Sahoo
- Department of Pediatrics, Kalinga Institute of Medical Sciences (KIMS), KIIT DU, Bhubaneswar, Odisha, India
| | - Deepti Damayanti Pradhan
- Department of Pediatrics, Kalinga Institute of Medical Sciences (KIMS), KIIT DU, Bhubaneswar, Odisha, India
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Shi R, Jiang J, Wang B, Liu F, Liu X, Yang D, Li Z, He H, Sun X, Liu Q, Li H, He J, Yu J, Zhang M, Reddy S, Yu Y, Zhao J. Dynamic Screening of Thyroid Function for the Timely Diagnosis of Congenital Hypothyroidism in Very Preterm Infants: A Prospective Multicenter Cohort Study. Thyroid 2023; 33:1055-1063. [PMID: 37566523 DOI: 10.1089/thy.2023.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
Background: Preterm infants presented a high prevalence of congenital hypothyroidism (CH), while the optimal screening pattern is still under debate. This study aimed at evaluating the characteristics of thyroid function by conducting weekly screening during the first month of life in very preterm infants (VPIs) to achieve timely diagnosis and treatment of CH. Methods: A prospective cohort study was carried out on VPIs born with gestational age (GA) <32 weeks (w) and admitted to the participating institutes from January 1, 2019 to December 31, 2022. Serial serum thyroid hormone levels were measured weekly within the first month after birth, and at 36 w of corrected age, or before discharge. Datasets for serial thyroid hormone levels and general information were obtained. Results: A total of 5992 VPIs were enrolled in this study, of which 456 (7.6%) [95% confidence interval (CI), 6.9-8.3%] were diagnosed with CH. The incidence of CH increased with lower GA, moving from 4.8% [CI, 3.4-6.1%] at GA 31 w to 16.9% [CI, 8.3-25.4%] at GA <26 w. Among the CH subjects, 57.7% [CI, 53.1-62.2%] were identified after the first screening and classified as delayed thyrotropin elevation (dTSH). With the decrease of GA, the proportion of dTSH also increased, moving from 38.1% [CI, 27.5-48.7%] at GA 31 w to 82.6% [CI, 65.8-99.4%] at GA <26 w. Through conducting weekly screening of thyroid function, it was remarkable that only 42.3% [CI, 37.8-46.9%] of CH subjects were diagnosed during the first screening. The cumulative rate of CH identified by rescreening performed at the second, third, and fourth week was 76.1% [CI, 72.2-80.0%], 90.6% [CI, 87.9-93.3%], and 98.9% [CI, 97.9-99.9%], respectively. Conclusion: The incidence of CH and dTSH both increase with lower GA in VPIs. Dynamic screening of thyroid function by weeks within the first month of life is crucial for the timely diagnosis and treatment of CH in VPIs, and it might effectively reduce the implications of missed diagnosis and delayed treatment. Clinical Trials Registration: ChiCTR1900025234 and ChiCTR2000037918 (Registration number).
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Affiliation(s)
- Ranran Shi
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Neonatology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Jie Jiang
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Baohong Wang
- Department of Neonatology, Yantai Yuhuangding Hospital, Yantai, China
| | - Fengmin Liu
- Department of Neonatology, Liaocheng People's Hospital, Liaocheng, China
| | - Xinjian Liu
- Department of Neonatology, Hebei PetroChina Central Hospital, Langfang, China
| | - Dejuan Yang
- Department of Neonatology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Zhongliang Li
- Department of Neonatology, W.F. Maternal and Child Health Hospital, Weifang, China
| | - Haiying He
- Department of Neonatology, The Third Hospital of Bao Gang Group, Baotou, China
| | - Xuemei Sun
- Department of Neonatology, Linyi People's Hospital, Linyi, China
| | - Qiongyu Liu
- Department of Neonatology, Women and Children's Healthcare Hospital of Linyi, Linyi, China
| | - Huimin Li
- Department of Neonatology, Jinan Maternity and Child Health Care Hospital, Jinan, China
| | - Jinrong He
- Department of Neonatology, Zibo Maternal and Child Health Hospital, Zibo, China
| | - Jiabi Yu
- Department of Neonatology, Qilu Hospital of Shandong University, Jinan, China
| | - Ming Zhang
- Department of Neonatology, Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, China
| | - Simmy Reddy
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yonghui Yu
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Department of Neonatology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Jiajun Zhao
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Shandong Provincial Key Laboratory of Endocrinology and Lipid Metabolism, Jinan, China
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