The relation of transient hypothyroxinemia in preterm infants to neurologic development at two years of age
The relation of transient hypothyroxinemia in preterm infants to neurologic development at two years of age
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DOI：
10.1056/nejm199603283341303
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发表时间：
1996-03-28
影响因子：
158.5
通讯作者：
Susser, M
中科院分区：
文献类型：
--
作者：
Reuss, ML;Paneth, N;Susser, M
背景短暂性低甲状腺素血症是早产儿的常见发现，不认为有长期后遗症或需要治疗。我们调查了早产儿低甲状腺素血症是否是随后运动和认知异常的原因。在这项历史性队列研究中，我们从出生时体重2000 g或以下、妊娠33周或更早出生、以及参加新生儿脑出血晚期后遗症的人群研究的儿童的国家筛查记录中检索了出生后第一周常规筛查获得的血液甲状腺素值。我们调查了这些值与463名有数据的受试者中致残性脑瘫的几率的关系，以及与400名受试者中2岁时贝利婴儿发育量表或斯坦福-比奈儿童智力量表的智力发育评分的关系。重度低甲状腺素血症定义为血甲状腺素值低于新泽西新生儿平均值2.6 SD以上，在校正胎龄和潜在混杂变量前后进行评估。在校正胎龄的分析中，患有严重低甲状腺素血症的婴儿发生致残性脑瘫的风险几乎是没有低甲状腺素血症的婴儿的11倍（优势比，10.8; 95%的置信区间，3.0到39.3），两岁时的平均智力发展分数低15.4分（95%置信区间，8.1至22.6分）比正常新生儿血液甲状腺素浓度的儿童的平均得分。校正胎龄和多个产前、围产期、新生儿早期和晚期变量后，重度低甲状腺素血症仍与致残性脑瘫风险增加相关（优势比，4. 4; 95%的置信区间，1.0至18.6）和近7个百分点的下降（95%置信区间，0.3 ~ 13.2分）。结论早产儿严重的低甲状腺素血症可能是在两岁时发现的神经和智力发育问题的重要原因。(C)1996年，马萨诸塞州医学会。
Background. Transient hypothyroxinemia, a common finding in premature infants, is not thought to have long-term sequelae or to require treatment. We investigated whether hypothyroxinemia in premature infants is a cause of subsequent motor and cognitive abnormalities.Methods. In this historical cohort study, we retrieved blood thyroxine values, obtained on routine screening in the first week of life, from state screening records of children who weighed 2000 g or less at birth, who were born at 33 weeks' gestation or earlier, and who were enrolled in a population-based study of the late sequelae of neonatal brain hemorrhage. We investigated the relation of these values to the odds for disabling cerebral palsy among 463 subjects for whom data were available and to the mental-development score on the Bayley Scales of Infant Development or the Stanford-Binet Intelligence Scales for Children at the age of two years in 400 subjects. The effects of severe hypothyroxinemia, defined as a blood thyroxine value more than 2.6 SD below the mean for New Jersey newborns, were assessed before and after adjustment for gestational age and potentially confounding variables.Results. In analyses adjusted for gestational age, infants with severe hypothyroxinemia had a risk of disabling cerebral palsy that was nearly 11 times that of infants without hypothyroxinemia (odds ratio, 10.8; 95 percent confidence interval, 3.0 to 39.3) and a mean mental-development score at the age of two that was 15.4 points lower (95 percent confidence interval, 8.1 to 22.6 points) than the mean score of children with normal neonatal blood thyroxine concentrations. After adjustment for gestational age and multiple prenatal, perinatal, and early and late neonatal variables, severe hypothyroxinemia was still associated with an increased risk of disabling cerebral palsy (odds ratio, 4.4; 95 percent confidence interval, 1.0 to 18.6) and a reduction of nearly 7 points (95 percent confidence interval, 0.3 to 13.2 points) in the mental-development score.Conclusions. Severe hypothyroxinemia in preterm infants may be an important cause of problems in neurologic and mental development detected at the age of two years. (C) 1996, Massachusetts Medical Society.