Serum thyroid hormones in preterm infants: Associations with postnatal illnesses and drug usage
Serum thyroid hormones in preterm infants: Associations with postnatal illnesses and drug usage
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DOI：
10.1210/jc.2005-1049
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发表时间：
2005-11-01
影响因子：
5.8
通讯作者：
Hume, R
中科院分区：
文献类型：
--
作者：
Williams, FLR;Ogston, SA;Hume, R
研究背景：短暂性低甲状腺素血症常见于孕30周以内的婴儿，与神经发育缺陷有关。使用疾病总体严重程度的替代指标，T-4和T-3水平降低而TSH不变是严重疾病的关键特征，但这些并不能告知个体疾病状况或药物使用的影响。目的：我们的目的是调查出生后因素对血清碘甲腺原氨酸、甲状腺结合球蛋白和TSH水平变化的贡献。设计：我们招募了一组婴儿（妊娠23 - 34周; n = 780）。设置和患者：研究涉及11个苏格兰III级新生儿重症监护病房，包括妊娠23 - 34周分娩的婴儿队列。我们评估了第7、14和28天的血清碘甲状腺原氨酸、甲状腺结合球蛋白和TSH水平，并对潜在的显著产后影响进行了调整（n = 31）。血清TSH、游离T-4、T-3和T-4水平升高，但与菌血症、气管内细菌培养、永存动脉导管、坏死性小肠结肠炎，脑超声检查的变化，在28天的氧依赖性，并使用氨茶碱，咖啡因，地塞米松，二乙酰吗啡，和dopamine.Conclusions：有更多的协会出生后因素与短暂性低甲状腺素血症比以前被认为是在早产儿。低甲状腺素血症的纠正应考虑其他策略，而不是单纯依赖激素替代的直接治疗。可能需要通过减少个别疾病的发生率或严重程度来采取更间接的预防方法。同样，应该评估那些干扰下丘脑-垂体-甲状腺轴的药物的替代品（e. G.其他正性肌力药代替多巴胺）。
Context: Transient hypothyroxinemia is common in infants less than 30 wk gestation and is associated with neurodevelopmental deficits. Reductions in T-4 and T-3 levels with TSH unchanged are the key features of severe illness using surrogate indices of overall severity of illness, but these do not inform the impact of individual disease conditions or drug use.Objective: Our objective was to investigate the contribution of postnatal factors to the variations in serum levels of iodothyronines, thyroid- binding globulin, and TSH.Design: We recruited a cohort of infants ( 23 - 34 wk gestation; n = 780) between January 1998 and September 2001.Setting and Patients: The study involved 11 level III Scottish neonatal intensive care units and included cohorts of infants delivered at 23 - 34 wk gestation.Main Outcome: We assessed serum levels of iodothyronines, thyroid-binding globulin, and TSH at 7, 14, and 28 d adjusted for the potentially significant postnatal influences ( n = 31).Results: Serum levels of TSH, free T-4, T-3, and T-4 are variably but significantly associated with bacteremia, endotracheal bacterial cultures, persistent ductus arteriosus, necrotizing enterocolitis, cerebral ultrasonography changes, oxygen dependence at 28 d, and the use of aminophylline, caffeine, dexamethasone, diamorphine, and dopamine.Conclusions: There are many more associations of postnatal factors with transient hypothyroxinemia than had previously been considered in preterm infants. Alternative strategies should be considered for correction of hypothyroxinemia rather than sole reliance on the direct therapy of hormone replacement. A more oblique preventative approach may be necessary through reduction in the incidence or severity of individual illness( es). Similarly, alternatives to those drugs that interfere with the hypothalamic- pituitary- thyroid axis should be evaluated ( e. g. other inotropics instead of dopamine).