34周以下早产儿促甲状腺激素延迟升高及影响因素
收稿日期: 2022-12-13
网络出版日期: 2023-10-08
基金资助
江西省卫生健康委科技计划(202130769)
Related factors affecting delayed thyroid stimulating hormone elevation in preterm infants with gestational age <34 weeks
Received date: 2022-12-13
Online published: 2023-10-08
目的 评估<34周早产儿促甲状腺激素延迟升高（dTSH）的相关因素。方法 回顾性分析2020年3月—2021年9月出生并入住新生儿重症监护室的<34周早产儿的临床资料、初筛和生后15~28天静脉血促甲状腺激素（TSH）结果。结果 共纳入441例<34周早产儿，男253例、女188例，平均胎龄（30.0±2.0）周。dTSH 17例（3.9%），其中暂时性高TSH血症7例，先天性甲状腺功能减退症（CH）10例。初筛与生后15~28天，dTSH组的TSH水平均高于正常组，差异有统计学意义（P<0.05）。多因素logistic回归分析发现，使用多巴胺、低出生体重、5分钟 Apgar评分<7是dTSH发生的独立危险因素（P<0.05）。结论 <34周早产儿存在dTSH现象，低出生体重、5分钟低Apgar评分，使用多巴胺更容易出现dTSH，对早产儿应注意甲状腺功能的动态监测。
卢晓燕 , 陈绍红 , 陈影影 , 周文俊 , 周婵 , 宋燕 , 李禄全 , 唐文燕 . 34周以下早产儿促甲状腺激素延迟升高及影响因素[J]. 临床儿科杂志, 2023 , 41(10) : 675 -679 . DOI: 10.12372/jcp.2023.22e1648
Objective To evaluate the related factors of delayed thyroid stimulating hormone elevation (dTSH) in premature infants with gestational age <34 weeks. Methods The clinical data, preliminary screening and venous blood thyroid stimulating hormone (TSH) results at 15-28d after birth of preterm infants with gestational age <34 weeks born in Jiangxi Maternal and Child Health Hospital and admitted to intensive care unit from March 2020 to September 2021 were retrospectively analyzed. Results A total of 441 preterm infants (253 boys and 188 girls) with gestational age <34 weeks were included, with an average gestational age of (30.0±2.0) weeks. There were 17 cases of dTSH (3.9%), including 7 cases of transient hyperthyrotropinemia and 10 cases of congenital hypothyroidism (CH). The TSH level in dTSH group was higher than that in normal group at first screening and 15 to 28 days after birth, and the difference was statistically significant (P<0.05). Multivariate logistic regression analysis showed that dopamine use, low birth weight and 5-minute Apgar score <7 were independent risk factors for dTSH development (P<0.05). Conclusions Preterm infants with gestational age <34 weeks may present with dTSH. Low birth weight, 5-minute low Apgar score, and use of dopamine are more likely to present dTSH. Attention should be paid to dynamic monitoring of thyroid function in preterm infants.
| [1] | Brady J, Cannupp A, Myers J, et al. Congenital hypo-thyroidism[J]. Neonatal Netw, 2021, 40(6): 377-385. |
| [2] | Stawerska R, Nowak-Bednarek M, Talar T, et al. The prevalence of hypothyroxinemia in premature newborns[J]. Front Endocrinol (Lausanne), 2022, 13: 940152. |
| [3] | Van Trotsenburg P, Stoupa A, Léger J, et al. Congenital hypothyroidism: A 2020-2021 Consensus Guidelines Update-An ENDO-European Reference Network Initiative Endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology[J]. Thyroid, 2021, 31(3): 387-419. |
| [4] | Kilberg MJ, Rasooly IR, LaFranchi SH, et al. New-born screening in the US may miss mild persistent hypothyroidism[J]. J Pediatr, 2018, 192: 204-208. |
| [5] | McGrath N, Hawkes C, Mayne P, et al. Optimal timing of repeat newborn screening for congenital hypothyroidism in preterm infants to detect delayed thyroid-stimulating hormone elevation[J]. J Pediatr, 2019, 205: 77-82. |
| [6] | Yoon SA, Chang YS, Ahn SY, et al. Initial and delayed thyroid-stimulating hormone elevation in extremely low-birth-weight infants[J]. BM Pediatr, 2019, 19(1): 347. |
| [7] | Cherella CE, Wassner AJ. Update on congenital hypothyroidism[J]. Curr Opin Endocrinol Diabetes Obes, 2020, 27(1): 63-69. |
| [8] | Al-Qahtani M. Congenital hypothyroidism[J]. J Matern Fetal Neonatal Med, 2022, 35(19): 3761-3769. |
| [9] | Tfayli H, Charafeddine L, Tamim H, et al. Higher incidence rates of hypothyroidism and late TSH rise in preterm very-low-birth-weight infants at a tertiary care center[J]. Horm Res Paediatr, 2018, 89(4): 224-232. |
| [10] | Soto-Rivera CL, Fichorova RN, Allred EN, et al. The relationship between TSH and systemic inflammation in extremely preterm newborns[J]. Endocrine, 2015, 48(2): 595-602. |
| [11] | Minamitani K. Newborn screening for congenital hypothyroidism in Japan[J]. Int J Neonatal Screen, 2021, 7(3): 34. |
| [12] | LaFranchi SH. Thyroid function in preterm/low birth weight infants: impact on diagnosis and management of thyroid dysfunction[J]. Front Endocrinol (Lausanne), 2021, 12: 666207. |
| [13] | Cortez AB, Lin B, May JA. Targeted secondary screening for congenital hypothyroidism in high-risk neonates: a 9 year review in a large california health care system[J]. Int J Neonatal Screen, 2021, 7(4): 81. |
| [14] | 多中心极低出生体重儿预后评估协作组. 极早产儿先天性甲状腺功能减低症围生期危险因素的多中心研究[J]. 中华儿科杂志, 2022, 60(6): 545-550. |
| [15] | Zung A, Radi A, Almashanu S. The natural history of congenital hypothyroidism with delayed TSH elevation in neonatal intensive care newborns[J]. Clin Endocrinol (Oxf), 2020, 92(5): 443-449. |
| [16] | 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 5版. 北京: 人民卫生出版社, 2019. |
| [17] | Di Dalmazi G, Carlucci MA, Semeraro D, et al. A detailed analysis of the factors influencing neonatal tsh: results from a 6-year congenital hypothyroidism screening program[J]. Front Endocrinol (Lausanne), 2020, 11: 456. |
| [18] | Tani N, Ishikawa M, Watanabe M, et al. Thyroid-related hormones as potential markers of hypoxia/ischemia[J]. Hum Cell, 2020, 33(3): 545-558. |
| [19] | Kobayashi A, Usuda T, Wada M, et al. Thyroid function in asphyxiated newborns who received hypothermia therapy[J]. Pediatr Int, 2018, 60(5): 433-437. |
| [20] | Lee KH, Park SY, Park JH, et al. Development of delayed thyroid stimulating hormone elevation in small-for-gestational-age infants: Is a second screening needed?[J]. Ann Pediatr Endocrinol Metab, 2022: 28. |
| [21] | Filippi L, Pezzati M, Poggi C, et al. Dopamine versus dobutamine in very low birthweight infants: endocrine effects[J]. Arch Dis Child Fetal Neonatal Ed, 2007, 92(5): F367-F371. |
| [22] | 张慧, 崔蕴璞, 韩彤妍, 等. 极低/超低出生体重儿甲状腺功能减退的临床分析[J]. 中国当代儿科杂志, 2020, 22(10): 1073-1078. |
| [23] | Bianco AC, Dumitrescu A, Gereben B, et al. Paradigms of dynamic control of thyroid hormone signaling[J]. Endocr Rev, 2019, 40(4): 1000-1047. |
| [24] | Feldt-Rasmussen U, Effraimidis G, Klose M. The hypothalamus-pituitary-thyroid (HPT)-axis and its role in physiology and pathophysiology of other hypothalamus-pituitary functions[J]. Mol Cell Endocrinol, 2021, 525: 111173. |
| [25] | Minakhina S, De Oliveira V, Kim SY, et al. Thyroid hormone receptor phosphorylation regulates acute fasting-induced suppression of the hypothalamic-pituitary-thyroid axis[J]. Proc Natl Acad Sci U S A, 2021, 118(39): e2107943118. |
| [26] | Grob F, Gutiérrez M, Leguizamón L, et al. Hyper-thyrotropinemia is common in preterm infants who are born small for gestational age[J]. Pediatr Endocrinol Metab, 2020, 33(3): 375-382. |
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