Evolution of circulating thyroid hormone levels in preterm infants during the first week of life: perinatal influences and impact on neurodevelopment
-
An Eerdekens
,
Gunnar Naulaers
Abstract
Background
For several decades, transient hypothyroxinemia of prematurity (THOP) has been a topic of debate. The pathophysiology is incompletely understood and consensus on the therapeutic approach is lacking. This study aimed at gaining a better insight into the pathogenesis by studying the trends in thyroid hormone (TH) levels during the first week of life.
Methods
This single-center prospective observational study analyzed the plasma levels of total thyroxine (T4) and free thyroxine (fT4), total triiodothyronine (T3), thyroid-stimulating hormone (TSH) and T4-binding globulin (TBG) in cord blood and at the end of the first week of life in 120 preterm infants (gestational age [GA] <37 weeks). The change over time was calculated (delta, ∆). The impact of perinatal and subsequently postnatal variables on ∆ was studied by hierarchical multiple regression. The impact of ∆ on the neurodevelopmental outcome at the corrected ages of 9 and 24 months, measured by the Bayley Scales of Infant Development (BSID)-II, was assessed by logistic regression.
Results
∆fT4 levels were negatively affected by GA and use of dopamine, whereas only GA was associated with low ∆T3 levels. Negative ∆fT4 levels were present in 75% of the extremely low-for-gestational-age infants, whereas 23.5% had a negative ∆T3 level. There was an increased risk for an abnormal mental developmental score (<85) with decreasing ∆T3 at 9 months, corrected age, but not at 24 months.
Conclusions
A negative evolution in circulating TH levels is principally an immaturity phenomenon, whereas dopamine can further suppress the hypothalamic-pituitary-thyroid axis. There is at least a temporary negative effect of this evolution on the infants’ neurodevelopment.
Acknowledgments
We thank the mothers and their babies for participating in the study and the midwives of the University Hospitals Leuven for supporting the recruitment of samples, the collaborators of the “Centrum voor Ontwikkelingsstoornissen, Leuven” for their help in the assessment of the BSID scores, Mrs. Annouschka Laenen (L-Stat, Catholic University Leuven) for statistical analysis support and Mrs. Herlinde Vekemans for language support.
Author contributions: All authors participated in designing the study, interpreting the data and critically reviewing the report. AE, LL and CV did the data analysis and interpretation. AE wrote the first draft of the article. AE had full access to anonymized individual participant data.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: None declared.
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©2019 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Review
- PCOS diagnosis in adolescents: the timeline of a controversy in a systematic review
- Original Articles
- Association between mild hyperthyrotropinemia and hypercholesterolemia in children with severe obesity
- Self-rated Tanner stage and subjective measures of puberty are associated with longitudinal gonadal hormone changes
- Early puberty in end stage renal failure and renal transplant recipients
- Present status of prophylactic thyroidectomy in pediatric multiple endocrine neoplasia 2: a nationwide survey in Japan 1997–2017
- Evolution of circulating thyroid hormone levels in preterm infants during the first week of life: perinatal influences and impact on neurodevelopment
- Wolcott-Rallison syndrome in Iran: a common cause of neonatal diabetes
- Etiology of primary adrenal insufficiency in children: a 29-year single-center experience
- The European Phenylketonuria Guidelines and the challenges on management practices in Portugal
- Case Reports
- Transient neonatal hypothyroidism following a short course of maternal amiodarone therapy
- A series of three case reports in patients with phenylketonuria performing regular exercise: first steps in dietary adjustment
- Utilization of a shared decision-making tool in a female infant with congenital adrenal hyperplasia and genital ambiguity
- Experience of intravenous calcium treatment and long-term responses to treatment in a patient with hereditary vitamin D-resistant rickets resulting from a novel mutation
Artikel in diesem Heft
- Frontmatter
- Review
- PCOS diagnosis in adolescents: the timeline of a controversy in a systematic review
- Original Articles
- Association between mild hyperthyrotropinemia and hypercholesterolemia in children with severe obesity
- Self-rated Tanner stage and subjective measures of puberty are associated with longitudinal gonadal hormone changes
- Early puberty in end stage renal failure and renal transplant recipients
- Present status of prophylactic thyroidectomy in pediatric multiple endocrine neoplasia 2: a nationwide survey in Japan 1997–2017
- Evolution of circulating thyroid hormone levels in preterm infants during the first week of life: perinatal influences and impact on neurodevelopment
- Wolcott-Rallison syndrome in Iran: a common cause of neonatal diabetes
- Etiology of primary adrenal insufficiency in children: a 29-year single-center experience
- The European Phenylketonuria Guidelines and the challenges on management practices in Portugal
- Case Reports
- Transient neonatal hypothyroidism following a short course of maternal amiodarone therapy
- A series of three case reports in patients with phenylketonuria performing regular exercise: first steps in dietary adjustment
- Utilization of a shared decision-making tool in a female infant with congenital adrenal hyperplasia and genital ambiguity
- Experience of intravenous calcium treatment and long-term responses to treatment in a patient with hereditary vitamin D-resistant rickets resulting from a novel mutation
