Amnon Zung1, Rachel Bier Palmon2, Agneta Golan3, Mara Troitzky4, Smadar Eventov-Friedman5, Ronella Marom6, Rimona Keidar7, Neri Kats8, Shlomo Almashanu9, Orna Flidel-Rimon10. 1. Pediatric Endocrinology Unit, Kaplan Medical Center, and the Hebrew University of Jerusalem, Rehovot 76100, Israel. 2. Division of Pediatrics, Kaplan Medical Center, Rehovot 76100, Israel. 3. Neonatal Department, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva 8499000, Israel. 4. Neonatal Intensive Care Unit, The Barzilai Medical Center, affiliated with the Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8499000, Israel. 5. Neonatology Unit, Hadassah Ein Kerem Hospital, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel. 6. Neonatology, Tel Aviv Medical Center, Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv 6997801, Israel. 7. Neonatal Intensive Care Unit, Assaf Harofeh Medical Center, Zerifin 70300, Israel. 8. Neonatal Intensive Care Unit, Wolfson Medical Center, Holon 5822012, Israel. 9. National Newborn Screening Program, Department of Community Genetics, Public Health Services, Ministry of Health, Ramat Gan 5265601, Israel. 10. Neonatoloy Unit, Kaplan Medical Center, and the Hebrew University of Jerusalem, Rehovot 76100, Israel.
Abstract
Context: Delayed thyrotropin (TSH) elevation (dTSH) is defined as elevated TSH at the second neonatal screening (after normal TSH levels at the initial screening) in premature, low-birth-weight, and ill newborns, mostly in the neonatal intensive care unit (NICU) setting. The pathogenesis of dTSH is elusive. Objective: To identify the risk factors for dTSH development among newborns in the NICU. Design, Setting, and Patients: A retrospective medical record review of neonates with dTSH was conducted in eight university-affiliated NICUs. Two controls were selected for each patient, matched for sex and birth weight. The risk factors for dTSH were identified by univariate analysis, followed by multivariate analysis. Main Outcome Measures: Maternal variables, types of NICU treatments and procedures, syndromes, and various medical conditions were compared between dTSH patients and their matched controls. Results: We enrolled 100 dTSH patients and 200 matched controls and 46 variables were compared between the two groups. Twelve risk factors for dTSH were identified on univariate analysis: cesarean section, mechanical ventilation, patent ductus arteriosus (PDA), pneumothorax, and administration of cefotaxime, vancomycin, fluconazole, dopamine, ibuprofen, furosemide, insulin, and packed red blood cells. On multivariate analysis, four risk factors were identified: PDA and vancomycin, insulin, and furosemide administration. In 26 twin pairs, in which one twin had dTSH, all variables presented similarly in both twins. Conclusions: Although some variables had direct effects on pituitary-thyroid axis dysfunction, these variables, altogether, reflect the severity of the clinical conditions in the NICU, which is the common basis for dTSH.
Context: Delayed thyrotropin (TSH) elevation (dTSH) is defined as elevated TSH at the second neonatal screening (after normal TSH levels at the initial screening) in premature, low-birth-weight, and ill newborns, mostly in the neonatal intensive care unit (NICU) setting. The pathogenesis of dTSH is elusive. Objective: To identify the risk factors for dTSH development among newborns in the NICU. Design, Setting, and Patients: A retrospective medical record review of neonates with dTSH was conducted in eight university-affiliated NICUs. Two controls were selected for each patient, matched for sex and birth weight. The risk factors for dTSH were identified by univariate analysis, followed by multivariate analysis. Main Outcome Measures: Maternal variables, types of NICU treatments and procedures, syndromes, and various medical conditions were compared between dTSHpatients and their matched controls. Results: We enrolled 100 dTSHpatients and 200 matched controls and 46 variables were compared between the two groups. Twelve risk factors for dTSH were identified on univariate analysis: cesarean section, mechanical ventilation, patent ductus arteriosus (PDA), pneumothorax, and administration of cefotaxime, vancomycin, fluconazole, dopamine, ibuprofen, furosemide, insulin, and packed red blood cells. On multivariate analysis, four risk factors were identified: PDA and vancomycin, insulin, and furosemide administration. In 26 twin pairs, in which one twin had dTSH, all variables presented similarly in both twins. Conclusions: Although some variables had direct effects on pituitary-thyroid axis dysfunction, these variables, altogether, reflect the severity of the clinical conditions in the NICU, which is the common basis for dTSH.
Authors: Susan R Rose; Christopher E Blunden; Olumide O Jarrett; Kyle Kaplan; Rheta Caravantes; Henry T Akinbi Journal: J Pediatr Date: 2021-11-06 Impact factor: 4.406
Authors: You Jung Heo; Young Ah Lee; Bora Lee; Yun Jeong Lee; Youn Hee Lim; Hye Rim Chung; Seung Han Shin; Choong Ho Shin; Sei Won Yang Journal: PLoS One Date: 2019-08-23 Impact factor: 3.240
Authors: Laura Lucaccioni; Monica Ficara; Valentina Cenciarelli; Alberto Berardi; Barbara Predieri; Lorenzo Iughetti Journal: Acta Biomed Date: 2020-09-15
Authors: Hye-Rim Kim; Young Hwa Jung; Chang Won Choi; Hye Rim Chung; Min-Jae Kang; Beyong Il Kim Journal: BMC Pediatr Date: 2019-10-29 Impact factor: 2.125