评估正常早产新生儿的甲状腺激素状况

Juwel Das, Sayeed Haq, Palash Sarker, Bijoy Pal
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摘要

导言:与足月新生儿(TN)相比,甲状腺功能障碍对早产新生儿(PN)构成的风险更大,由于早产新生儿甲状腺素(TSH)升高延迟,因此在新生儿筛查中往往无法发现甲状腺功能障碍。目的评估妊娠 32 周前出生的早产儿在出生后第二周的甲状腺功能,并确定与甲状腺功能改变相关的因素。方法一项回顾性研究检查了妊娠小于32周新生儿的甲状腺功能,分析了甲状腺素(T4L)和促甲状腺激素(TSH)水平与围产期和新生儿预后的关系。研究共纳入358名患者,平均胎龄为29.3周,平均出生体重为1127克。研究结果T4L与出生体重(BW)(R=0.356;p<0.001)和胎龄(GA)(R=0.442;p<0.001)之间呈线性相关。TSH 值与胎龄小(SGA)(SGA 为 5.3 mU/L [1.5-37] vs. 非 SGA 为 2.89 mU/L [0.2-19.5]; p<0.001)、肌力支持(是为 3.98 mU/L [0.6-22.9] vs. 否为 3.16 mU/L [0.2-37]; p=0.019)和体重(R=-0.249; p<0.001)相关。2.5%的患者接受了左旋甲状腺素治疗,其中 6 例为 SGA。结论在第二周分析甲状腺功能有助于识别无症状、有甲状腺功能障碍风险的新生儿,尤其是SGA新生儿,他们更容易发生甲状腺功能改变。
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Evaluation of the Thyroid Hormone Status among Normal New Born Preterm Infants
Introduction: Thyroid dysfunction poses a greater risk in preterm newborns (PN) compared to term newborns (TN), often eluding detection in neonatal screening due to delayed thyrotropin (TSH) elevation in these cases. Objective: To assess thyroid function during the second week of life in PN born before 32 weeks gestation and identify factors associated with its alteration. Methods: A retrospective study examined thyroid function in < 32 weeks gestation neonates, analyzing thyroxine (T4L) and TSH levels in relation to perinatal and neonatal outcomes. The study included 358 patients with a mean gestational age of 29.3 weeks and a mean birth weight of 1127 grams. Results: Linear correlations were observed between T4L and birth weight (BW) (R=0.356; p<0.001) and gestational age (GA) (R=0.442; p<0.001). TSH values were associated with small for gestational age (SGA) (5.3 mU/L [1.5-37] for SGA vs. 2.89 mU/L [0.2-19.5] for non-SGA; p<0.001), inotropic support (3.98 mU/L [0.6-22.9] for Yes vs. 3.16 mU/L [0.2-37] for No; p=0.019), and BW (R=-0.249; p<0.001). Levothyroxine treatment was administered to 2.5% of patients, with six being SGA. Conclusions: Analyzing thyroid function in the second week aids in identifying asymptomatic newborns at risk of thyroid dysfunction, particularly in the case of SGA newborns who exhibit a higher susceptibility to thyroid function alterations.
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