Leeuwen Lisette, van Heijst Arno F J, Vijfhuize Sanne, Beurskens Leonardus W J E, Weijman Gert, Tibboel Dick, van den Akker Erica L T, IJsselstijn Hanneke
Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
Neonatology. 2017;111(2):93-99. doi: 10.1159/000448238. Epub 2016 Sep 17.
Thyroid hormone concentrations may deviate from normal values during critical illness. This condition is known as nonthyroidal illness syndrome (NTIS), and it can influence the results of screening for congenital hypothyroidism (CH) during neonatal extracorporeal membrane oxygenation (ECMO).
To determine the incidence of aberrant CH screening results in ECMO-treated neonates, to identify possible determinants, and to follow up patients with abnormal thyroid hormone concentrations.
In this retrospective cohort study, we included 168 ECMO-treated neonates admitted from 2004 to 2014 and screened by protocol and divided them into the following 3 groups: group 1 (screened during ECMO, n = 107), group 2 (screened shortly before ECMO, n = 26), and group 3 (screened shortly after ECMO, n = 35).
CH screening results were aberrant in 67.3% (72/107) of the neonates screened during ECMO, in 73.1% (19/26) of the neonates screened before ECMO, and in 31.4% (11/35) of the neonates screened after ECMO (p < 0.001). Of the neonates with an aberrant screening result, all but 2 (i.e. 98%) had a low thyroxine concentration with a normal thyrotropin concentration at screening, as is seen in NTIS. None was diagnosed with CH. Mortality did not significantly differ between neonates with an aberrant screening result (32.4%) and neonates with a normal screening result (22.7%; p = 0.18). Screening before ECMO (OR 5.92; 95% CI 1.93-18.20), screening during ECMO (OR 4.49; 95% CI 1.98-10.19), and a higher Pediatric Logistic Organ Dysfunction-2 score (OR 1.31; 95% CI 1.04-1.66) were associated with an aberrant screening result.
Aberrant CH screening results were found in most ECMO-treated neonates screened before or during ECMO, which is likely due to NTIS. Follow-up of thyroid hormone concentrations is best started after recovery from critical illness. Our results suggest that thyroxine therapy is not required during ECMO.
危重症期间甲状腺激素浓度可能偏离正常范围。这种情况被称为非甲状腺疾病综合征（NTIS），它会影响新生儿体外膜肺氧合（ECMO）期间先天性甲状腺功能减退症（CH）的筛查结果。
确定接受ECMO治疗的新生儿中CH筛查结果异常的发生率，识别可能的决定因素，并对甲状腺激素浓度异常的患者进行随访。
在这项回顾性队列研究中，我们纳入了2004年至2014年收治并按方案进行筛查的168例接受ECMO治疗的新生儿，并将他们分为以下3组：第1组（在ECMO期间进行筛查，n = 107），第2组（在ECMO前不久进行筛查，n = 26），以及第3组（在ECMO后不久进行筛查，n = 35）。
在ECMO期间进行筛查的新生儿中，67.3%（72/107）的CH筛查结果异常；在ECMO前进行筛查的新生儿中，73.1%（19/26）的筛查结果异常；在ECMO后进行筛查的新生儿中，31.4%（11/35）的筛查结果异常（p < 0.001）。在筛查结果异常的新生儿中，除2例（即98%）外，所有新生儿在筛查时促甲状腺激素浓度正常但甲状腺素浓度较低，这在NTIS中可见。无一例被诊断为CH。筛查结果异常的新生儿（32.4%）与筛查结果正常的新生儿（22.7%；p = 0.18）之间的死亡率无显著差异。ECMO前筛查（比值比5.92；95%置信区间1.93 - 18.20）、ECMO期间筛查（比值比4.49；95%置信区间1.98 - 10.19）以及较高的小儿逻辑器官功能障碍-2评分（比值比1.31；95%置信区间1.04 - 1.66）与筛查结果异常相关。
在大多数于ECMO前或ECMO期间进行筛查的接受ECMO治疗的新生儿中发现了CH筛查结果异常，这可能是由于NTIS所致。甲状腺激素浓度的随访最好在危重症恢复后开始。我们的结果表明在ECMO期间不需要进行甲状腺素治疗。
