Pediatric Endocrinology Unit, Kaplan Medical Center, and the Hebrew University of Jerusalem, Rehovot 76100, Israel.
Division of Pediatrics, Kaplan Medical Center, Rehovot 76100, Israel.
J Clin Endocrinol Metab. 2017 Aug 1;102(8):3050-3055. doi: 10.1210/jc.2017-00701.
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.
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.
Maternal variables, types of NICU treatments and procedures, syndromes, and various medical conditions were compared between dTSH patients and their matched controls.
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.
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.
延迟性促甲状腺激素（TSH）升高（dTSH）定义为早产儿、低出生体重儿和患病新生儿在首次筛查时 TSH 水平正常，而在第二次新生儿筛查时 TSH 升高（通常在新生儿重症监护病房（NICU）中发生）。dTSH 的发病机制尚不清楚。
确定 NICU 新生儿发生 dTSH 的危险因素。
设计、地点和患者：对 8 所大学附属医院 NICU 中患有 dTSH 的新生儿进行了回顾性病历回顾。为每位患者选择了 2 名对照，匹配性别和出生体重。通过单因素分析确定 dTSH 的危险因素，然后进行多因素分析。
比较 dTSH 患者与其匹配对照的母亲变量、NICU 治疗和操作类型、综合征和各种医疗状况。
我们共纳入 100 例 dTSH 患者和 200 例匹配对照，比较两组 46 个变量。单因素分析发现 12 个 dTSH 的危险因素：剖宫产、机械通气、动脉导管未闭（PDA）、气胸和头孢噻肟、万古霉素、氟康唑、多巴胺、布洛芬、呋塞米、胰岛素和浓缩红细胞的应用。多因素分析发现 4 个危险因素：PDA 和万古霉素、胰岛素和呋塞米的应用。在 26 对双胞胎中，其中一个双胞胎患有 dTSH，两个双胞胎的所有变量均相似。
尽管某些变量对垂体-甲状腺轴功能障碍有直接影响，但这些变量共同反映了 NICU 中临床情况的严重程度，这是 dTSH 的共同基础。
