Departments of Pediatrics and
Departments of Pediatrics and.
Pediatrics. 2019 Aug;144(2). doi: 10.1542/peds.2019-0290. Epub 2019 Jul 16.
Many newborn screening (NBS) programs now perform repeat or serial NBS to detect congenital hypothyroidism. There is wide variation in thyroid-stimulating hormone (TSH) cutoffs used by NBS programs. Data on TSH reference ranges in preterm infants at increasing postnatal age are limited. Our study objective was to determine TSH reference ranges for preterm infants born at <32 weeks' gestation.
We analyzed serial TSH levels on NBS performed on infants born between 22 and 31 weeks' gestation from 2012 to 2016 in Wisconsin. The study cohort was divided into 2 groups (22-27 and 28-31 weeks), and TSH percentiles were defined from birth to the term equivalent gestational age.
The study cohort consisted of 1022 and 2115 infants born at 22 to 27 and 28 to 31 weeks' gestation, respectively. The 95th percentile TSH level for the group born at 22 to 27 weeks' gestation gradually decreased and reached a nadir at ∼10 to 11 weeks. In contrast, for the group born at 28 to 31 weeks' gestation, the 95th percentile TSH level reached a nadir at ∼5 to 6 weeks. At 3 to 4 weeks after birth, the 95th percentile TSH level ranged from 11 to 11.8 μIU/mL for the group born at 22 to 27 weeks' gestation and ranged from 8.2 to 9 μIU/mL for the group born at 28 to 31 weeks' gestation.
Using a statewide cohort of preterm infants, we constructed TSH reference charts from birth to the term equivalent gestation for preterm infants born at <32 weeks' gestation. Use of a single cutoff for all preterm infants might lead to misdiagnosis. The differences in TSH levels according to gestational-age categories might explain the increased frequency in congenital hypothyroidism diagnoses among preterm infants. These data are useful for defining age-adjusted NBS TSH cutoffs for preterm infants.
目前许多新生儿筛查（NBS）计划会进行重复或连续的 NBS 以检测先天性甲状腺功能减退症。NBS 计划使用的促甲状腺激素（TSH）临界值存在广泛差异。早产儿在出生后不同时间点的 TSH 参考范围数据有限。我们的研究目的是确定胎龄<32 周早产儿的 TSH 参考范围。
我们分析了 2012 年至 2016 年间威斯康星州 22 至 31 周出生的 NBS 中连续的 TSH 水平。该研究队列分为 2 组（22-27 周和 28-31 周），并定义了从出生到胎龄相等的 TSH 百分位数。
研究队列分别由 1022 名和 2115 名胎龄为 22 至 27 周和 28 至 31 周出生的婴儿组成。22 至 27 周出生的婴儿组的 TSH 第 95 百分位水平逐渐下降，在 10 至 11 周达到最低点。相比之下，28 至 31 周出生的婴儿组的 TSH 第 95 百分位水平在 5 至 6 周时达到最低点。出生后 3 至 4 周时，22 至 27 周出生的婴儿组 TSH 第 95 百分位水平在 11 至 11.8 μIU/mL 之间，28 至 31 周出生的婴儿组在 8.2 至 9 μIU/mL 之间。
使用全州范围内的早产儿队列，我们为胎龄<32 周的早产儿建立了从出生到胎龄相等的 TSH 参考图表。对所有早产儿使用单一的临界值可能会导致误诊。根据胎龄分类的 TSH 水平差异可能解释了早产儿中先天性甲状腺功能减退症诊断频率的增加。这些数据对于定义早产儿年龄调整的 NBS TSH 临界值很有用。
