Grob Francisca, Gutiérrez Monserrat, Leguizamón Liliana, Fabres Jorge
Pontificia Universidad Católica de Chile, Faculty of Medicine, School of Medicine, Pediatrics Division, Diagonal Paraguay 362, Piso 8, Santiago 8330074, Chile, Phone: +56-223549088, Fax: +56-226384307.
Pontificia Universidad Católica de Chile, Faculty of Medicine, School of Medicine, Pediatrics Division, Santiago, Chile.
J Pediatr Endocrinol Metab. 2020 Mar 26;33(3):375-382. doi: 10.1515/jpem-2019-0461.
Background To determine the incidence of congenital hypothyroidism (CH) with a delayed increase in thyroid-stimulating hormone (TSH) levels in preterm infants and to describe the associated factors. Methods A prospective newborn screening (NBS) was conducted in 122 very low birth weight (VLBW) premature neonates born between June 2016 and September 2017. A dried blood spot thyroid stimulating hormone (TSH) level ≥15 mIU/L at 7 and 15 days of life, ≥10 in serum at the second screen or ≥5 at the third screen was defined as positive for CH. A concomitant increase in the TSH level and normal free thyroxine (T4) level was classified as hyperthyrotropinemia (HT). Results Before the first month of life, no cases of CH were identified. However, the second and third NBS identified 10 and six subjects with HT, respectively, but no cases of CH. The overall cumulative incidence of HT was 1:8. Small for gestational age (SGA) was a variable that was significantly associated with HT, even after the exclusion of patients with Down syndrome. Conclusions A high incidence of HT, but not CH, was found after the first month of life in preterm infants. Being SGA was strongly associated with having higher TSH. The need for repeating TSH screening after the first month of life in this population remains to be established.
确定甲状腺功能减退（CH）在早产儿中促甲状腺激素（TSH）水平延迟升高的发生率，并描述相关因素。方法：对2016年6月至2017年9月出生的122例极低出生体重（VLBW）早产儿进行前瞻性新生儿筛查（NBS）。出生后7天和15天干血斑促甲状腺激素（TSH）水平≥15 mIU/L、第二次筛查时血清TSH≥10 mIU/L或第三次筛查时TSH≥5 mIU/L定义为CH阳性。TSH水平升高且游离甲状腺素（T4）水平正常被归类为高促甲状腺素血症（HT）。结果：在出生后第一个月内，未发现CH病例。然而，第二次和第三次NBS分别确定了10例和6例HT患者，但无CH病例。HT的总体累积发病率为1:8。小于胎龄（SGA）是一个与HT显著相关的变量，即使排除唐氏综合征患者后也是如此。结论：在早产儿出生后第一个月后发现HT的发病率较高，但CH发病率不高。SGA与较高的TSH密切相关。该人群在出生后第一个月后重复进行TSH筛查的必要性仍有待确定。
