Coquelet Stephanie, Deforge Helene, Hascoët Jean-Michel
Department of Neonatology, Regional Maternity, Centre Hospitalier Regional Universitaire de Nancy, Nancy, France.
EA3450- DevAH, University of Lorraine, Vandœuvre-lès-Nancy, France.
Front Pediatr. 2020 May 5;8:224. doi: 10.3389/fped.2020.00224. eCollection 2020.
Transient hypothyroxinaemia of prematurity (THOP) presents as decreased free thyroxine without an increase in thyroid stimulating hormone. Thyroxine availability is important in case of premature birth, and THOP could be associated with impaired adaptation to extra-uterine life but the association of thyroxine level and clinical status has not yet been clearly defined. To defined a free thyroxine threshold likely associated with neonatal clinical impairment and outcomes at age three years. This retrospective cohort study included infants born before or at 28 weeks' gestation at the Regional Maternity in Nancy, France. We defined a free thyroxine threshold as a function of clinical impairment by Receiver Operating Curve analysis, validated by log likelihood iteration in binary logistic regression, in infants born from October 2008 to December 2012 and meeting neonatal clinical impairment criteria. This threshold was validated in a distinct cohort of infants born from January 2014 to December 2016. Clinical impairment was defined as assisted ventilation requirement at seven days of age plus four minor clinical disorders among heart rate, blood pressure, temperature, serum sodium and potassium, APGAR score at five minutes, vasopressor treatment and patent ductus arteriosus. The first cohort was assessed at age three years for neurodevelopmental outcomes. We identified a ≤10 pmol/L threshold with 85.7% sensitivity and 51% specificity. From the first and second cohorts, 196 and 176 infants respectively had available data, and 85% (97/112) and 26% (20/78) with free thyroxine ≤10 pmol/L met clinical impairment criteria. For infants with values >10 pmol/L, 41% (35/84) and 3% (3/98) from the first and second cohorts met impairment criteria. Of 147 children with available data at age 3 years, 65% (58/89) with neonatal free thyroxine ≤10 pmol/L had adverse neurodevelopmental outcomes vs. 34% (20/58) with >10 pmol/L (OR 3.55; 95% confidence interval, 1.77-7.13; < 0.001). A free thyroxine level ≤10 pmol/L in infants is associated with neonatal clinical impairment and poor outcome at age three years.
早产儿短暂性甲状腺素血症（THOP）表现为游离甲状腺素降低，而促甲状腺激素未升高。甲状腺素的可利用性在早产情况下很重要，THOP可能与宫外生活适应受损有关，但甲状腺素水平与临床状况之间的关联尚未明确界定。为了确定一个可能与新生儿临床损害及3岁时的预后相关的游离甲状腺素阈值。这项回顾性队列研究纳入了在法国南锡地区妇产医院妊娠28周之前或之时出生的婴儿。我们通过接受者操作特征曲线分析，将游离甲状腺素阈值定义为临床损害的函数，并在二元逻辑回归中通过对数似然迭代进行验证，研究对象为2008年10月至2012年12月出生且符合新生儿临床损害标准的婴儿。该阈值在2014年1月至2016年12月出生的另一组婴儿中得到验证。临床损害定义为7日龄时需要辅助通气，加上心率、血压、体温、血清钠和钾、5分钟阿氏评分、血管升压药治疗和动脉导管未闭这四种轻微临床病症。第一组队列在3岁时评估神经发育结局。我们确定了一个≤10 pmol/L的阈值，敏感性为85.7%，特异性为51%。第一组和第二组队列分别有196例和176例婴儿有可用数据，游离甲状腺素≤10 pmol/L的婴儿中分别有85%（97/112）和26%（20/78）符合临床损害标准。对于游离甲状腺素值>10 pmol/L的婴儿，第一组和第二组队列中分别有41%（35/84）和3%（3/98）符合损害标准。在147例3岁时有可用数据的儿童中，新生儿游离甲状腺素≤10 pmol/L的儿童中有65%（58/89）有不良神经发育结局，而游离甲状腺素>10 pmol/L的儿童中有34%（20/58）有不良结局（比值比3.55；95%置信区间，1.77 - 7.13；P < 0.001）。婴儿游离甲状腺素水平≤10 pmol/L与新生儿临床损害及3岁时的不良结局相关。
