Section of Endocrinology, Department of Medicine and Aging Science, Center for Advanced Studies and Technology (CAST), G. D'Annunzio University, Chieti-Pescara, Italy.
Department of Medicine and Aging Science, Center for Advanced Studies and Technology (CAST) and Translational Medicine, University of Chieti G. D'Annunzio, Chieti, Italy.
Front Endocrinol (Lausanne). 2020 Jul 17;11:456. doi: 10.3389/fendo.2020.00456. eCollection 2020.
Neonatal thyrotropin (TSH) on dried blood spot (DBS), the most common screening strategy for primary congenital hypothyroidism (CH), is influenced by numerous factors that may hinder a true CH diagnosis. A second test can thus be performed to clarify the initial findings, although its application varies among screening programs. The aim of this study was to evaluate the effect of maternal and neonatal factors on neonatal TSH levels and offer practical screening recommendations. We retrospectively analyzed screening data of 62,132 neonates born in Abruzzo, an Italian region considered mildly iodine deficient, between 2011 and 2016. We then performed a multiple linear regression to model the relationship between TSH (the dependent variable) and 13 independent variables extracted from blood collection cards. Most neonates (53,551 of 62,132, 86%) had normal TSH and no clinical indications for a second screening. A minority (1,423, 2.3%) had elevated TSH in the initial DBS, which was confirmed in 97 cases (7%) on a second screen. The remaining neonates (6,594, 10.6%) had a normal initial TSH but underwent a second test in accordance with screening protocols, and were found to have delayed TSH elevation in 23 cases (0.4%). Those 120 newborns (97 + 23), considered highly suspicious for primary CH, were referred to a pediatrician for confirmatory testing and excluded from subsequent analysis of factors influencing TSH levels. Sex (β regression coefficient, β = 1.11 female to male, 95% CI 1.09, 1.12) and age at collection (β = 0.78 day 5 to days 2-3, 95% CI 0.74, 0.83) affected neonatal TSH, suggesting the utility of specific nomograms. In addition, prematurity (β = 0.85 term to preterm, 95% CI 0.80, 0.91), dopamine use (β = 0.71, 95% CI 0.62, 0.81), and birth weight (β = 1.40 normal vs. very low, 95% CI 1.05, 1.89) strongly influenced neonatal TSH. Neonatal TSH is influenced by several factors supporting the delineation of local sex- and age-adjusted TSH cutoffs, and the universal adoption of a second TSH test in neonates at risk of missed primary CH diagnosis.
新生儿促甲状腺素（TSH）在干血斑（DBS）中的检测，是原发性先天性甲状腺功能减退症（CH）的最常见的筛查策略，但它受到许多因素的影响，这些因素可能会干扰真正的 CH 诊断。因此，可以进行第二次测试以澄清最初的发现，尽管其应用在不同的筛查计划中有所不同。本研究旨在评估母婴和新生儿因素对新生儿 TSH 水平的影响，并提供实用的筛查建议。我们回顾性分析了 2011 年至 2016 年间在意大利轻度碘缺乏的阿布鲁佐地区出生的 62132 名新生儿的筛查数据。然后，我们进行了多元线性回归分析，以建立 TSH（因变量）与从采血卡中提取的 13 个独立变量之间的关系。大多数新生儿（62132 例中的 53551 例，86%）TSH 正常，无第二次筛查的临床指征。少数新生儿（1423 例，2.3%）在初次 DBS 中 TSH 升高，其中 97 例（7%）在第二次筛查中得到证实。其余新生儿（6594 例，10.6%）初次 TSH 正常，但根据筛查方案进行了第二次测试，其中 23 例（0.4%）发现 TSH 延迟升高。这 120 名新生儿（97 + 23）被认为高度怀疑原发性 CH，被转介给儿科医生进行确认性检测，并排除在随后的 TSH 水平影响因素分析之外。性别（β回归系数，β=1.11 女性对男性，95%CI 1.09，1.12）和采血时间（β=0.78 第 5 天至第 2-3 天，95%CI 0.74，0.83）影响新生儿 TSH，表明特定的列线图具有一定的实用性。此外，早产（β=0.85 足月至早产，95%CI 0.80，0.91）、多巴胺使用（β=0.71，95%CI 0.62，0.81）和出生体重（β=1.40 正常 vs. 极低，95%CI 1.05，1.89）也强烈影响新生儿 TSH。新生儿 TSH 受多种因素影响，支持划定本地性别和年龄调整 TSH 切点，并在有原发性 CH 漏诊风险的新生儿中普遍采用第二次 TSH 测试。
