Dursun Mesut, Ozcabi Bahar
Pediatrics and Neonatology, Biruni University Medical Faculty, Istanbul, TUR.
Pediatric Endocrinology, Memorial Bahçelievler Hospital, Istanbul, TUR.
Cureus. 2021 Aug 13;13(8):e17159. doi: 10.7759/cureus.17159. eCollection 2021 Aug.
Aim This study examined the associations of respiratory distress syndrome (RDS) severity and other factors on thyroid hormone levels in very low birth weight (VLBW) infants. Methods The demographic characteristics, clinical course, morbidity, and initial thyroid function test results of VLBW infants diagnosed with RDS between July 2016 and September 2018 were obtained retrospectively. RDS severity was determined according to the requirement for multiple surfactants. Patients were divided into groups without and with hypothyroxinemia, and variables of interest were compared between the two groups. Results Our study involved 98 infants meeting the inclusion criteria; the incidence of hypothyroxinemia was 56.1%. Free T4 (fT4) levels were found to be negatively correlated with gestational week (p < 0.001) and birth weight (p < 0.001). The fT4 levels were significantly lower in infants requiring multiple surfactant doses. In infants with hypothyroxinemia, the duration of invasive mechanical ventilation and oxygen treatment was longer and hemodynamically significant patent ductus arteriosus, grade ≥ 3 intraventricular hemorrhage, and moderate to severe bronchopulmonary dysplasia were more common. Multiple pregnancy (odds ratio (OR) = 5.616, 95%; confidence interval (CI): 1.765-17.874) and the duration of invasive mechanical ventilation (OR = 1.05, 95%; CI: 1.005-1.096) were significant risk factors for the development of hypothyroxinemia in logistic regression analysis. Conclusions Transient hypothyroxinemia of prematurity is associated with RDS severity and early morbidities of prematurity. In the presence of multiple pregnancy, patients should be followed up more closely due to the possibility of hypothyroxinemia.
目的 本研究探讨极低出生体重（VLBW）儿呼吸窘迫综合征（RDS）严重程度及其他因素与甲状腺激素水平的相关性。方法 回顾性收集2016年7月至2018年9月诊断为RDS的VLBW儿的人口统计学特征、临床病程、发病率及初始甲状腺功能检查结果。根据使用多种表面活性剂的需求确定RDS严重程度。将患者分为无低甲状腺素血症组和有低甲状腺素血症组，比较两组的相关变量。结果 本研究纳入98例符合纳入标准的婴儿；低甲状腺素血症的发生率为56.1%。发现游离T4（fT4）水平与孕周（p<0.001）和出生体重（p<0.001）呈负相关。需要多次使用表面活性剂的婴儿fT4水平显著更低。在低甲状腺素血症的婴儿中，有创机械通气和氧疗的持续时间更长，血流动力学显著的动脉导管未闭、≥3级脑室内出血以及中重度支气管肺发育不良更为常见。多胎妊娠（比值比（OR）=5.616，95%；置信区间（CI）：1.765 - 17.874）和有创机械通气的持续时间（OR = 1.05，95%；CI：1.005 - 1.096）在逻辑回归分析中是低甲状腺素血症发生的显著危险因素。结论 早产儿短暂性低甲状腺素血症与RDS严重程度及早产早期发病率相关。存在多胎妊娠时，由于可能发生低甲状腺素血症，应更密切地随访患者。
