重症监护病房接受肠外营养的新生儿甲状腺功能障碍的患病率。

Prevalence of thyroid dysfunction in neonates receiving parenteral nutrition in the intensive care unit.

机构信息

Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brazil.

Hospital de Clínicas de Porto Alegre, Serviço de Neonatologia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Programa de Pós-Graduação em Pediatria, Porto Alegre, RS, Brazil.

出版信息

J Pediatr (Rio J). 2023 Jan-Feb;99(1):79-85. doi: 10.1016/j.jped.2022.06.004. Epub 2022 Aug 28.

DOI:10.1016/j.jped.2022.06.004

PMID:36030816

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9875250/

Abstract

OBJECTIVE

The use of parenteral nutrition (PN) formulations that do not contain iodine can contribute to the deficiency of this mineral, potentially leading to hypothyroidism and, ultimately, neurocognitive impairments. This study aimed to evaluate TSH alterations in newborns receiving PN.

METHODS

Retrospective study of neonatal intensive care unit patients receiving PN for > 15 days. Nutritional, anthropometric, and biochemical variables (TSH, T4, CRP) were analyzed. Hypothyroidism was defined by TSH > 10 mU/L.

RESULTS

Two hundred newborns were evaluated [156 (78%) preterm, 31±5 weeks of gestational age, 112 (56%) with very or extremely low birth weight]. The median (IQR) hospital stay was 68 (42-110) days, PN duration was 31 (21-47) days, and 188 (94%) patients also received enteral nutrition. Overall, 143 (71.5%) newborns underwent at least one TSH measurement. The prevalence of hypothyroidism was 10.5%. The Median PN duration in this group was 51 (34-109) days. Among those with hypothyroidism, 10 received Lugol's solution and six levothyroxine. Thirteen patients received prophylactic Lugol's solution with a median PN duration of 63 (48-197) days. TSH levels correlated positively with PN duration (r = 0.19, p = .02).

CONCLUSIONS

The present data suggest that changes in TSH and T4 levels are present in neonates receiving PN for > 15 days, suggesting this population may be at risk for developing hypothyroidism. Therefore, the authors suggest that TSH and T4 measurements should be included as routine in neonatal patients receiving PN for > 15 days if PN formulations are not supplemented with iodine, and that iodine supplementation be provided as necessary.

摘要

目的

使用不含碘的肠外营养（PN）制剂可能导致这种矿物质的缺乏，从而导致甲状腺功能减退，并最终导致神经认知障碍。本研究旨在评估接受 PN 的新生儿 TSH 的变化。

方法

回顾性研究在新生儿重症监护病房接受 PN 治疗超过 15 天的患者。分析营养、人体测量和生化变量（TSH、T4、CRP）。甲状腺功能减退症的定义为 TSH＞10mU/L。

结果

共评估了 200 名新生儿[156 名（78%）早产儿，胎龄 31±5 周，112 名（56%）极低出生体重或超低出生体重]。中位（IQR）住院时间为 68（42-110）天，PN 持续时间为 31（21-47）天，188（94%）名患者还接受了肠内营养。总体而言，143 名（71.5%）新生儿至少进行了一次 TSH 测量。甲状腺功能减退症的患病率为 10.5%。该组的中位 PN 持续时间为 51（34-109）天。在患有甲状腺功能减退症的患者中，10 名患者接受了卢戈氏液治疗，6 名患者接受了甲状腺素治疗。13 名患者预防性使用卢戈氏液，PN 持续时间中位数为 63（48-197）天。TSH 水平与 PN 持续时间呈正相关（r=0.19，p=0.02）。