Shi Ranran, Jiang Jie, Wang Baohong, Liu Fengmin, Liu Xinjian, Yang Dejuan, Li Zhongliang, He Haiying, Sun Xuemei, Liu Qiongyu, Li Huimin, He Jinrong, Yu Jiabi, Zhang Ming, Reddy Simmy, Yu Yonghui, Zhao Jiajun
Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
Department of Neonatology, Shandong Provincial Hospital, Shandong University, Jinan, China.
Thyroid. 2023 Sep;33(9):1055-1063. doi: 10.1089/thy.2023.0100. Epub 2023 Aug 11.
Preterm infants presented a high prevalence of congenital hypothyroidism (CH), while the optimal screening pattern is still under debate. This study aimed at evaluating the characteristics of thyroid function by conducting weekly screening during the first month of life in very preterm infants (VPIs) to achieve timely diagnosis and treatment of CH. A prospective cohort study was carried out on VPIs born with gestational age (GA) <32 weeks (w) and admitted to the participating institutes from January 1, 2019 to December 31, 2022. Serial serum thyroid hormone levels were measured weekly within the first month after birth, and at 36 w of corrected age, or before discharge. Datasets for serial thyroid hormone levels and general information were obtained. A total of 5992 VPIs were enrolled in this study, of which 456 (7.6%) [95% confidence interval (CI), 6.9-8.3%] were diagnosed with CH. The incidence of CH increased with lower GA, moving from 4.8% [CI, 3.4-6.1%] at GA 31 w to 16.9% [CI, 8.3-25.4%] at GA <26 w. Among the CH subjects, 57.7% [CI, 53.1-62.2%] were identified after the first screening and classified as delayed thyrotropin elevation (dTSH). With the decrease of GA, the proportion of dTSH also increased, moving from 38.1% [CI, 27.5-48.7%] at GA 31 w to 82.6% [CI, 65.8-99.4%] at GA <26 w. Through conducting weekly screening of thyroid function, it was remarkable that only 42.3% [CI, 37.8-46.9%] of CH subjects were diagnosed during the first screening. The cumulative rate of CH identified by rescreening performed at the second, third, and fourth week was 76.1% [CI, 72.2-80.0%], 90.6% [CI, 87.9-93.3%], and 98.9% [CI, 97.9-99.9%], respectively. The incidence of CH and dTSH both increase with lower GA in VPIs. Dynamic screening of thyroid function by weeks within the first month of life is crucial for the timely diagnosis and treatment of CH in VPIs, and it might effectively reduce the implications of missed diagnosis and delayed treatment. ChiCTR1900025234 and ChiCTR2000037918 (Registration number).
早产儿先天性甲状腺功能减退症（CH）的患病率较高，而最佳筛查模式仍存在争议。本研究旨在通过对极早产儿（VPI）出生后第一个月进行每周一次的筛查来评估甲状腺功能特征，以实现CH的及时诊断和治疗。对2019年1月1日至2022年12月31日期间在参与机构住院的胎龄（GA）<32周的VPI进行了一项前瞻性队列研究。在出生后第一个月内每周测量一次系列血清甲状腺激素水平，并在矫正年龄36周时或出院前测量。获得了系列甲状腺激素水平和一般信息的数据集。本研究共纳入5992例VPI，其中456例（7.6%）[95%置信区间（CI），6.9 - 8.3%]被诊断为CH。CH的发病率随着GA降低而增加，从GA 31周时的4.8%[CI，3.4 - 6.1%]增至GA<26周时的16.9%[CI，8.3 - 25.4%]。在CH患者中，57.7%[CI，53.1 - 62.2%]在首次筛查后被确诊，并归类为促甲状腺素延迟升高（dTSH）。随着GA降低，dTSH的比例也增加，从GA 31周时的38.1%[CI，27.5 - 48.7%]增至GA<26周时的82.6%[CI，65.8 - 99.4%]。通过每周进行甲状腺功能筛查发现，值得注意的是，仅42.3%[CI，37.8 - 46.9%]的CH患者在首次筛查时被诊断出来。在第二、第三和第四周进行复查时CH的累计确诊率分别为76.1%[CI，72.2 - 80.0%]、90.6%[CI，87.9 - 93.3%]和98.9%[CI，97.9 - 99.9%]。VPI中CH和dTSH的发病率均随着GA降低而增加。在出生后第一个月内按周动态筛查甲状腺功能对于VPI中CH的及时诊断和治疗至关重要，并且可能有效减少漏诊和延迟治疗的影响。ChiCTR1900025234和ChiCTR2000037918（注册号）
