一种基于胎龄的实用算法，用于及时检测早产儿甲状腺功能减退症。
A practical gestational age-based algorithm for timely detection of hypothyroidism in premature infants.
作者信息
Shah Avni N, Li Wen, Zheng Denise, Lalani Sana, Kaluarachchi Dinushan C, Findley Tina O
机构信息
Division of Pediatric Endocrinology, Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA.
Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA.
出版信息
J Perinatol. 2025 Apr;45(4):531-536. doi: 10.1038/s41372-024-01985-5. Epub 2024 May 11.
OBJECTIVES
To assess utility and accuracy of a gestational age-based screening targeting premature infants to detect congenital hypothyroidism.
STUDY DESIGN
A prospective cohort study was conducted in infants <35 weeks' gestational age with clinical outcomes at 2-3 years of age. Patients received newborn screenings at 24 hours and 10-14 days of life. Free T4 (FT4) and thyroid-stimulating hormone (TSH) levels were measured at one month of life and repeated based on algorithm by corrected gestational age.
RESULTS
Among infants <35 weeks gestation (n = 938), the incidence of hypothyroidism requiring treatment was 1:58. TSH levels at one month of age was predictive of treatment (AUC 0.96, 95% CI 0.88-1). The optimal TSH threshold of 8 mIU/L (8 µU/ml) increased the specificity to 0.97 and sensitivity to 0.88. Following initiation of treatment for hypothyroidism during NICU hospitalization, 43.8% (n = 7) were diagnosed with permanent congenital hypothyroidism.
CONCLUSIONS
Our study supports a gestational age-based screening algorithm for early detection of hypothyroidism in premature infants.
目的
评估针对早产儿的基于孕周的先天性甲状腺功能减退症筛查的效用和准确性。
研究设计
对孕周小于35周的婴儿进行前瞻性队列研究，并随访其2至3岁时的临床结局。患者在出生后24小时和10至14天接受新生儿筛查。在出生后1个月测量游离甲状腺素（FT4）和促甲状腺激素（TSH）水平，并根据校正孕周按照算法重复测量。
结果
在孕周小于35周的婴儿（n = 938）中，需要治疗的甲状腺功能减退症的发病率为1:58。出生后1个月时的TSH水平可预测是否需要治疗（曲线下面积0.96，95%可信区间0.88 - 1）。最佳TSH阈值为8 mIU/L（8 µU/ml）时，特异性提高到0.97，敏感性提高到0.88。在新生儿重症监护病房住院期间开始治疗甲状腺功能减退症后，43.8%（n = 7）被诊断为永久性先天性甲状腺功能减退症。
结论
我们的研究支持基于孕周的筛查算法用于早产儿甲状腺功能减退症的早期检测。
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