Saslow J G, Post E M, Southard C A
Children's Regional Hospital, Robert Wood Johnson Medical School at Camden, New Jersey, USA.
Pediatrics. 1996 Jul;98(1):41-4.
As neonatal discharge before 24 hours of life becomes commonplace, the rejection of congenital hypothyroidism (CH) screening specimens obtained too early has created the need for numerous additional tests. We sought to determine whether the specimens obtained before 24 hours could be used safely.
During a 31-day period we measured thyrotropin in all thyroid-screening specimens that had been obtained before 24 hours. We also examined the early specimens from every infant diagnosed in New Jersey with CH during 1993 or 1994.
Among the 663 specimens, those obtained at or before 12 hours and those from infants with birth weights less than 2500 g had too many low thyroxine results to be useful. Among the 515 specimens obtained at more than 12 to 24 hours from newborns weighing 2500 g or more, 37 (7%) had low thyroxine levels and 12 (2.3%) had thyrotropin levels of 20 microIU/mL (mU/L) or higher. Four hundred seventy-one of the 515 infants had subsequent specimens obtained at more than 24 hours, and none of the results were abnormal. There was no child weighing more than or equal to 2500 g who was diagnosed with CH in 1993 and 1994 whose specimen obtained at 24 hours or less was normal.
Accepting specimens obtained at more than 12 to 24 hours from infants weighing 2500 g or more would have resulted in more than the usual number of false-positive results but no false-negative results. This would have decreased the requests for additional specimens by more than 90%.
随着出生后24小时内出院在新生儿中变得越来越普遍，过早采集的先天性甲状腺功能减退症（CH）筛查样本被拒收，这使得需要进行大量额外检测。我们试图确定24小时之前采集的样本是否可以安全使用。
在31天的时间里，我们检测了所有在24小时之前采集的甲状腺筛查样本中的促甲状腺激素。我们还检查了1993年或1994年在新泽西州被诊断为CH的每个婴儿的早期样本。
在663份样本中，12小时及之前采集的样本以及出生体重低于2500g的婴儿的样本，甲状腺素水平过低的情况过多，无法使用。在体重2500g及以上的新生儿出生12至24小时之后采集的515份样本中，37份（7%）甲状腺素水平较低，12份（2.3%）促甲状腺激素水平为20微国际单位/毫升（mU/L）或更高。515名婴儿中有471名随后在出生24小时之后采集了样本，且结果均无异常。1993年和1994年被诊断为CH且出生体重2500g及以上的儿童中，24小时及以内采集的样本没有一份是正常的。
接受体重2500g及以上婴儿在出生12至24小时之后采集的样本会导致假阳性结果比通常情况更多，但不会出现假阴性结果。这将使额外样本的需求减少90%以上。
