Linder N, Davidovitch N, Reichman B, Kuint J, Lubin D, Meyerovitch J, Sela B A, Dolfin Z, Sack J
Department of Neonatology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
J Pediatr. 1997 Sep;131(3):434-9. doi: 10.1016/s0022-3476(97)80071-6.
The influence of topical iodine-containing antiseptics on thyroid function test results of premature infants was determined in two separate studies. Thyroxine and thyrotropin levels were measured on blood-spotted filter paper. Samples were obtained from 128 premature infants on their tenth day of life; the infants were treated in two neonatal intensive care units. Both units used similar treatment protocols; however, one routinely used topical iodinated antiseptic agents (n = 73), whereas the other used chlorhexidine-containing antiseptics (n = 55). There was no difference in the mean T4 levels between the two groups. The mean thyrotropin levels were elevated in preterm babies exposed to iodine (15.4 vs 7.8 mIU/L, p < 0.01). Among the iodine-exposed infants, elevated thyrotropin levels (> 30 mIU/L) were found in 13.7% of infants, compared with none in the chlorhexidine-treated group (p < 0.01). We then studied an additional 46 premature infants who were treated in one neonatal intensive care unit. Iodine-containing solutions were used in 24 infants and chlorhexidine was used in 22 infants. T4 and thyrotropin levels were measured weekly during the first 28 days, one every 2 weeks until the age of 60 days, and at the age of 90 days. Among iodine-exposed infants, 20.8% had thyrotropin values > 30 mIU/L, whereas none of the infants in the chlorhexidine group had elevated thyrotropin values (p < 0.05). The elevated thyrotropin levels correlated positively with the area of disinfection. Elevated urine iodine levels were present reflecting an abnormally high iodine absorption. This study suggests that iodine absorption from topical iodine-containing antiseptics may cause disturbances in thyroid function test results in premature infants. We recommend that caution be exercised in the use of iodine-containing antiseptics in premature infants.
在两项独立研究中确定了局部含碘防腐剂对早产儿甲状腺功能测试结果的影响。在血斑滤纸上测量甲状腺素和促甲状腺激素水平。从128名早产儿出生第十天采集样本；这些婴儿在两个新生儿重症监护病房接受治疗。两个病房采用相似的治疗方案；然而，一个病房常规使用局部碘化防腐剂（n = 73），而另一个病房使用含氯己定的防腐剂（n = 55）。两组之间的平均T4水平没有差异。暴露于碘的早产儿促甲状腺激素平均水平升高（15.4对7.8 mIU/L，p < 0.01）。在暴露于碘的婴儿中，13.7%的婴儿促甲状腺激素水平升高（> 30 mIU/L），而氯己定治疗组无一例升高（p < 0.01）。然后我们研究了在一个新生儿重症监护病房接受治疗的另外46名早产儿。24名婴儿使用含碘溶液，22名婴儿使用氯己定。在出生后的前28天每周测量T4和促甲状腺激素水平，直到60天龄每2周测量一次，在90天龄时测量一次。在暴露于碘的婴儿中，20.8%的婴儿促甲状腺激素值> 30 mIU/L，而氯己定组的婴儿无一例促甲状腺激素值升高（p < 0.05）。促甲状腺激素水平升高与消毒面积呈正相关。尿碘水平升高反映碘吸收异常高。这项研究表明，局部含碘防腐剂吸收的碘可能会干扰早产儿的甲状腺功能测试结果。我们建议在早产儿中使用含碘防腐剂时应谨慎。
