BackgroundWeight loss of greater than 7% from birth weight indicates possible feeding problems. Inadequate oral intake causes weight loss and increases the bilirubin enterohepatic circulation. The objective of this study was to describe the association between total serum bilirubin (TSB) levels and weight loss in healthy term infants readmitted for hyperbilirubinemia after birth hospitalization.MethodsWe reviewed medical records of breastfed term infants who received phototherapy according to TSB levels readmitted to Caja Petrolera de Salud Clinic in La Paz, Bolivia during January 2005 through October 2008.ResultsSeventy-nine infants were studied (64.6% were males). The hyperbilirubinemia readmission rate was 5% among breastfed infants. Term infants were readmitted at a median age of 4 days. Mean TSB level was 18.6 ± 3 mg/dL. Thirty (38%) had significant weight loss. A weak correlation between TSB levels and percent of weight loss was identified (r = 0.20; p < 0.05). The frequency of severe hyperbilirubinemia (> 20 mg/dL) was notably higher among infants with significant weight loss (46.7% vs. 18.4%; p < 0.05). The risk of having severe hyperbilirubinemia was approximately 4 times greater for infants with significant weight loss (OR: 3.9; 95% CI: 1.4-10.8; p < 0.05).ConclusionsSignificant weight loss could be a useful parameter to identify breastfed term infants at risk of severe hyperbilirubinemia either during birth hospitalization or outpatient follow-up visits in settings where routine pre-discharge TSB levels have not been implemented yet.

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The effects of maternal use of methadone during pregnancy on tests of thyroid function were studied in 14 women and their offspring. Twelve normal nonaddicted women and their infants served as a control group. Concentrations of thyrotropin (TSH), thyroxine (T4), and triiodothyronine (T3) were not significantly different in maternal and cord serum, and in infant serum at age 24 hours. There was no significant difference in infants' TSH concentrations at 2, 3, and 7 days of age. At 2 and 7 days, T3 levels were significantly higher in the methadone than in the control group (P = .01 and &lt; .01, respectively). At 3 days, differences were of borderline significance (P = .08). Increased T4 levels in the methadone group of infants were statistically significant at 2 days (P &lt; .01) and at 3 and 7 days (P = .05). The mechanisms responsible for the biochemical evidence of hyperthyroidism were not determined, but may have been related to altered autonomic function and/or increased metabolic activity which occurs during neonatal narcotic withdrawal.

The frequency of thyroid surgeries has increased proportionality to the increment incidence of thyroid cancer. Yet, the number of experienced thyroid surgeons has not raised accordingly to that of thyroid cancer incidence. As a result, many thyroid surgeries are conducted by low volume surgeons that might affect the risk of surgical complications and remaining postoperative thyroid tissue. These poor surgical outcomes might be higher among countries affected by more thyroid cancer diagnosis yet with limited thyroid surgical expertise such as in a resource limited setting as Ecuador. The purpose of this study is to assess the outcomes of thyroid cancer surgery in a referral thyroid cancer center in Ecuador, and to explore the risk factors associated with poor surgical outcomes. Methods Around 344 patients with non-metastatic differentiated thyroid undergoing initial thyroid surgery (total thyroidectomy, central neck dissection) for a primary tumor were identified from an institutional database, and treated between June 1st, 2014 to December 31st, 2017. Poor surgical outcome was described in patients experience any surgical complications (recurrent laryngeal injury assessed with laryngoscopy and postoperative temporary and permanent hypoparathyroidism) or a stimulated post-operative Tg> 2mg/dL. Results Of the 344 patients, 127 patients had surgical complication and post-operative stimulated Tg data available to analyze. From this cohort, 22 (17%) patients had surgical complications, 19 (15%) hypoparathyroidism ( 8% temporary and 7% permanent) and 5 (4%) recurrent laryngeal nerve injury. A total of 74 (58%) out of 127 patients had a sTg value higher than 2 ng/ml. A poor surgical outcome was present in 88 (64%) patients. The multivariate analysis showed that the factor that was independently associated with poor surgical outcome was tumor size ≥1cm (OR: 3.3, 95% CI 1.18 - 9.3). Sex, age at diagnosis, benign non-nodular thyroid disease, BMI, place of surgery, tumor focallity, histology, extra thyroid extension variables were not- associated with poor surgical outcomes. Conclusion Two thirds of thyroid cancer surgeries, assessed in an Ecuadorian thyroid cancer referral center, had a poor surgical outcome that may lead to low patient’s low quality of life, and the need for additional treatment strategies. These estimates are higher than what is reported from the literature and suggest that the overdiagnosis of thyroid cancer in non-high-income country income countries might result in worse surgical outcomes.