Maternal CD4 count is significantly and specifically associated with the risk of serious infections with encapsulated bacteria in HEU infants.

ContextNeonatal hyperthyroidism was first described in 1912 and in 1964 was shown to be linked to transplacental passage of maternal antibodies. Few multicenter studies have described the perinatal factors leading to fetal and neonatal dysthyroidism.ObjectiveTo show how fetal dysthyroidism (FD) and neonatal dysthyroidism (ND) can be predicted from perinatal variables, in particular, the levels of anti-thyrotropin receptor antibodies (TRAbs) circulating in the mother and child.Design and PatientsThis was a retrospective multicenter study of data from the medical records of all patients monitored for pregnancy from 2007 to 2014.SettingAmong 280,000 births, the medical records of 2288 women with thyroid dysfunction were selected and screened, and 417 women with Graves disease and positive for TRAbs during pregnancy were included.ResultsUsing the maternal TRAb levels, the cutoff value of 2.5 IU/L best predicted for FD, with a sensitivity of 100% and specificity of 64%. Using the newborn TRAb levels, the cutoff value of 6.8 IU/L best predicted for ND, with a sensitivity of 100% and a specificity of 94%. In our study, 65% of women with a history of Graves disease did not receive antithyroid drugs during pregnancy but still had infants at risk of ND.ConclusionsIn pregnant women with TRAb levels ≥2.5 IU/L, fetal ultrasound monitoring is essential until delivery. All newborns with TRAb levels ≥6.8 IU/L should be examined by a pediatrician with special attention for thyroid dysfunction and treated, if necessary.

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Context Early treatment is essential to avoid the cardiac complication of Neonatal hyperthyroidism (NH). Our results have direct implications for clinical care. Objective NH can cause potentially fatal neonatal thyrotoxicosis. Here, we evaluated the feasibility of neonatal hyperthyroidism screening using the thyroid-stimulating hormone value in dried blood collected routinely on filter paper on the third postnatal day of life for congenital hypothyroidism screening. Design Retrospective case-control Methods Cases were identified using data from our previously published study of 280,000 infants born in ten maternity units in France in 2007-2014. Controls were identified among the 1,362,564 infants born in the Ile-de-France region during the same period. Results A screening thyroid-stimulating hormone level below 0.18 mIU/L on the third postnatal day had 71% (95% confidence interval [95%CI], 44%–90%) sensitivity, 99% (95%CI, 99%–100%) specificity, 81% (95%CI, 74%–86%) positive predictive value, and 98% (95%CI, 97%–99%) negative predictive value for detecting severe NH. By univariate regression analysis, the screening thyroid-stimulating hormone value was the strongest predictor of NH (p<0.00001), with an area under the receiver-operating characteristics curve of 0.98 (95%CI, 0.95–1.0). Expected frequencies were not significantly different from observed frequencies (Hosmer-Lemeshow test, p=0.99). Conclusions The screening thyroid-stimulating hormone test can be used to detect severe NH, the optimal cut-off being 0.18 mIU/L. The additional cost compared to screening for congenital hypothyroidism only would be small. Infants with neonatal hyperthyroidism would benefit from an earlier diagnosis with treatment initiation at the pre-symptomatic stage in many cases, ensuring optimal outcomes.