Increased Congenital Hypothyroidism Detection in Preterm Infants with Serial Newborn Screening

Kaluarachchi, Dinushan C.; Allen, David B.; Eickhoff, Jens; Dawe, Sandra; Baker, Mei W.

doi:10.1016/j.jpeds.2018.11.044

Cited by 42 publications

(29 citation statements)

References 22 publications

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“…In recent years, the diagnosis of congenital hypothyroidism (CH) in preterm infants has increased gradually. Many newborn screening (NBS) programs provide repeated or serial neonatal screenings to improve the detection rate of CH in preterm infants (1)(2)(3). However, the detection methods used by different NBS programs are not the same, and the cutoffs are also different (4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Dynamic Change of Thyroid Hormones With Postmenstrual Age in Very Preterm Infants Born With Gestational Age <32 Weeks: A Multicenter Prospective Cohort Study

et al. 2021

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BackgroundAt present, the relationship between thyrotropin (TSH) and free thyroxine (FT4) in relation to postmenstrual age (PMA) in preterm infants is still unclear, and there is no reliable standard thyroid hormone reference ranges, resulting in different diagnostic criteria for congenital hypothyroidism been used by different newborn screening programs and different countries.ObjectivesTo investigate the relationship between TSH/FT4 and PMA in very preterm infants (VPIs) born with gestational age (GA) <32 weeks and to derive thyroid function reference charts based on PMA.MethodsA prospective cohort study was performed on VPIs born with GA<32 weeks and born in or transferred to the 27 neonatal intensive care units from January 1, 2019 to December 31, 2019. Serial TSH and FT4 values were measured at the end of each week during the first month after birth and also at PMA36 weeks, PMA40 weeks and at discharge, respectively. The 2.5th, 5th, 50th, 95th, and 97.5th percentiles of TSH and FT4 of different PMA groups were calculated to draw the percentile charts based on PMA.Results1,093 preterm infants were included in this study. The percentile charts of TSH and FT4 levels based on PMA were drawn respectively, and the result indicated that the percentile charts of TSH values were gradually increased initially and then decreased with increasing PMA. The 97.5th percentile chart reached the peak at PMA30 weeks (17.38μIU/ml), and then decreased gradually, reaching the same level as full-term infants (9.07μIU/ml) at PMA38–40 weeks. The 2.5th percentile chart of FT4 was at its lowest point at PMA26–27 weeks (5.23pmol/L), then increased slowly with PMA and reached the same level as full-term infants at PMA38–40 weeks (10.87pmol/L). At PMA36 weeks, the reference intervals of the 2.5th to 97.5th percentiles of TSH and FT4 were 1.18–12.3μIU/ml and 8.59–25.98pmol/L, respectively.ConclusionThe percentile charts of TSH and FT4 in VPIs showed characteristic change with PMA. The results prompt that age-related cutoffs, instead of a single reference range, might be more useful to explain the thyroid function of VPIs. And repeated screening is necessary for preterm infants.

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Section: Introductionmentioning

confidence: 99%

Dynamic Change of Thyroid Hormones With Postmenstrual Age in Very Preterm Infants Born With Gestational Age <32 Weeks: A Multicenter Prospective Cohort Study

et al. 2021

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“…PCH occurs due to defective thyroid gland development (thyroid dysgenesis) or hormone biosynthetic defect (dyshormonogenesis) [ 3 ]. The incidence of CH has increased recently, especially in preterm newborns, with an overall incidence of 1:1714, and up to 1:62 among preterm infants born before 32 weeks of gestation [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…There is controversy around the world over which is the best newborn screening strategy for CH in preterm infants. Several studies have shown that serial TSH testing improves detection of CH [ 4 , 9 ], but this strategy fails to detect CCH. Some authors have suggested using specific cutoff values for this population, but there is no consensus on which TSH or tT4 cutoff values for preterm infants should be used [ 4 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Reference Percentiles and Changes over Time for Total Thyroxine in Preterm Infants: A Retrospective Cohort Study

et al. 2020

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Hypothyroxinemia of prematurity increases the rate of false-positive results in total thyroxine (tT4)-based screening programs for congenital hypothyroidism. The use of specific cutoff values for preterm infants has been proposed, but data on tT4 reference ranges in this population are limited. The primary aim was to establish reference percentiles for tT4 in dried blood spots among Mexican preterm infants. Secondary aims included a comparison of the change of tT4 concentrations over time according to gestational age and to discuss its impact on tT4-based screening programs. This was a retrospective cohort study; 1561 preterm infants were included. Percentile 10th for tT4 concentration at 24–27, 28–30, 31–34, and 35–36 weeks of gestational age, measured in the first week of life was: 47.6, 56.6, 82.3, and 117.1 nmol/L, respectively. tT4 concentrations were compared in three different time points: first week of life, 2–3 weeks of life, and term-corrected gestational age (38 weeks of gestation), progressively increased in infants below 30 weeks, remained stable in infants from 31 to 34 weeks, and decreased in late preterm newborns (35–36 weeks). This study suggests that preterm infants may require the use of lower tT4 cutoff values in newborn screening.

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“…These recommendations stem from several large‐scale, population‐based retrospective studies where dTSH was reported to be common among low‐BW and preterm newborns, with a prevalence that was negatively correlated with BW . Two recent studies further emphasize the high prevalence of dTSH among preterm and small‐for‐gestational (SGA) newborns …”

Section: Introductionmentioning

confidence: 99%

The natural history of congenital hypothyroidism with delayed TSH elevation in neonatal intensive care newborns

Zung

Radi

Almashanu

2020

Clinical Endocrinology

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Delayed TSH elevation (dTSH) is defined as elevated TSH in the second neonatal screening after normal TSH in the initial screening. A second screening is currently recommended by both the European and American Pediatric and Endocrinology societies for low-birthweight (BW), preterm and ill neonates admitted to the neonatal intensive care unit (NICU). 1,2 These recommendations stem from several large-scale, population-based retrospective studies where dTSH was reported to be common among low-BW and preterm newborns, with a prevalence that was negatively correlated with BW. [3][4][5][6][7] Two recent studies further emphasize the high prevalence of dTSH among preterm 8 and small-for-gestational (SGA) newborns. 9In contrast to these studies, we found that dTSH is much more common than previously reported (1 out of every 40 NICU newborns with low T4), especially among newborns with BW > 1500 g (66% of our entire series). 10 In a subsequent study, we identified several risk Abstract Objective: To assess the clinical and neurological outcomes in newborns with primary congenital hypothyroidism presented with delayed TSH elevation (dTSH), and to define parameters that may predict the evolution of transient vs. permanent hypothyroidism in these newborns. Design and patients: An observational study was performed of a cohort of 113 children with a history of dTSH. Measurements: Birth parameters, thyroid screening results, thyroid gland imaging, levothyroxine dose and neurological outcome were compared between newborns with spontaneous recovery and children with a final diagnosis of either transient or permanent hypothyroidism. Results: Of the children with a history of dTSH, 93% demonstrated recovery, either spontaneously or following levothyroxine treatment (transient hypothyroidism).Newborns with spontaneous recovery demonstrated milder thyroid dysfunction at the newborn screening compared to those who started levothyroxine treatment.Levothyroxine dose was lower in children with transient vs. permanent hypothyroidism only during the first 6 months of life; otherwise, these groups were similar in birth parameters, thyroid screening results and gland images. Seventeen out of 61 children (28%) that underwent neurological assessment demonstrated a developmental delay.Duration of treatment was highly variable in children with transient hypothyroidism. Conclusions:Thyroid dysfunction is transient in most cases of dTSH. No reliable parameters can predict a priori transient vs. permanent hypothyroidism. K E Y W O R D Scongenital hypothyroidism, delayed TSH elevation, newborns, outcome

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Increased Congenital Hypothyroidism Detection in Preterm Infants with Serial Newborn Screening

Cited by 42 publications

References 22 publications

Dynamic Change of Thyroid Hormones With Postmenstrual Age in Very Preterm Infants Born With Gestational Age <32 Weeks: A Multicenter Prospective Cohort Study

Dynamic Change of Thyroid Hormones With Postmenstrual Age in Very Preterm Infants Born With Gestational Age <32 Weeks: A Multicenter Prospective Cohort Study

Reference Percentiles and Changes over Time for Total Thyroxine in Preterm Infants: A Retrospective Cohort Study

The natural history of congenital hypothyroidism with delayed TSH elevation in neonatal intensive care newborns

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