WHAT'S KNOWN ON THIS SUBJECT: Preterm infants have transiently lowered thyroid hormone levels during the early postnatal period. Past research suggests that low thyroid hormone levels are related to cognitive and developmental deficits in children born preterm.
WHAT THIS STUDY ADDS:Contrary to expectations, in this study of children born ,30 weeks' gestation, higher concentrations of free thyroxine over the first 6 weeks of life were associated with poorer cognitive function at 7 years of age. abstract BACKGROUND AND OBJECTIVES: Preterm infants commonly have transient hypothyroxinemia of prematurity after birth, which has been associated with deficits in general intellectual functioning, memory, attention, and academic achievement. However, research has predominantly focused on thyroxine levels in the first 2 weeks of life and outcomes are limited to the preschool period. Our objective was to evaluate the relationships between free thyroxine (fT 4 ) levels over the first 6 weeks after very preterm (VPT) birth with cognitive functioning and brain development at age 7 years.
METHODS:A total of 83 infants born VPT (,30 weeks' gestation) had fT 4 concentrations measured postnatally and 2-and 6-week area under the curve (AUC) summary measures were calculated. Follow-up at age 7 years included a neuropsychological assessment and brain MRI. Univariable and multivariable regression modeling was used where AUC for fT 4 was the main predictor of neurodevelopmental outcome at age 7 years.RESULTS: Multivariable modeling revealed that higher, not lower, postnatal fT 4 levels (2-week AUC) were associated with poorer cognitive performances at age 7 years on tasks of verbal learning (P = .02), verbal memory (P = .03), and simple reaction time (P , .001). A similar pattern of results was found when the 6-week AUC was examined. No significant associations between postnatal fT 4 levels and brain volumes at age 7 years were identified.
CONCLUSIONS:Results are contradictory to previous observations and suggest that after adjustment for confounders, higher postnatal fT 4 levels in VPT infants, rather than lower levels, may be a marker of adverse neuropsychological development in childhood. Dr Scratch conceptualized and designed the study, analyzed the data, and drafted the initial manuscript; Dr Hunt collected the blood specimens for hormone analysis, was involved in initial cerebral MRI interpretation, assisted with the conceptualization and design of the study, supervised data collection at all time points, and reviewed and revised the manuscript; Dr Thompson supervised the collection and analysis of the MRI scans and reviewed and revised the manuscript; Ms Ahmadzai performed the post-acquisition analysis of the MRI scans and reviewed and revised the manuscript; Dr Doyle assisted with the conceptualization and design of the study, supervised data collection at all time points, and reviewed and revised the manuscript; Dr Inder was involved in initial cerebral MRI interpretation, assisted with the conceptualization and design of the ...