Topical Iodine-Containing Antiseptics and Neonatal Hypothyroidism in Very-Low-Birthweight Infants

Smerdely, Peter; Boyages, Steven; Wu, Dengyan; Leslie, Garth I.; John, Elizabeth; Lim, Arianne C.; Waite, Kay; Roberts, Victor J.; Arnold, J D; Eastman, Creswell J

doi:10.1016/s0140-6736(89)90903-3

Cited by 140 publications

(70 citation statements)

References 20 publications

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“…Temporary inhibition of thyroid hormone synthesis by iodine has been described [23]. The lack of influence in our patients can probably be explained by the limited use of iodine during the insertion of central catheters only as opposed to its liberal use in other studies.…”

Section: Discussionmentioning

confidence: 57%

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Low thyroxinaemia occurs in the majority of very preterm newborns

et al. 1996

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Section: Discussionmentioning

confidence: 57%

“…Thus, thyroid hormone synthesis may be blocked as a consequence of increased absorption of iodine from locally applied antiseptics (Wolff-Chaikoff effect) [23]. Another cause is iodine deficiency to which preterm neonates may be unduly susceptible [4].…”

Section: Discussionmentioning

confidence: 99%

Low thyroxinaemia occurs in the majority of very preterm newborns

et al. 1996

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“…31,33,[36][37][38] Therefore, it is reasonable to assume that the use of these products in NICUs has declined, so it seems unlikely that iodine excess can account for the reported increase in the incidence rate of CH in the United States. Nevertheless, questioning about iodine exposure continues to be an important part of the medical history for newborns with positive screen results for hypothyroidism, and iodine excess from procedurerelated exposure should be suspected when newborns from a particular hospital have a high rate of elevated TSH concentrations.…”

Section: Iodine Excessmentioning

confidence: 99%

The Impact of Transient Hypothyroidism on the Increasing Rate of Congenital Hypothyroidism in the United States

et al. 2010

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The reported incidence rate of primary congenital hypothyroidism (CH) has been increasing in the United States over the past 2 decades. We have considered the possibility that the inclusion of cases of transient hypothyroidism has inflated the reported incidence rate of CH. Assessing the effects of cases of transient hypothyroidism on the incidence rate is problematic, because the definitions, diagnostic criteria, and differentiation from transient hyperthyrotropinemia vary widely among state newborn screening programs. Among the 4 etiologies for transient hypothyroidism (maternal thyrotropin receptor-blocking antibodies, exposure to maternal antithyroid medications, iodine deficiency, and iodine excess), there is little evidence of increases in the incidence rate from thyrotropin receptor-blocking antibodies. Exposure to antithyroid drugs could contribute significantly to the incidence rate of transient CH, given the high estimated incidence of active maternal hyperthyroidism. Iodine deficiency or excess in the United States seems unlikely to have contributed significantly to the incidence rate of CH, because the secular trend toward lower iodine intake among women of reproductive age in the 1980s and 1990s seems to have plateaued, and perinatal iodine exposure has presumably declined as a result of recommendations to discontinue using iodinecontaining disinfectants. Although the female-to-male sex ratio among newborns with thyroid agenesis or dysgenesis (the most common causes of CH) is typically 2:1, analysis of the sex ratio of newborns diagnosed with presumed CH in the United States suggests that a substantial proportion might have transient hypothyroidism or hyperthyrotropinemia, because the sex ratio has been well below the expected 2:1 ratio. Combined ultrasonography and 123 I scintigraphy of the thyroid gland are effective tools for identifying cases of thyroid agenesis and dysgenesis and can help to differentiate cases of transient hypothyroidism from true CH. Imaging is also a vital component in evaluating children who, at 3 years of age, undergo a trial of discontinuation of levothyroxine treatment to test for persistence of hypothyroidism. Ultimately, thyroid gland imaging, in conjunction with longterm follow-up studies that appropriately assess and report whether there was permanence of hypothyroidism, will be necessary to address the true incidence rate of CH and any contribution to the observed rate by transient cases of hypothyroidism or hyperthyrotropinemia.

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“…However, laboratory findings consistent with transient hypothyroidism from systemic absorption of iodine after iodophor scrubs have been reported by several authors. 6,7 Transient hypothyroidism has not been widely reported in North America. 8,9 Recent trials in adults and neonates suggest that a cutaneous chlorhexidine gluconate (CHG) scrub before central venous catheter (CVC) or peripheral catheter insertion may be more effective than PI for prevention of CRBSI in adults and catheter colonization in neonates.…”

Section: Introductionmentioning

confidence: 99%

Pilot trial to compare tolerance of chlorhexidine gluconate to povidone-iodine antisepsis for central venous catheter placement in neonates

et al. 2009

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Objective: The purpose of this pilot trial was to determine whether rates of contact dermatitis following cutaneous antisepsis for central catheter placement were similar among neonates treated with chlorhexidine gluconate and povidone-iodine. Chlorhexidine gluconate absorption was also evaluated.Study Design: Infants weighing X1500 g and X7 days of age were randomized to a 10% povidone-iodine or 2% chlorhexidine gluconate site scrub before catheter placement. Primary outcomes evaluated included dermatitis, catheter colonization and chlorhexidine gluconate absorption.Result: A total of 48 neonates were enrolled. Colonization rates were similar among treatment groups (P<0.6). Dermatitis did not occur at chlorhexidine gluconate (central catheters, n ¼ 24; peripheral catheters, n ¼ 29) sites. Seven neonates had measurable chlorhexidine gluconate concentrations (range 13 to 100 ng ml À1 ) during catheterization. Conclusion:In this small trial chlorhexidine gluconate antisepsis was tolerated by study neonates. Chlorhexidine gluconate was cutaneously absorbed. Larger trials are needed to determine efficacy and tolerance of chlorhexidine gluconate in neonates.

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Topical Iodine-Containing Antiseptics and Neonatal Hypothyroidism in Very-Low-Birthweight Infants

Cited by 140 publications

References 20 publications

Low thyroxinaemia occurs in the majority of very preterm newborns

Low thyroxinaemia occurs in the majority of very preterm newborns

The Impact of Transient Hypothyroidism on the Increasing Rate of Congenital Hypothyroidism in the United States

Pilot trial to compare tolerance of chlorhexidine gluconate to povidone-iodine antisepsis for central venous catheter placement in neonates

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