Transient hypothyroxinaemia associated with developmental delay in very preterm infants.

Meijer, Wouter J.; Verloove-Vanhorick, S.P.; Brand, Ronald; Brande, J. L. Van den

doi:10.1136/adc.67.7.944

Cited by 132 publications

(64 citation statements)

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“…19 Consistent with this literature, the low levels of T 4 associated with THOP have been found to be related to neurodevelopmental deficits in children born preterm, such as delayed development of motor, cognitive, language, and educational skills. [20][21][22][23][24] Research to date has predominantly focused on TH levels in the first 2 weeks of life, and in most studies outcome assessments have been limited to infancy and the preschool period. The current study aimed to examine the relationship between fT 4 over the first 6 weeks after VPT birth and cognitive functioning and brain development at age 7 years.…”

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Free Thyroxine Levels After Very Preterm Birth and Neurodevelopmental Outcomes at Age 7 Years

et al. 2014

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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 ...

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Free Thyroxine Levels After Very Preterm Birth and Neurodevelopmental Outcomes at Age 7 Years

et al. 2014

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“…Motor and cognitive deficits are seen in these children despite early thyroxine replacement. Thus, even transiently low thyroxine levels are considered to be a potent risk factor for adverse neurodevelopmental outcome in preterm infants and have been the subject of many elegant long-term studies [1][2][3][4][5]. All cohorts have documented a measure of abnormal mental development in children with THOP.…”

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confidence: 99%

“…These infants account for the bulk of a nation's preterm population (of all USA preterm births, 74% are late-preterm), adversely impact on national breastfeeding rates, increase direct healthcare cost by need for readmission of infants for severe hyperbilirubinemia and hypernatremic dehydration, as well as increase the risk for irreversible brain damage due to kernicterus [1][2][3][4].…”

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confidence: 99%

Transient hypothyroxinemia of prematurity: Does it have clinical relevance?

Seth

2012

Indian Pediatr

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“…However, thyroid dysfunction is common in preterm infants, and this has been associated with neurodevelopmental delays and cognitive dysfunction in later life (2)(3)(4)(5). Transient hyperthyrotropinemia (HTT) with hypothyroxinemia is common in preterm infants.…”

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confidence: 99%

Gestational age, not transient hyperthyrotropinemia impacts brain white matter diffusion tensor imaging in premature infants

et al. 2017

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Abstract. Transient hypothyroidism is common in premature infants and increases the risk of adverse neurodevelopmental outcomes. Thyroid hormone (TH) is involved in oligodendrocyte development and myelination, however, whether transient hypothyroidism is associated with oligodendrocyte dysplasia and abnormal myelination is unclear. The aim of the present study was to investigate correlations among TH levels, neurodevelopmental outcomes and white matter (WM) microstructure in premature infants. The authors designed a cohort study recruiting 81 premature infants (age, 23-35 weeks). A total of 17 were born with a gestational age (GA) <30 weeks (early preterm group) and 64 of them were born with a GA ≥30 weeks (late preterm group). For outcome measurement, thyroid stimulating hormone (TSH) levels at 0, 18, and 24 h of admission were measured. Neurodevelopmental outcomes were assessed using Bayley III test. Diffusion tensor imaging was used to explore the characterization of WM microstructure. The data demonstrated that GA, however not TSH level was associated with neurodevelopmental outcomes in the following 2 years. Fractional anisotrophy (FA) increased with TSH0 levels over anterior limb of internal capsule, while axial diffusivity decreased with TSH0 levels over splenium of corpus callosum (CC). The late preterm group had more intact WM integrity over the internal and external capsule (EC) in FA compared with the early preterm group. Infants with motor dysfunction had significantly increased mean diffusivity (MD) values at regions of interest in the genu and splenium of CC.The results of the present study demonstrated that GA, however not transient hypothyroidism influenced neurodevelopmental outcomes in the premature infants. FA increased with age in a regionally-specific manner over regions of the internal capsule and EC. MD may act as a potential predictor for motor function in premature babies.

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Transient hypothyroxinaemia associated with developmental delay in very preterm infants.

Cited by 132 publications

References 29 publications

Free Thyroxine Levels After Very Preterm Birth and Neurodevelopmental Outcomes at Age 7 Years

Free Thyroxine Levels After Very Preterm Birth and Neurodevelopmental Outcomes at Age 7 Years

Transient hypothyroxinemia of prematurity: Does it have clinical relevance?

Gestational age, not transient hyperthyrotropinemia impacts brain white matter diffusion tensor imaging in premature infants

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