Assessment of thyroid hormones in full-term neonates with late-onset sepsis

Abstract

Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of infection with or without bacteremia in neonatal age. The incidence of neonatal sepsis in India is 38 per 1000 live births according to the data obtained from the National Neonatal Perinatal Database [1]. It is classified into two types depending on the time of onset of symptoms: Early onset of sepsis (EOS) which presents within the first 72 h of life and late onset of sepsis (LOS) that occurs after 72 h of life [2].Many neuroendocrine changes take place during critical illness; however, reports of these changes in neonatal sepsis are limited. Thyroid hormones play an important role in the adaptation of metabolic function to stress, regulation of the metabolic homeostasis, and critical illness. Although the exact cause of alteration of thyroid hormones during sepsis is not known, it has been hypothesized that the immune system cells can affect systemic thyroid hormone activity. This activity may be attributed to the complex pathophysiological interplay between thyroidstimulating hormone (TSH) and the immune system [3,4]. The various lymphokines and monokines factors act as a marker in sepsis and can influence the hypothalamic-pituitary-thyroid axis modulating thyroid hormone levels [3,5].Multiple studies have been performed in the recent past showing correlation of sepsis and thyroid hormones [6][7][8][9][10][11][12]. A study conducted by Kurt et al. showed a significant change in thyroid hormone levels before and after the treatment of neonatal sepsis with antibiotics [6]. Joosten et al. performed a study on children with meningococcal sepsis found that the children who do not survive meningococcal sepsis have an impaired adrenal response, altered thyroid hormones, and below normal reference values of T4, T3, rT3, and TSH levels [7].The majority of the previous studies present in the literature have correlated LOS with T3, T4 hormone levels, or assay only, but in our study, we have included TSH, T3, and T4 along with fT3, and fT4 which are highly sensitive in the detection of thyroid hormone levels. Hence, the present study was conducted to find the relationship between thyroid profile and development of neonatal LOS in full-term neonates. MATERIALS AND METHODSThis analytical prospective study was carried out in the neonatal intensive care unit of the Department of Pediatric ABSTRACT Background: Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of infection with or without bacteremia in neonatal age. The previous studies found that there might be an association between thyroid hormone profile and outcomes in patients with late-onset of sepsis (LOS). Objective: The objective of the study was to assess the thyroid hormone levels in full-term neonates with late-onset sepsis. Materials and Methods: This analytical prospective cohort study was conducted in the neonatal intensive care unit of a tertiary care teaching institution in Central India. Full-term neonates, with culture-proven LOS, were taken as the study po...

Frequency of non-thyroidal illness syndrome in pediatric patients with sepsis and septic shock

“…Moreover, medications widely used in PICU could be incriminated. We found that NTIS frequency in septic shock group was nearly double that of the sepsis (65% versus 30%) which was in accordance with results obtained by previous studies that reported thyroid hormone levels were significantly lower in children with septic shock, compared to sepsis [27][28][29]. Also, NTIS was more prevalent among non-survivors than survivors; however, the values did not reach level of significance.…”