Postnatal Serum Total Thyroxine of Very Preterm Infants and Long-Term Neurodevelopmental Outcome

Abstract

Primary congenital hypothyroidism is a disease associated with low serum thyroxine and elevated thyroid-stimulating hormone (TSH) levels. The processes of screening and treating congenital hypothyroidism, in order to prevent neurodevelopmental impairment (NDI) in newborns, have been well investigated. Unlike term infants, very preterm infants (VPIs) may experience low thyroxine with normal TSH levels (<10.0 μIU/mL) during long-stay hospitalization. In the current literature, thyroxine treatment has been evaluated only for TSH-elevated VPIs. However, the long-term impact of low thyroxine levels in certain VPIs with normal TSH levels deserves more research. Since July 2007, VPIs of this study unit received screenings at 1 month postnatal age (PNA) for serum TSH levels and total thyroxine (TT4), in addition to two national TSH screenings scheduled at 3–5 days PNA and at term equivalent age. This study aimed to establish the correlation between postnatal 1-month-old TT4 concentration and long-term NDI at 24 months corrected age among VPIs with serial normal TSH levels. VPIs born in August 2007–July 2016 were enrolled. Perinatal demography, hospitalization morbidities, and thyroid function profiles were analyzed, and we excluded those with congenital anomalies, brain injuries, elevated TSH levels, or a history of thyroxine treatments. In total, 334 VPIs were analyzed and 302 (90.4%) VPIs were followed-up. The postnatal TT4 concentration was not associated with NDI after multivariate adjustment (odd ratios 1.131, 95% confidence interval 0.969–1.32). To attribute the NDI of TSH-normal VPIs to a single postnatal TT4 concentration measurement may require more research.

Clinical Study of Influence of Continuous Nursing Intervention Combined with Comfort Nursing Intervention under Medical-Nursing Combination on Self-Care Ability and Satisfaction of Elderly Patients with Chronic Diseases

“…Comfort nursing, as the name implies, is a nursing model that enables the maintenance of physical and mental pleasure and reduces adverse emotions in nursing subjects [7][8][9]. In contrast to continuous nursing, comfort nursing cares more about patients' experience and comfort and easily ignores some objective needs.…”

Postnatal Serum Total Thyroxine Level Associated with Short- and Long-Term Anthropometric Outcomes in Very Preterm Infants

“…As shown in Figure 1 , the study unit conducted a local screening policy (stage II) for thyroid function in very preterm infants, in addition to the national screenings at birth (stage I) and at the term-equivalent age (stage III) [ 10 , 11 , 17 ].…”

“…Hence, at present, most scholars agree that extra thyroid function screening during the hospitalization of very preterm infants is necessary [ 15 ]. After being screened, the current consensus suggests very preterm infants with elevated TSH levels (≥10.0 μIU/mL) should undergo a further follow-up, regardless of thyroxine concentration, and should be considered for treatment [ 11 , 16 , 17 ]. However, when the TSH is not elevated, the decision to initiate thyroid hormone supplementation is uncertain [ 7 , 17 , 18 , 19 , 20 , 21 , 22 ].…”

“…After being screened, the current consensus suggests very preterm infants with elevated TSH levels (≥10.0 μIU/mL) should undergo a further follow-up, regardless of thyroxine concentration, and should be considered for treatment [ 11 , 16 , 17 ]. However, when the TSH is not elevated, the decision to initiate thyroid hormone supplementation is uncertain [ 7 , 17 , 18 , 19 , 20 , 21 , 22 ]. The effect of the temporary reduction in T4, which can last for 6–8 weeks, remains unknown in very preterm infants, who usually present rapid growth in this time window.…”

“…In this study, we aimed to establish the relationship between the postnatal thyroxine concentration obtained at 1-month-old and short- or long-term growth outcomes by utilizing a previously reported cohort [ 17 ]. The short-term growth outcome was the bodyweight changes over 28 days after screening, while the long-term growth outcome was anthropometric parameters at the corrected age of two years.…”