Postnatal Thyroxine Administration for Idiopathic Respiratory Distress Syndrome in Preterm Infants

Amato, Maurizio; Pasquier, Sylviane; Carasso, A.; Muralt, G. Von

doi:10.1159/000180961

Cited by 40 publications

(19 citation statements)

References 12 publications

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“…In developing CLD, pneumocyte proliferation and surfactant synthesis may require larger amounts of thyroid hormones than in healthy individuals. In IRDS of preterm infants, hypothyroxinemia does not seem to be an etiological factor [14,23]. Recently Job et al [14] have demonstrated unaltered free T 4 levels in IRDS between day 2 and day 7.…”

Section: Discussionmentioning

confidence: 98%

Thyroid Function in Healthy and Sick Very-Low-Birth-Weight Infants – Thyrotropin and Free Thyroxine Levels until the Sixth Week of Age

et al. 2001

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Hypothyroxinemia in preterm infants without congenital hypothyroidism is associated with developmental delay. Longitudinal information on thyroid function in very-low-birth-weight (VLBW, <1,500 g birth weight) infants is limited: we present data on thyroid function in sick and healthy VLBW infants until 6 weeks of age. Free T₄ and TSH levels routinely obtained on days 14–21 and days 35–49 in 92 consecutive VLBW infants were correlated retrospectively with neonatal morbidity. Free T₄ levels were positively correlated with gestational age; an independent effect of neonatal disease on thyroid function was not detectable.

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Section: Discussionmentioning

confidence: 98%

Thyroid Function in Healthy and Sick Very-Low-Birth-Weight Infants – Thyrotropin and Free Thyroxine Levels until the Sixth Week of Age

et al. 2001

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“…Il secondo motivo è giustificato dal fatto che alcuni AA. propongono di effettuare la profilassi per l'Ipotiroidismo Transitorio del neonato ELGAN a partire dal 2°-3° giorno di vita [12][13][14][15][16][17][18][19][20].…”

Section: Discussioneunclassified

“…Tuttavia è determinante per il clinico avere un punto di riferimento preciso da cui partire, per stabilire se i livelli di TSH e T4 di un determinato bambino incrementano o diminuiscono nei giorni successivi alla nascita. I lavori svolti, concernenti la somministrazione di ormoni tiroidei alla nascita nel neonato pretermine, hanno dimostrato risultati discordanti, per quanto riguarda sia il deficit neurocognitivo di tali soggetti, sia l'incidenza di distress respiratorio e di BPD [11][12][13][14][15][16][17][18][19][20]. Attualmente infatti non esistono indicazioni precise, in rapporto agli studi effettuati, per somministrare gli ormoni tiroidei a tutti i soggetti ELGAN.…”

Section: Discussioneunclassified

“…Per tali motivi alcuni AA. hanno prospettato la necessità di somministrare ormoni tiroidei fin dai primi giorni di vita nel neonato di età gestazionale estremamente bassa (ELGAN) [10][11][12][13][14][15][16][17][18][19][20]. Tuttavia non sono presenti in letteratura lavori che abbiano valutato in 2°-3° giornata di vita, momento in cui i fenomeni di adattamento neonatale sono ormai completati, i livelli di TSH e tT4 in un numero sufficientemente ampio di soggetti ELGAN, suddivisi in varie fasce di età gestazionale (EG).…”

Section: Introduzioneunclassified

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Thyroid Stimulating Hormone and Thyroxine Screening in the Preterm Newborn: Reference Values

et al. 2013

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InTrODUZIOneLo Screening per l'Ipotiroidismo Congenito, introdotto negli anni '70, ha messo in evidenza livelli di tireotropina (TSH) e ormoni tiroidei (TH) differenti nei neonati prematuri rispetto ai nati a termine. Il neonato pretermine presenta una secrezione ormonale ridotta rispetto al neonato a termine, a causa della minor riserva tiroidea, della difficoltà ad alimentarsi, della ridotta sintesi epatica di TBG, dell'immaturità sia enzimatica che dell'asse ipotalamo-ipofisi-tiroide [1][2][3]. Il neonato prematuro di basso peso va incontro inoltre ad un'aumentata mortalità e morbidità perinatale, dovuta secondo alcuni autori (AA.) anche ai più bassi livelli di ormoni tiroidei, che persistono nelle prime 2-3 settimane di vita, con tendenza a risolversi spontaneamente entro il primo mese [3-8, 29,31]. Oltre a ciò, in questi neonati è riportato un peggior outcome neurologico a distanza [9]. Per tali motivi alcuni AA. hanno prospettato la necessità di somministrare ormoni tiroidei fin dai primi giorni di vita nel neonato di età gestazionale estremamente bassa (ELGAN) [10][11][12][13][14][15][16][17][18][19][20]. Tuttavia non sono presenti in letteratura lavori che abbiano valutato in 2°-3° giornata di vita, momento in cui i fenomeni di adattamento neonatale sono ormai completati, i livelli di TSH e tT4 in un numero sufficientemente ampio di soggetti ELGAN, suddivisi in varie fasce di età gestazionale (EG). I valori di riferimento ottenuti nelle varie fasce di età, possono essere utilizzati per stabilire l'opportunità o meno del trattamento ormonale sostitutivo del neonato estremamente prematuro. Abstract. The screening test for Congenital Hypothyroidism, performed in the 2nd -3rd day of life, highlighted in the premature infant significant lower levels of thyroid stimulating hormone (TSH) and thyroxine (tT4) than those found in the full term newborn. Studies carried out after birth in the preterm infant, showed a persistence of low levels of thyroid hormones (TH) in the first two weeks of life, with a tendency toward spontaneous resolution at the end of the first month. This hormone deficiency has an incidence which is inversely related to gestational age (GA). However, there are no works which have evaluated the levels of TSH and tT4 in an appropriate large population of extremely low gestational age newborns (ELGANs) in the 2nd -3rd day of life divided by different GAs. To assess the levels of TSH and tT4 in the 2nd -3rd day of life, from the lowest GA up to the end, in order to indicate the reference values which can be used to establish whether a replacement therapy with thyroid hormones in the premature infant is useful or not. In the present study we examined a total population of 1,671 adapted for gestational age newborns (AGA) of which 1,159 resulted in full term and 512 resulted in preterm. The population was divided into eight groups of [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] and for each age group the median values of TSH and tT4 was determined. The TSH and tT4 were obtain...

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“…However mental outcome in a subgroup of T 4 -treated infants less than 27 wk gestation was significantly better than in the placebo infants when tested at 2 y of age. Two studies examining respiratory factors as end points, one giving T 4 (12) and another T 3 (13), have not shown any clear-cut benefit.…”

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confidence: 99%

Pulmonary Effects of Triiodothyronine (T3) and Hydrocortisone (HC) Supplementation in Preterm Infants less than 30 Weeks Gestation: Results of the THORN Trial—Thyroid Hormone Replacement in Neonates

et al. 2003

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The THORN trial was a multicenter, randomized, doubleblind, placebo-controlled clinical trial to test the hypothesis that administration of triiodothyronine (T 3 ) and hydrocortisone would decrease mortality and respiratory morbidity in preterm infants of less than 30 wk gestation. Two hundred fifty-three infants were randomized to receive either 6 g·kg Ϫ1 ·d Ϫ1 of T 3 with 1 mg·kg Ϫ1 ·d Ϫ1 of hydrocortisone or 5% dextrose (placebo) as a continuous i.v. infusion for 7 d. The dose was halved on d 5. Our first primary outcome was death or ventilator dependence at 1 wk, and the second was death or oxygen dependence at 2 wk. The overall mortality rate for both groups was 11.4%. Relative risk of death or ventilator dependence at 1 wk, treated versus placebo, was 0.87, p ϭ 0.2, and death or oxygen dependence at 2 wk, 1.00, p ϭ 0.9. We examined the relationship between free T 3 (FT 3 ) and free thyroxine (FT 4 ) levels in the first 7 d and the primary outcome death or ventilator dependence at 1 wk in all 253 babies. We found significant positive correlations of p ϭ 0.05 for FT 3 and p ϭ 0.002 for FT 4 . Thus the higher the FT 3 and FT 4 levels, the better the outcome. No beneficial effects of T 3 and hydrocortisone were shown. In this study, although FT 3 levels were doubled by the treatment infusion, FT 4 levels were significantly suppressed. The lack of any beneficial effect of T 3 in our study may be explained by suppression of A number of studies have demonstrated that premature babies have low levels of T 3 and T 4 (1-5) and that hypothyroxinemia has been associated with developmental problems (6 -8) and increased respiratory morbidity (9, 10). Consequently, several studies have examined thyroid hormone substitution in preterm infants, but most of these have involved small numbers of subjects. One large study of T 4 given to babies of less than 30 wk gestation assessed neurodevelopmental outcome and found no overall beneficial effect (11). However mental outcome in a subgroup of T 4 -treated infants less than 27 wk gestation was significantly better than in the placebo infants when tested at 2 y of age. Two studies examining respiratory factors as end points, one giving T 4 (12) and another T 3 (13), have not shown any clear-cut benefit.In spite of improvements in neonatal care during the past few decades (14), most tertiary level neonatal units have seen an increase in the incidence (15) of bronchopulmonary dysplasia (chronic lung disease) defined as an oxygen requirement at the age of 4 wk or beyond 36 wk conceptual age. Much of the increase can be attributed to the increasing survival of very premature babies born before 30 wk gestational age, which in turn raises the question of why these infants develop chronic lung disease when pulmonary surfactants are readily available.

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Postnatal Thyroxine Administration for Idiopathic Respiratory Distress Syndrome in Preterm Infants

Cited by 40 publications

References 12 publications

Thyroid Function in Healthy and Sick Very-Low-Birth-Weight Infants – Thyrotropin and Free Thyroxine Levels until the Sixth Week of Age

Thyroid Function in Healthy and Sick Very-Low-Birth-Weight Infants – Thyrotropin and Free Thyroxine Levels until the Sixth Week of Age

Thyroid Stimulating Hormone and Thyroxine Screening in the Preterm Newborn: Reference Values

Pulmonary Effects of Triiodothyronine (T3) and Hydrocortisone (HC) Supplementation in Preterm Infants less than 30 Weeks Gestation: Results of the THORN Trial—Thyroid Hormone Replacement in Neonates

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