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Postnatal thyroid hormones for respiratory distress syndrome in preterm infants
1Royal Prince Alfred Hospital, RPA Newborn Care, Missenden Road, Camperdown, New South Wales, Australia, 2050. david.osborn@email.cs.nsw.gov.au
Insights
Postnatal thyroid hormone therapy does not improve respiratory distress syndrome outcomes in preterm infants. Studies found no significant benefits in neonatal morbidity or mortality for infants treated with thyroid hormones.
Area of Science:
- Neonatology
- Pediatric Respiratory Medicine
- Endocrinology
Background:
- Preterm infants with respiratory distress syndrome (RDS) face risks of adverse neonatal and developmental outcomes.
- Antenatal thyroid hormone administration in animal models stimulates surfactant production and reduces RDS severity.
Purpose of the Study:
- To evaluate the efficacy of postnatal thyroid hormone therapy in preterm infants with suspected RDS.
- To determine if this therapy improves respiratory morbidity and subsequent neonatal/long-term outcomes.
Main Methods:
- Searched CENTRAL, MEDLINE, PREMEDLINE, EMBASE, and other sources up to March 2006.
- Included trials of preterm infants with suspected RDS, comparing thyroid hormone treatment to control within 48 hours of birth.
- Conducted independent quality assessment and data extraction, synthesizing data using standard meta-analysis methods.
Main Results:
- Two studies (80 infants) with methodological concerns were analyzed.
- No significant benefits were observed in neonatal morbidity or mortality.
- Meta-analysis showed no significant difference in mortality to discharge or need for mechanical ventilation.
Conclusions:
- Controlled clinical trials provide no evidence that postnatal thyroid hormone treatment benefits preterm infants with RDS.
- The therapy did not reduce RDS severity, neonatal morbidity, or mortality.
Background:
Preterm infants with respiratory distress syndrome are at increased risk of adverse neonatal and developmental outcomes. In animal research, thyroid hormones stimulate surfactant production and reduce the incidence and severity of respiratory distress when given antenatally.
Objectives:
To determine whether thyroid hormone therapy used postnatally in preterm infants with suspected respiratory distress syndrome results in clinically important improvements in respiratory morbidity and subsequent improvements in neonatal and long term outcomes.
Search Strategy:
Searches were performed of The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2006), MEDLINE (1966 - March 2006), PREMEDLINE (March 2006), EMBASE (1980 - March 2006), previous reviews including cross references, abstracts and conference proceedings, supplemented by requests to expert informants.
Selection Criteria:
Trials that enrolled preterm infants with suspected respiratory distress syndrome and allocated infants thyroid hormone treatment compared to control commenced in the first 48 hours after birth.
Data Collection And Analysis:
Independent assessment of trial quality and data extraction by each author. Synthesis of data using relative risk (RR) and weighted mean difference (WMD) using standard methods of the Cochrane Collaboration and its Neonatal Review Group.
Main Results:
Two studies enrolled preterm infants with respiratory distress. Amato (1988) allocated infants to L-thyroxine 50 mug/dose at 1 and at 24 hours or no treatment. Amato (1989) allocated infants to L-triiodothyronine 50 mug/day in two divided doses for two days or no treatment. Both studies had methodological concerns including quasi-random methods of patient allocation, no blinding of treatment or measurement and substantial post allocation losses. Neither study reported any significant benefits in neonatal morbidity or mortality from use of thyroid hormones. Meta-analysis of two studies (80 infants) found no significant difference in mortality to discharge (typical RR 1.00, 95% CI 0.47, 2.14). Amato 1988 reported no significant difference in use of mechanical ventilation (RR 0.64, 95% CI 0.38, 1.09). No significant effects were found in use of mechanical ventilation, duration of mechanical ventilation, air leak, CLD at 28 days in survivors, patent ductus arteriosus, intraventricular haemorrhage or necrotising enterocolitis. Neurodevelopment was not reported.
Authors' Conclusions:
There is no evidence from controlled clinical trials that postnatal thyroid hormone treatment reduces the severity of respiratory distress syndrome, neonatal morbidity or mortality in preterm infants with respiratory distress syndrome.
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