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Published on: November 20, 2015
Thyroxine for transient hypothyroxinemia and cerebral palsy in extremely preterm infants
Hiroshi Suzumura1, Akihisa Nitta, Yayoi Tsuboi
1Department of Pediatrics, Dokkyo Medical University, Tochigi, Japan. suzumura@dokkyomed.ac.jp
Insights
Thyroxine supplementation may reduce cerebral palsy (CP) in extremely preterm infants with transient hypothyroxinemia. Further research is needed to confirm these findings for premature infants.
Area of Science:
- Neonatal Neurology
- Pediatric Endocrinology
- Developmental Pediatrics
Background:
- The link between thyroxine supplementation and cerebral palsy (CP) in extremely preterm infants (<28 weeks gestation) with transient hypothyroxinemia is not well-established.
- Transient hypothyroxinemia is common in premature infants and may impact neurodevelopmental outcomes.
- Cerebral palsy (CP) is a significant concern in this vulnerable population.
Purpose of the Study:
- To investigate the effect of thyroxine supplementation on the incidence of cerebral palsy (CP) in extremely preterm infants.
- To compare CP rates in infants born before and after the implementation of routine free T4 (FT4) monitoring and thyroxine treatment.
Main Methods:
- A retrospective cohort study compared CP incidence at 18 months and 3 years corrected age between two groups of extremely preterm infants.
- The first group (n=54) received no routine FT4 measurement or treatment, while the second group (n=60) received l-thyroxine for low FT4 levels (<0.8 ng/dL).
- Infants were born over two distinct 3-year periods.
Main Results:
- The incidence of CP at 18 months corrected age was significantly lower in the second period (3.3%) compared to the first period (16.6%).
- CP incidence at 3 years of age was also significantly reduced in the second period.
- Logistic regression analysis did not identify perinatal factors, excluding thyroxine, associated with CP development.
Conclusions:
- Thyroxine supplementation for transient hypothyroxinemia in extremely preterm infants may be associated with a reduced incidence of cerebral palsy.
- Larger randomized controlled trials are necessary to definitively establish the efficacy of thyroxine supplementation in preventing CP in this population.
Background:
The relationship of thyroxine supplementation for transient hypothyroxinemia of prematurity to the incidence of cerebral palsy (CP) in infants <28 weeks of gestation is unclear.
Methods:
The incidence of CP at a corrected age of 18 months was compared between infants born in a 3-year period in which routine measurement of free T4 (FT4) in the blood was not performed (first period, n= 54), and those born in a later 3-year period in which FT4 was measured (second period, n= 60; mainly at 7 days old), and in which l-thyroxine 5-10 µg/kg per day (mean, 9 µg/kg/day) was administered for FT4 levels <0.8 ng/dL. Incidence of CP at 3 years of age was also compared between the same groups.
Results:
Background clinical factors between the two groups were comparable except for prenatal steroid administration, which was reduced in the second period. Incidence of CP at a corrected age of 18 months was significantly lower in the second period (3.3%) than in the first period (16.6%). Incidence of CP at 3 years of age was also significantly lower in the second period. Multiple logistic regression analysis using factors except thyroxine supplementation, for the total of 114 infants from both groups, found no perinatal factors related to the development of CP at a corrected age of 18 months.
Conclusions:
Thyroxine supplementation for transient hypothyroxinemia of prematurity may reduce the incidence of CP in extremely preterm infants. Large-scale randomized controlled trials are essential to determine the effects of thyroxine supplementation in reducing the incidence of CP among extremely preterm infants.
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