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Higher Incidence Rates of Hypothyroidism and Late TSH Rise in Preterm Very-Low-Birth-Weight Infants at a Tertiary
Insights
Second newborn screening is crucial for very low birth weight (VLBW) infants, detecting high rates of hypothyroidism and delayed thyroid-stimulating hormone (TSH) rise. This vigilance ensures timely diagnosis and management in these vulnerable preterm newborns.
Area of Science:
- Neonatal Medicine
- Endocrinology
- Pediatric Screening
Background:
- Very low birth weight (VLBW) preterm infants (<1,500 g) exhibit atypical hypothyroidism with delayed TSH rise.
- This necessitates a second newborn screening specimen collection for accurate diagnosis.
Purpose of the Study:
- To assess compliance with second newborn screening in VLBW infants.
- To determine the incidence of delayed TSH rise and atypical hypothyroidism in this population.
- To evaluate the effectiveness of repeat screening in a tertiary care setting.
Main Methods:
- Retrospective review of medical records for 104 VLBW preterm infants.
- Definition of late TSH rise: increased TSH concentration after 14 days of age with a normal initial screen.
Main Results:
- A high compliance rate of 92% for the second screening was observed.
- Significant rates of hypothyroidism (16.3%) and late TSH rise (4.8%) were detected.
- Infants with hypothyroidism and late TSH rise had significantly lower birth weights.
Conclusions:
- The observed rates of early and late TSH rise exceed those reported in existing literature, potentially linked to povidone-iodine use.
- The high yield of the second TSH screening underscores the importance of vigilant screening protocols for VLBW preterm infants.
Background/Aims:
Preterm newborns with a very low birth weight (VLBW) of < 1,500 g have an atypical form of hypothyroidism with a delayed rise in TSH, necessitating a second newborn screening specimen collection. The aims of this study were to survey the compliance with second newborn screening to detect delayed TSH rise in VLBW preterm infants at a tertiary care center, and to determine the rate of atypical hypothyroidism.
Methods:
Retrospective review of the records of 104 preterm VLBW infants. Late TSH rise was defined as an increase in TSH concentration after 14 days of age in the presence of a normal initial screen.
Results:
The compliance rate was 92% for the second screening. High rates of hypothyroidism (16.3%) and of late TSH rise (4.8%) were detected. Patients with hypothyroidism had a significantly lower birth weight (p = 0.01) and longer hospital stay (p = 0.004). Patients with late versus those with early TSH rise had a significantly lower mean birth weight (851 ± 302 vs. 1,191 ± 121 g, p = 0.004).
Conclusion:
The rates of early and late TSH rise in this VLBW population were higher than those in the literature and could be due to the use of povidone-iodine disinfectants. The yield of a second TSH screening in this study was high indicating the need for vigilance in screening VLBW preterm infants.
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