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The initiation of cell-mediated immunity can be observed as early as the third month of fetal growth, with active antibody-mediated immunity following approximately one month later.
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Initial and delayed thyroid-stimulating hormone elevation in extremely low-birth-weight infants.

Shin Ae Yoon1, Yun Sil Chang2, So Yoon Ahn2

  • 1Department of Pediatrics, Chungbuk National University Hospital, 1 Sunhwan-ro 776, Seowon-gu, Cheongju, 28644, South Korea.

BMC Pediatrics
|October 13, 2019
PubMed
Summary

Thyroid-stimulating hormone (TSH) elevation is common in extremely low-birth-weight infants (ELBWIs), often linked to perinatal stressors. Levothyroxine treatment reduced mortality but did not improve long-term growth or neurodevelopmental outcomes.

Keywords:
Hypothalamic–pituitary–thyroid axisPreterm infantsThyroid function testsThyroxine supplementationTransient hypothyroxinemia of prematurity

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Area of Science:

  • Neonatal endocrinology
  • Pediatric critical care
  • Thyroid function in preterm infants

Background:

  • Thyroid-stimulating hormone (TSH) elevation is a concern in extremely low-birth-weight infants (ELBWIs).
  • Understanding the incidence, causes, and outcomes of TSH elevation is crucial for this vulnerable population.

Purpose of the Study:

  • To determine the incidence, etiology, and outcomes of TSH elevation in ELBWIs.
  • To assess the impact of levothyroxine replacement on outcomes in ELBWIs with TSH elevation.

Main Methods:

  • Retrospective analysis of newborn thyroid screening data from 584 ELBWIs (birth weight < 1000g).
  • Identification of initial (≤ 2 weeks) and delayed (> 2 weeks) TSH elevations.
  • Assessment of growth and neurodevelopmental outcomes at 2 years corrected age, considering levothyroxine treatment.

Main Results:

  • Incidence rates of initial and delayed TSH elevations were 0.9% and 7.2%, respectively.
  • Perinatal asphyxia was associated with initial TSH elevation; stressors like respiratory support and surgery were linked to delayed elevation.
  • Levothyroxine treatment was associated with higher TSH, lower free T4, and reduced mortality, but no significant effect on long-term growth or neurodevelopment.

Conclusions:

  • The timing of insults relative to hypothalamic-pituitary-thyroid axis maturation influences TSH elevation timing in ELBWIs.
  • Levothyroxine replacement therapy in ELBWIs with TSH elevation does not appear to impact long-term growth or neurodevelopmental outcomes.