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Neurodevelopmental Outcomes at 42 Months After Thyroxine Supplementation in Infants Below 28 Weeks' Gestation: A

Sze May Ng1,2, Mark A Turner1, A Michael Weindling1

  • 1Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.

Thyroid : Official Journal of the American Thyroid Association
|February 20, 2020
PubMed

Insights

Levothyroxine (LT4) supplementation may improve neurodevelopment in extremely premature infants. Early LT4 treatment showed benefits in motor, language, and cognitive skills at 42 months, but more research is needed.

Area of Science:

  • Neonatal Medicine
  • Developmental Pediatrics
  • Endocrinology

Background:

  • Infants born before 28 weeks' gestation exhibit lower thyroid hormone levels, increasing their risk for developmental disabilities.
  • Thyroid hormone plays a crucial role in fetal and neonatal brain development.

Purpose of the Study:

  • To investigate the impact of levothyroxine (LT4) supplementation on neurodevelopmental outcomes at 42 months in extremely premature infants (<28 weeks' gestation).

Main Methods:

  • A double-blind, randomized, placebo-controlled trial involving 153 infants (<28 weeks' gestation) across 5 UK neonatal units.
  • Infants received either LT4 (intravenous then oral) or placebo until 32 weeks' corrected gestational age.
  • Neurodevelopmental outcomes assessed at 42 months using Bayley III scales; cognition correlated with fT4 levels and DTI markers.

Main Results:

  • LT4-supplemented infants demonstrated significantly better performance in motor (p=0.034), language (p=0.041), and cognitive (p=0.045) domains compared to placebo.
  • Neurodevelopmental outcomes showed associations with subarachnoid space width, plasma fT4 levels, and diffusion tensor imaging (DTI) markers.
  • Specific correlations found between fT4 at 36 weeks and cognition (p=0.01), and DTI at 36 weeks and cognition (p>0.05).

Conclusions:

  • Early LT4 supplementation shows potential for improving long-term neurodevelopment in extremely premature infants.
  • Observed improvements, while statistically significant, are not yet robust enough to alter current clinical practice.
  • Larger clinical trials are recommended to confirm these findings and establish definitive guidelines.

Keywords:
RCTextreme pretermneurodevelopmentthyroxine supplementation

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