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Topical iodine-containing antiseptics and subclinical hypothyroidism in preterm infants
N Linder1, N Davidovitch, B Reichman
1Department of Neonatology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Insights
Topical iodine antiseptics can elevate thyroid-stimulating hormone (thyrotropin) levels in premature infants, potentially affecting thyroid function tests. Caution is advised when using these agents in neonatal intensive care units.
Area of Science:
- Neonatal Medicine
- Endocrinology
- Pediatric Care
Background:
- Thyroid function is critical for premature infant development.
- Topical antiseptics are commonly used in neonatal intensive care units (NICUs).
- The impact of iodine-containing antiseptics on neonatal thyroid function requires investigation.
Purpose of the Study:
- To determine the influence of topical iodine-containing antiseptics on thyroid function test results in premature infants.
- To compare thyroid function in premature infants exposed to iodine versus chlorhexidine antiseptics.
Main Methods:
- Two studies involving 128 and 46 premature infants in NICUs.
- Measurement of thyroxine (T4) and thyrotropin (TSH) levels via blood-spotted filter paper.
- Comparison between infants treated with iodinated antiseptics and those treated with chlorhexidine.
Main Results:
- No significant difference in mean T4 levels between groups.
- Significantly elevated mean TSH levels in iodine-exposed infants (15.4 vs 7.8 mIU/L).
- Higher incidence of elevated TSH (>30 mIU/L) in iodine-exposed infants (13.7% and 20.8% in the two studies).
- Elevated TSH correlated with the area of disinfection and increased urine iodine levels, indicating absorption.
Conclusions:
- Iodine absorption from topical antiseptics can lead to disturbances in thyroid function test results in premature infants.
- Elevated TSH levels suggest potential thyroid dysfunction induced by iodine exposure.
- Recommend caution in the use of iodine-containing antiseptics for premature infants due to potential thyroid function interference.
Abstract:
The influence of topical iodine-containing antiseptics on thyroid function test results of premature infants was determined in two separate studies. Thyroxine and thyrotropin levels were measured on blood-spotted filter paper. Samples were obtained from 128 premature infants on their tenth day of life; the infants were treated in two neonatal intensive care units. Both units used similar treatment protocols; however, one routinely used topical iodinated antiseptic agents (n = 73), whereas the other used chlorhexidine-containing antiseptics (n = 55). There was no difference in the mean T4 levels between the two groups. The mean thyrotropin levels were elevated in preterm babies exposed to iodine (15.4 vs 7.8 mIU/L, p < 0.01). Among the iodine-exposed infants, elevated thyrotropin levels (> 30 mIU/L) were found in 13.7% of infants, compared with none in the chlorhexidine-treated group (p < 0.01). We then studied an additional 46 premature infants who were treated in one neonatal intensive care unit. Iodine-containing solutions were used in 24 infants and chlorhexidine was used in 22 infants. T4 and thyrotropin levels were measured weekly during the first 28 days, one every 2 weeks until the age of 60 days, and at the age of 90 days. Among iodine-exposed infants, 20.8% had thyrotropin values > 30 mIU/L, whereas none of the infants in the chlorhexidine group had elevated thyrotropin values (p < 0.05). The elevated thyrotropin levels correlated positively with the area of disinfection. Elevated urine iodine levels were present reflecting an abnormally high iodine absorption. This study suggests that iodine absorption from topical iodine-containing antiseptics may cause disturbances in thyroid function test results in premature infants. We recommend that caution be exercised in the use of iodine-containing antiseptics in premature infants.