Increased Congenital Hypothyroidism Detection in Preterm Infants with Serial Newborn Screening - 21/12/18

Doi : 10.1016/j.jpeds.2018.11.044

Dinushan C. Kaluarachchi, MBBS ^1,^* , David B. Allen, MD ¹, Jens C. Eickhoff, PhD ², Sandra J. Dawe, PhD ³, Mei W. Baker, MD ^1,³
¹ Department of Pediatrics, University of Wisconsin-Madison, Madison, WI
² Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI
³ Wisconsin State Laboratory of Hygiene, University of Wisconsin School of Medicine and Public Health, Madison, WI

^*Reprint requests: Dinushan C. Kaluarachchi, MBBS, 411 McConnell Hall, 1010 Mound St, Madison, WI 53715.411 McConnell Hall1010 Mound StMadisonWI53715

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 21 December 2018

Abstract

Objectives

To determine the incidence of congenital hypothyroidism in preterm infants and to identify associated risk factors.

Study design

A population-based cohort study was performed in preterm infants born at <32 weeks of gestational age between 2012 and 2016 in Wisconsin. Newborn screening (NBS) results and demographic data were obtained from the Wisconsin State Laboratory of Hygiene. Congenital hypothyroidism was subdivided to early TSH elevation (eTSH) and delayed TSH elevation (dTSH). Multivariate logistic regression analyses were performed to identify demographic factors associated with dTSH.

Results

A total of 3137 preterm infants born at 22-31 weeks of gestational age were included in the study. Mean gestational age was 28.4 ± 2.4 weeks and mean birth weight was 1191 ± 399 g. Forty-nine infants were diagnosed with congenital hypothyroidism. The overall incidence of congenital hypothyroidism was 1.56%, including a 0.13% incidence of eTSH and a 1.43% incidence of dTSH. Birth weight <1000 g, multiple gestation, and initial TSH level were identified as independent predictors for dTSH.

Conclusion

Targeted serial NBS in Wisconsin led to a higher rate of diagnosis of congenital hypothyroidism in preterm infants than has been reported previously. The majority (92%) of congenital hypothyroidism cases were diagnosed with dTSH. Birth weight <1000 g, multiple gestation, and elevated initial TSH level were associated with increased risk for development of dTSH. We recommend obtaining targeted serial NBS in preterm infants (<32 weeks of gestational age) to improve the detection of congenital hypothyroidism.

Le texte complet de cet article est disponible en PDF.

Keywords : congenital hypothyroidism, preterm infants, TSH elevation

Abbreviations : dTSH, ELBW, eTSH, FT4, NBS, NICU, TSH, VLBW