Journal List > Korean J Perinatol > v.26(1) > 1013782

Choi, Lee, Lee, Kim, Lee, Jung, Heo, Shin, Kim, Kim, and Choi: Comparison of Enteral Feeding in Early Neonatal Period in Very Low Birthweight Infants with Hypothyroidism

Abstract

Purpose

We investigated the effects of hypothyroidism on feeding advancement in very low birth weight infants (VLBW).

Methods

This study was a retrospective case-control study of 14 very low birth weight infants (VLBWIs) diagnosed with hypothyroidism and other 14 infants were recruited as age- and weight-matched controls without hypothyroidism or hypothyroxinemia in Seoul National University Children's Hospital between January 2007 and August 2009. We examined whether these infants gained weight more, achieved full-volume enteral feedings sooner, had fewer episodes of increased pre-gavage residuals, and had fewer days of parenteral nutrition.

Results

Until full enteral feeding (120 mL/kg/day) was not statistically significant between the groups. In the hypothyroidism group, during the first 14 days after birth, the volume of feeding was smaller [14.7 (0.5–84.0) mL/ kg/day, P=0.041], the episodes of increased pre-gavage residuals were frequently observed [16.7 (0.2–78) times, P=0.036], and the duration of central line was significantly longer [18 (10–50) days, P=0.018]. In hypothyroidism group, mean day at first L-thyroxine supplementation was 24.2±10.2 days after birth. L-thyroxine administration boosted thyroid function for hypothyroidism infants, helped them tolerate a larger amount of enteral feeding [from 89.5 (2.9–160.8) to 146.9 (31.8–178.8) mL/kg/day, P=0.002] and decreased episodes of excessive gastric residuals [from 5.5 (0–41.6) to 0 (0–44) time, P=0.026]. However, no more weight gain was statistically found.

Conclusion

In VLBW infants, hypothyroidism may induce feeding intolerance. L-thyroxine supplementation was effective in feeding advancement on preterm infants with hypothyroidism.

References

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Fig. 1.
Comparison of feeding volumes (A) and episodes of residues per day during 14 days after birth (B) between the hypothyroidism group and control group.
kjp-26-46f1.tif
Fig. 2.
In hypothyroidism infants, comparison of episodes of gastric residues per day between 2 weeks before and after L-thyroxine administration, respectively. They showed fewer episodes of residue per day after L-thyroxine administration (P=0.01). In control group, “day 0” means the 24 days after birth which is the mean day of L-thyroxine administration for hypothyroidism infants.
kjp-26-46f2.tif
Table 1.
Demographics and first thyroid function test in study population
  Hypothyroidism (n=14) Control (n=14) P-value
Male sex 9 (64.3) 8 (57.1%) 1.000
Multiple birth 6 (42.9%) 5 (35.7%) 1.000
Gestational age (wks) 28.3±1.4 28.3±3.0 0.982
Birth weight (g) 878±225 959±205 0.325
SGA 6 (42.9%) 4 (28.6%) 0.347
PDA 11 (78.6%) 10 (71.4%) 0.500
RDS 7 (50.0%) 2 (14.3%) 0.052
BPD 10 (71.4%) 9 (64.3%) 1.000
Jaundice 3 (21.4%) 4 (28.6%) 0.500
Day of first TFT (days) 7.5±1.6 7.8±2.7 0.731
First free T4 (ng/dl) 0.9±0.4 1.2±0.3 0.105
First TSH (uIU/ml) 8.3 (0.5–33.5) 4.8 (1.1–7.6) 0.024
Feeding start day (days) 4.9±3.2 3.9±2.4 0.317
Time to first meconium pass (hours) 9.1±5.5 10.0±6.1 0.645

Data are presented as number (percent) and mean±standard deviation or median (range). Abbreviations: SGA, small for gestational age; PDA, patent ductus arteriosus; RDS, respiratory distress syndrome; BPD, bronchopulmonary dysplasia; TFT, thyroid function test; TSH, thyroid stimulating hormone.

Table 2.
Comparison of weight gain and feeding tolerance during the first 14 days of life between hypothyroidism group and control group
  During 14 days after birth
Hypothyroidism (n=14) Control (n=14) P-value
Time to full enteral feeding (120 mL/kg/day) (days)
  15.6±6.4 13.5 ± 4.4 0.158
Duration of central line (days) 18 (10–52) 12 (0–22) 0.018
Mean weight gain (g/day) 2.5±7.8 5.9 ± 8.6 0.284
Mean weight gain (%/day) 0.8±0.7 1.0 ± 0.3 0.232
Volume of feeding (mL/kg/day) 14.7 (0.5–84.0) 49.3 (8.2–98.1) 0.041
Episodes of residues (n) 10.8 (1.0–51.0) 5.9 (0–27.0) 0.036

Values are expressed as mean±standard deviation or median (range).

Table 3.
Comparison of thyroid function, weight gain and feeding tolerance between 2 weeks before and after L-thyroxine administration in hypothyroidism group (n=14)
  During 2 weeks before and after L-thyroxine administration
Before After P-value
Free T4 (ng/dl) 0.49±0.34 1.33±0.47 0.001
TSH (uIU/ml) 70.4 (10.4–305) 8.8 (0.07–131) 0.009
Mean weight gain (g/day) 16.8±12.5 22.8±11.1 0.070
Mean weight gain (%/day) 1.91 (−1.0–2.3) 1.66 (0.4–3.3) 0.754
Volume of feeding (mL/kg/day) 89.5 (2.9–160.8) 146.9 (31.8–178.8) 0.002
Episodes of residues (n) 5.50 (0–41.7) 0 (0–44) 0.026

Values are expressed as mean±standard deviation or median (range). Abbreviations: TSH, thyroid stimulating hormone.

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