Perinatal Factors Associated with the Preterm Thyroid Screening Test

Joo Hyung Park; Chung Joon Moon; Min Ho Jung; In Kyung Sung; So Young Kim

doi:10.14734/kjp.2016.27.1.45

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Park, Moon, Jung, Sung, and Kim: Perinatal Factors Associated with the Preterm Thyroid Screening Test

Original Article

Korean J Perinatol 2016;27(1):45-52.

Published online: 19 March 2016

DOI: https://doi.org/10.14734/kjp.2016.27.1.45

Perinatal Factors Associated with the Preterm Thyroid Screening Test

Joo Hyung Park, M.D., Chung Joon Moon, M.D., Min Ho Jung, M.D., In Kyung Sung, M.D., So Young Kim, M.D.

Department of Pediatrics, School of Medicine, The Catholic University of Korea, Seoul, Korea Perinatal Factors Associated with the Preterm Thyroid Screening Test

Correspondence to: So Young Kim, M.D., Ph.D. Department of Pediatrics, Yeouido St. Mary's Hospital, 10, 63-ro, Yeongdeungpo-gu, Seoul 07345, Korea Tel: +82-2-3779-1043, Fax: +82-2-783-2589 E-mail: sykimped@catholic.ac.kr

Received 26 January 2016 Revised 25 February 2016 Accepted 26 February 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

The aim of this study was to evaluate the usefulness of thyroid function screening in preterm infants and the relation between thyroid hormone level, perinatal environment, and clinical presentation after preterm birth.

Methods:

We retrospectively evaluated 46 preterm infants from March 2013 to December 2014, who had been screened for congenital hypothyroidism during the 1st week with thyroid stimulating hormone (TSH), triiodothyronine (T₃) and free thyroxine (fT₄) measured by the radioimmunoassay method. The effects of pregnancy associated maternal factors, gestational age, growth parameters, Apgar score, 1^st meconium passage time, respiratory distress syndrome and apnea on thyroid hormone levels were assessed by Mann-Whitney U-test and multiple linear regression analysis.

Results:

With advancing gestational age, T₃ and fT₄ displayed a tendency to increase. FT₄ showed a positive correlation pattern with antenatal steroid therapy, corrected gestational age at examination and a negative correlation pattern with 1st meconium passage time and apnea (P<0.05). TSH displayed a positive correlation pattern with 1st meconium passage time, 5-minute Apgar score and a negative correlation pattern with sampling age (P<0.05).

Conclusion:

In the preterm period, both fT₄ and TSH seems to correlate significantly with various perinatal factors and clinical presentation. We recommend that early fT₄ screening should be included in the screening for hypothyroidism in preterm infants.

Keywords: Prematurity, Thyroid hormones, Thyroxine, Triiodothyronine, Thyrotropin

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Fig. 1

Thyroid function test such as (A) T₃ (B) FT₄ (C) TSH according to corrected gestational age at 1 week sampling in preterm infants. Abbreviations: T₃, triiodothyronine; fT₄, free thyroxine; TSH, thyroid stimulating hormone.

Table 1.

FT₄ (1st week) Concentration according to Categorical Variables

Variables	Number (%)	fT₄ (ng/dL) P-value
GA
<32 weeks	6 (13.0%)	0.90±0.26 0.000^†
≥32 weeks	40 (87.0%)	1.47±0.19
Gender
Male	22 (47.8%)	1.38±0.27 0.605
Female	24 (52.2%)	1.41±0.27
Mode of delivery
Vaginal	18 (39.1%)	1.38±0.28 0.839
Caesarean section	28 (60.9%)	1.41±0.28
Antenatal steroid therapy
Yes	7 (15.2%)	1.25±0.20 0.039∗
No	39 (84.8%)	1.42±0.28
GDM
Yes	4 (8.7%)	1.49±0.13 0.507
No	42 (91.3%)	1.39±0.29
PROM
<24 hours	33 (71.7%)	1.40±0.20 0.788
≥24 hours	13 (28.3%)	1.39±0.30
U. urealyticum culture
Positive	5 (10.9%)	1.41±0.18 0.986
Negative	41 (89.1%)	1.39±0.29
O₂ therapy right after birth
Yes	36 (78.3%)	1.37±0.30 0.101
No	10 (21.7%)	1.51±0.13
RDS
Yes	6 (13.0%)	1.00±0.33 0.001^†
No	40 (87.0%)	1.46±0.21
Apnea
Yes	9 (19.6%)	1.05±0.33 0.000^†
No	37 (80.4%)	1.48±0.19
1^st meconium passage
<24 hours	41 (89.1%)	1.44±0.23 0.019∗
≥24 hours	5 (10.9%)	1.05±0.40

∗P<0.05,

^† P<0.01. FT₄ Values are mean±SD and a Mann-Whiney test was used forP-value. Abbreviations: GA, gestational age; fT₄, free thyroxine; GDM, gestational diabetes mellitus; PROM, premature rupture of membrane; RDS, respiratory distress syndrome.

Table 2.

Relationship between 1^st week FT₄ and Perinatal Variables

Variables	Standardized Coefficient	95% CI Coefficient	P-value
Age at sampling (day)	-0.002	-0.028, 0.028	0.985
Corrected GA at exam	0.621	0.021, 0.139	0.009^†
1-minute Apgar score	0.189	-0.047, 0.112	0.412
5-minute Apgar score	-0.081	-0.115, 0.079	0.708
Birth weight	-0.220	0.000, 0.000	0.212
Head circumference	0.016	-0.040, 0.043	0.925
1^st meconium passage time	-0.331	-0.020, -0.004	0.006^†
Antenatal steroid therapy	0.299	0.032, 0.423	0.024∗
RDS	0.040	-0.216, 0.280	0.793
Apnea	-0.367	-0.438, -0.068	0.009^†

∗P<0.05, ^†P<0.01.

Abbreviations: fT₄, free thyroxine; CI, confidence interval; GA, gestational age; RDS, respiratory distress syndrome.

Table 3.

Relationship between 1^st week TSH and Perinatal Variables

Variables	Standardized Coefficient	95% CI Coefficient	P-value
Age at sampling (day)	-0.528	-1.261, -0.362	0.001^†
Corrected GA at exam	0.168	-0.673, 1.218	0.562
1-minute Apgar score	-0.497	-2.349, 0.203	0.097
5-minute Apgar score	0.566	0.024, 3.126	0.047∗
Birth weight	-0.103	-0.004, 0.003	0.646
Head circumference	0.226	-0.331, 0.999	0.315
1st meconium passage time	0.634	0.149, 0.411	0.000^†
Antenatal steroid therapy	-0.064	-3.747, 2.535	0.698
RDS	0.082	-3.137, 4.810	0.672
Apnea	-0.264	-5.237, 0.698	0.129

∗P<0.05, ^†P<0.01.

Abbreviations: TSH, thyroid stimulating hormone; CI, confidence interval; GA, gestational age; RDS, respiratory distress syndrome.

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