Journal of perinatology : official journal of the California Perinatal Association · 2024
A practical gestational age-based algorithm for timely detection of hypothyroidism in premature infants.
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Shah Avni N, Li Wen, Zheng Denise, Lalani Sana, Kaluarachchi Dinushan C, Findley Tina O
Аннотация
OBJECTIVES: To assess utility and accuracy of a gestational age-based screening targeting premature infants to detect congenital hypothyroidism.
STUDY DESIGN: A prospective cohort study was conducted in infants <35 weeks' gestational age with clinical outcomes at 2-3 years of age. Patients received newborn screenings at 24 hours and 10-14 days of life. Free T4 (FT4) and thyroid-stimulating hormone (TSH) levels were measured at one month of life and repeated based on algorithm by corrected gestational age.
RESULTS: Among infants <35 weeks gestation (n = 938), the incidence of hypothyroidism requiring treatment was 1:58. TSH levels at one month of age was predictive of treatment (AUC 0.96, 95% CI 0.88-1). The optimal TSH threshold of 8 mIU/L (8 µU/ml) increased the specificity to 0.97 and sensitivity to 0.88. Following initiation of treatment for hypothyroidism during NICU hospitalization, 43.8% (n = 7) were diagnosed with permanent congenital hypothyroidism.
CONCLUSIONS: Our study supports a gestational age-based screening algorithm for early detection of hypothyroidism in premature infants.
STUDY DESIGN: A prospective cohort study was conducted in infants <35 weeks' gestational age with clinical outcomes at 2-3 years of age. Patients received newborn screenings at 24 hours and 10-14 days of life. Free T4 (FT4) and thyroid-stimulating hormone (TSH) levels were measured at one month of life and repeated based on algorithm by corrected gestational age.
RESULTS: Among infants <35 weeks gestation (n = 938), the incidence of hypothyroidism requiring treatment was 1:58. TSH levels at one month of age was predictive of treatment (AUC 0.96, 95% CI 0.88-1). The optimal TSH threshold of 8 mIU/L (8 µU/ml) increased the specificity to 0.97 and sensitivity to 0.88. Following initiation of treatment for hypothyroidism during NICU hospitalization, 43.8% (n = 7) were diagnosed with permanent congenital hypothyroidism.
CONCLUSIONS: Our study supports a gestational age-based screening algorithm for early detection of hypothyroidism in premature infants.