| ObjectiveAbnormal thyroid function is a high-risk factor leading to the development of premature infants,especially the development of the central nervous system,which can cause them to lag behind in terms of emotion,behavior,intelligence,vision,social and learning conditions.In premature infants,transient hypothyroxinemia of prematurity(THOP)and low triiodothyronine(T3)syndromes are the most common in thyroid dysfunction.At present,the etiology of THOP and low T3 syndrome is not clear,and the diagnostic criteria have not yet been unified.In this study,by measuring the levels of serum T4,T3 and TSH in preterm infants after birth,tracking the outcome of children with THOP and low T3 syndrome,and analyzing the perinatal factors and main observation indicators of preterm infants,in this way,we can understand the influencing factors of THOP and low T3 syndrome in premature infants,as well as its influence on premature infants,and provide clinical basis for the prevention,diagnosis and treatment of temporary thyroid dysfunction.MethodPremature infants admitted to the neonatal ward from January 2019 to February2020 in our hospital were selected as the research subjects,and blood was collected at the age of 4 days after birth to test thyroid function,and rechecked every 2 weeks until thyroid function returned to normal until.According to thyroid function,the subjects were divided into 3 groups(THOP group,low T3 syndrome group and normal control group).Collect 10 related perinatal factors,including: gender,delivery method,whether multiple pregnancy,asphyxia,neonatal respiratory distress syndrome,whether to inhale oxygen after birth,use dexamethasone before birth,whether to use antibiotics after birth,white Protein,gamma globulin,chi-square test and logistic regression were used to analyze the influencing factors,and the main observation indicators were collected,including hospitalization time,jaundice time,time to restore birth weight,feeding intolerance,and correction of gestational age at40 weeks NBNA score,then statistical analysis.Results1.There were 20 infants suffering from transient hypothyroxinemia,38 infants suffering from low T3 syndrome,and 100 infants in normal group.The prevalence rate of transient hypothyroxinemia was 12.7%,and the prevalence rate of low T3 syndrome was 21.4%.Serum T3 and T4 at 4 days after birth were positively correlated with gestational age,and the difference was statistically significant(p<0.01).The correlation coefficients were r(T3)=0.586 and r(T4)=0.579,respectively.Serum T3 and T4 at 4 days after birth T4 was positively correlated with body weight,and the difference was statistically significant(p<0.01).The correlation coefficients were r(T3)=0.630 and r(T4)=0.651,respectively.There was no correlation between TSH and gestational age and weight(P>0.05).2.Among the 10 factors the perinatal factor that had influence on THOP was the application of antibiotics after birth(OR=0.108,95%CI 0.014～0.865),which was the protective factor of THOP,and Perinatal factor that has an impact on low T3 syndrome was asphyxia(OR=19.500,95%CI 1.299～292.750).3.The length of hospitalization,duration of jaundice,and time to regain birth weight in the THOP group and the low T3 syndrome group are longer than those in the control group,and there are more cases of feeding intolerance.Compared with the control group,there are significant differences,but no significant differences in NBNA score.4.The natural outcome of children with THOP and low T3 syndrome: followed THOP group of children with thyroid function changes: 4 cases returned to normal in2 weeks after birth,8 cases restored to normal 4 weeks after birth,5 patients returned to normal in 6 weeks,3 cases returned to normal at 8 weeks after birth.Followed low T3 syndrome group of children with thyroid function changes: 6 cases returned to normal in 2 weeks after birth,28 cases restored to normal 4 weeks after birth,3 cases in 6 weeks back to normal,1 case of returned to normal at 8 weeks after birth.Conclusions1.Temporary thyroid dysfunction is a common disease in preterm infants.The serum T3 and T4 of preterm infants are positively correlated with their gestational age.Therefore,the diagnostic criteria of thyroid function for preterm infants should be developed based on different gestational ages.2.Postnatal antibiotic use is a protective factor for THOP and asphyxia is a risk factor for low T3 syndrome.3.THOP and low T3 syndrome have no significant effect on the short-term neurodevelopment of preterm infants,but they will prolong the duration of jaundice,the length of hospitalization and the time to return to birth weight,and increase the incidence of feeding intolerance in preterm infants.4.Thyroid function in preterm infants with THOP and low T3 syndrome can return to normal on their own without the need for routine treatment with levothyroxine. |
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