How can the occurrence of delayed elevation of thyroid stimulating hormone in preterm infants born between 35 and 36 weeks gestation be predicted?

We evaluated frequency and risk factors of delayed TSH elevation (dTSH) and investigated follow-up outcomes in the dTSH group with venous TSH (v-TSH) levels of 6-20 mU/L according to whether late preterm infants born at gestational age (GA) 35-36 weeks had risk factors. The medical records of 810 ne...

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Veröffentlicht in:PloS one 2019-08, Vol.14 (8), p.e0220240-e0220240
Hauptverfasser: Heo, You Jung, Lee, Young Ah, Lee, Bora, Lee, Yun Jeong, Lim, Youn Hee, Chung, Hye Rim, Shin, Seung Han, Shin, Choong Ho, Yang, Sei Won
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container_title PloS one
container_volume 14
creator Heo, You Jung
Lee, Young Ah
Lee, Bora
Lee, Yun Jeong
Lim, Youn Hee
Chung, Hye Rim
Shin, Seung Han
Shin, Choong Ho
Yang, Sei Won
description We evaluated frequency and risk factors of delayed TSH elevation (dTSH) and investigated follow-up outcomes in the dTSH group with venous TSH (v-TSH) levels of 6-20 mU/L according to whether late preterm infants born at gestational age (GA) 35-36 weeks had risk factors. The medical records of 810 neonates (414 boys) born at Seoul National University Hospital who had a normal neonatal screening test (NST) and underwent the first repeat venous blood test at 10-21 days post birth were reviewed. Seventy-three (9.0%) neonates showed dTSH, defined as a v-TSH level ≥6.0 mU/L, 12 of whom (1.5%) were started on levothyroxine medication. A multivariate-adjusted model indicated that a low birth weight (LBW
doi_str_mv 10.1371/journal.pone.0220240
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The medical records of 810 neonates (414 boys) born at Seoul National University Hospital who had a normal neonatal screening test (NST) and underwent the first repeat venous blood test at 10-21 days post birth were reviewed. Seventy-three (9.0%) neonates showed dTSH, defined as a v-TSH level ≥6.0 mU/L, 12 of whom (1.5%) were started on levothyroxine medication. A multivariate-adjusted model indicated that a low birth weight (LBW &lt;2,000 g), a congenital anomaly, and exposure to iodine contrast media (ICM) were significant predictors for dTSH (all p &lt; 0.05). Among these 73 dTSH infants, all 5 infants with TSH levels ≥20 mU/L began levothyroxine medication, and 6 of 16 infants with v-TSH levels of 10-20 mU/L were indicated for levothyroxine, regardless of coexisting risk factors. However, only 1 of 52 infants with v-TSH levels of 6-10 mU/L who had a congenital anomaly was indicated for levothyroxine. All healthy late preterm infants, including LBW and multiple births, with v-TSH levels of 6-10 mU/L exhibited normal thyroid function. dTSH was detected in 9.0% and levothyroxine was indicated in 1.5% of infants born at GA 35-36 weeks, particularly those with a LBW, a congenital anomaly, or history of ICM exposure. Either levothyroxine or retesting is indicated for late preterm neonates with TSH levels ≥10 mU/L regardless of risk factors. If healthy preterm neonates show v-TSH levels of 6-10 mU/L, a second repeat test may not be necessary; however, further studies are required to set a threshold for retesting.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0220240</identifier><identifier>PMID: 31442229</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Biology and Life Sciences ; Birth weight ; Blood tests ; Congenital anomalies ; Congenital diseases ; Contrast agents ; Contrast media ; Drug dosages ; Drugs ; Endocrinology ; Exposure ; Female ; Genetic disorders ; Gestation ; Gestational Age ; Glycoproteins ; Health risks ; Health screening ; Hormones ; Hospitals ; Humans ; Hypothyroidism ; In vitro fertilization ; Infant, Newborn ; Infant, Premature - metabolism ; Infants ; Intensive care ; Iodine ; Levels ; Levothyroxine ; Low birth weight ; Male ; Measurement ; Medical records ; Medical screening ; Medical tests ; Medicine ; Medicine and Health Sciences ; Multiple births ; Neonates ; Newborn babies ; Newborn infants ; Pediatrics ; People and Places ; Physiological aspects ; Pituitary hormones ; Pregnancy ; Premature babies ; Premature infants ; Risk analysis ; Risk Factors ; Thyroid ; Thyroid gland ; Thyroid-stimulating hormone ; Thyrotropin ; Thyrotropin - metabolism ; Thyroxine ; Thyroxine - pharmacology ; Time Factors</subject><ispartof>PloS one, 2019-08, Vol.14 (8), p.e0220240-e0220240</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Heo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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The medical records of 810 neonates (414 boys) born at Seoul National University Hospital who had a normal neonatal screening test (NST) and underwent the first repeat venous blood test at 10-21 days post birth were reviewed. Seventy-three (9.0%) neonates showed dTSH, defined as a v-TSH level ≥6.0 mU/L, 12 of whom (1.5%) were started on levothyroxine medication. A multivariate-adjusted model indicated that a low birth weight (LBW &lt;2,000 g), a congenital anomaly, and exposure to iodine contrast media (ICM) were significant predictors for dTSH (all p &lt; 0.05). Among these 73 dTSH infants, all 5 infants with TSH levels ≥20 mU/L began levothyroxine medication, and 6 of 16 infants with v-TSH levels of 10-20 mU/L were indicated for levothyroxine, regardless of coexisting risk factors. However, only 1 of 52 infants with v-TSH levels of 6-10 mU/L who had a congenital anomaly was indicated for levothyroxine. All healthy late preterm infants, including LBW and multiple births, with v-TSH levels of 6-10 mU/L exhibited normal thyroid function. dTSH was detected in 9.0% and levothyroxine was indicated in 1.5% of infants born at GA 35-36 weeks, particularly those with a LBW, a congenital anomaly, or history of ICM exposure. Either levothyroxine or retesting is indicated for late preterm neonates with TSH levels ≥10 mU/L regardless of risk factors. If healthy preterm neonates show v-TSH levels of 6-10 mU/L, a second repeat test may not be necessary; however, further studies are required to set a threshold for retesting.</description><subject>Biology and Life Sciences</subject><subject>Birth weight</subject><subject>Blood tests</subject><subject>Congenital anomalies</subject><subject>Congenital diseases</subject><subject>Contrast agents</subject><subject>Contrast media</subject><subject>Drug dosages</subject><subject>Drugs</subject><subject>Endocrinology</subject><subject>Exposure</subject><subject>Female</subject><subject>Genetic disorders</subject><subject>Gestation</subject><subject>Gestational Age</subject><subject>Glycoproteins</subject><subject>Health risks</subject><subject>Health screening</subject><subject>Hormones</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypothyroidism</subject><subject>In vitro fertilization</subject><subject>Infant, Newborn</subject><subject>Infant, Premature - metabolism</subject><subject>Infants</subject><subject>Intensive care</subject><subject>Iodine</subject><subject>Levels</subject><subject>Levothyroxine</subject><subject>Low birth weight</subject><subject>Male</subject><subject>Measurement</subject><subject>Medical records</subject><subject>Medical screening</subject><subject>Medical tests</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Multiple births</subject><subject>Neonates</subject><subject>Newborn babies</subject><subject>Newborn infants</subject><subject>Pediatrics</subject><subject>People and Places</subject><subject>Physiological aspects</subject><subject>Pituitary hormones</subject><subject>Pregnancy</subject><subject>Premature babies</subject><subject>Premature infants</subject><subject>Risk analysis</subject><subject>Risk Factors</subject><subject>Thyroid</subject><subject>Thyroid gland</subject><subject>Thyroid-stimulating hormone</subject><subject>Thyrotropin</subject><subject>Thyrotropin - metabolism</subject><subject>Thyroxine</subject><subject>Thyroxine - pharmacology</subject><subject>Time Factors</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk81u1DAQxyMEoqXwBggsISE47OKP2N5cQFUFdKVKlfi6Wo4z2c2S2FvbadnX4Ilx2LTaoB6QD5mMf_P3eMaTZc8JnhMmybuN673V7XzrLMwxpZjm-EF2TApGZ4Ji9vDAPsqehLDBmLOFEI-zI0bynFJaHGe_z90NMtqiuAbkjOm9B2uSWaMKWr2DCkEL1zo2zg7OuN5511QoxKbr2-S2K7R2vktJoMairYcIvktmrW0MqHTeohLiDYBFjCNtK8QESr8_A1pBiHvhEobIqjERqg9Ps0e1bgM8G78n2fdPH7-dnc8uLj8vz04vZkYUNM5gUUgwUJmi0phqkle84BQ0YUJjTAUvicA8x0B5zQxj3BjDiJGiwAU2RLKT7OVed9u6oMZyBkWpLDDFnLBELPdE5fRGbX3Tab9TTjfqr8P5ldI-NqYFhXOJeSnLnMhFTiXXJRNGl4tFEpJcVknr_XhaX3Ypa7DR63YiOt2xzVqt3LUSEktBRRJ4Mwp4d9Wn0qmuCQbaVltw_ZD3ghNMCCsS-uof9P7bjdRKpwukjrl0rhlE1SkvJKXpleWJmt9DpVVB15jU9rpJ_knA20lAYiL8iivdh6CWX7_8P3v5Y8q-PmDXoNu4Dq7thwcUpmC-B413IXio74pMsBpG57YaahgdNY5OCntx2KC7oNtZYX8AiwATUg</recordid><startdate>20190823</startdate><enddate>20190823</enddate><creator>Heo, You Jung</creator><creator>Lee, Young Ah</creator><creator>Lee, Bora</creator><creator>Lee, Yun Jeong</creator><creator>Lim, Youn Hee</creator><creator>Chung, Hye Rim</creator><creator>Shin, Seung Han</creator><creator>Shin, Choong Ho</creator><creator>Yang, Sei Won</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-9813-1134</orcidid><orcidid>https://orcid.org/0000-0001-9179-1247</orcidid></search><sort><creationdate>20190823</creationdate><title>How can the occurrence of delayed elevation of thyroid stimulating hormone in preterm infants born between 35 and 36 weeks gestation be predicted?</title><author>Heo, You Jung ; Lee, Young Ah ; Lee, Bora ; Lee, Yun Jeong ; Lim, Youn Hee ; Chung, Hye Rim ; Shin, Seung Han ; Shin, Choong Ho ; Yang, Sei Won</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-e897ecedc9da02a14d5952ea136a00265b160540e25f3c335ccc31c769090c173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Biology and Life Sciences</topic><topic>Birth weight</topic><topic>Blood tests</topic><topic>Congenital anomalies</topic><topic>Congenital diseases</topic><topic>Contrast agents</topic><topic>Contrast media</topic><topic>Drug dosages</topic><topic>Drugs</topic><topic>Endocrinology</topic><topic>Exposure</topic><topic>Female</topic><topic>Genetic disorders</topic><topic>Gestation</topic><topic>Gestational Age</topic><topic>Glycoproteins</topic><topic>Health risks</topic><topic>Health screening</topic><topic>Hormones</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypothyroidism</topic><topic>In vitro fertilization</topic><topic>Infant, Newborn</topic><topic>Infant, Premature - metabolism</topic><topic>Infants</topic><topic>Intensive care</topic><topic>Iodine</topic><topic>Levels</topic><topic>Levothyroxine</topic><topic>Low birth weight</topic><topic>Male</topic><topic>Measurement</topic><topic>Medical records</topic><topic>Medical screening</topic><topic>Medical tests</topic><topic>Medicine</topic><topic>Medicine and Health Sciences</topic><topic>Multiple births</topic><topic>Neonates</topic><topic>Newborn babies</topic><topic>Newborn infants</topic><topic>Pediatrics</topic><topic>People and Places</topic><topic>Physiological aspects</topic><topic>Pituitary hormones</topic><topic>Pregnancy</topic><topic>Premature babies</topic><topic>Premature infants</topic><topic>Risk analysis</topic><topic>Risk Factors</topic><topic>Thyroid</topic><topic>Thyroid gland</topic><topic>Thyroid-stimulating hormone</topic><topic>Thyrotropin</topic><topic>Thyrotropin - metabolism</topic><topic>Thyroxine</topic><topic>Thyroxine - pharmacology</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Heo, You Jung</creatorcontrib><creatorcontrib>Lee, Young Ah</creatorcontrib><creatorcontrib>Lee, Bora</creatorcontrib><creatorcontrib>Lee, Yun Jeong</creatorcontrib><creatorcontrib>Lim, Youn Hee</creatorcontrib><creatorcontrib>Chung, Hye Rim</creatorcontrib><creatorcontrib>Shin, Seung Han</creatorcontrib><creatorcontrib>Shin, Choong Ho</creatorcontrib><creatorcontrib>Yang, Sei Won</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing &amp; Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological &amp; Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science &amp; Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies &amp; Aerospace Collection</collection><collection>Agricultural &amp; Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>Meteorological &amp; Geoastrophysical Abstracts - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Heo, You Jung</au><au>Lee, Young Ah</au><au>Lee, Bora</au><au>Lee, Yun Jeong</au><au>Lim, Youn Hee</au><au>Chung, Hye Rim</au><au>Shin, Seung Han</au><au>Shin, Choong Ho</au><au>Yang, Sei Won</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>How can the occurrence of delayed elevation of thyroid stimulating hormone in preterm infants born between 35 and 36 weeks gestation be predicted?</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-08-23</date><risdate>2019</risdate><volume>14</volume><issue>8</issue><spage>e0220240</spage><epage>e0220240</epage><pages>e0220240-e0220240</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>We evaluated frequency and risk factors of delayed TSH elevation (dTSH) and investigated follow-up outcomes in the dTSH group with venous TSH (v-TSH) levels of 6-20 mU/L according to whether late preterm infants born at gestational age (GA) 35-36 weeks had risk factors. The medical records of 810 neonates (414 boys) born at Seoul National University Hospital who had a normal neonatal screening test (NST) and underwent the first repeat venous blood test at 10-21 days post birth were reviewed. Seventy-three (9.0%) neonates showed dTSH, defined as a v-TSH level ≥6.0 mU/L, 12 of whom (1.5%) were started on levothyroxine medication. A multivariate-adjusted model indicated that a low birth weight (LBW &lt;2,000 g), a congenital anomaly, and exposure to iodine contrast media (ICM) were significant predictors for dTSH (all p &lt; 0.05). Among these 73 dTSH infants, all 5 infants with TSH levels ≥20 mU/L began levothyroxine medication, and 6 of 16 infants with v-TSH levels of 10-20 mU/L were indicated for levothyroxine, regardless of coexisting risk factors. However, only 1 of 52 infants with v-TSH levels of 6-10 mU/L who had a congenital anomaly was indicated for levothyroxine. All healthy late preterm infants, including LBW and multiple births, with v-TSH levels of 6-10 mU/L exhibited normal thyroid function. dTSH was detected in 9.0% and levothyroxine was indicated in 1.5% of infants born at GA 35-36 weeks, particularly those with a LBW, a congenital anomaly, or history of ICM exposure. Either levothyroxine or retesting is indicated for late preterm neonates with TSH levels ≥10 mU/L regardless of risk factors. If healthy preterm neonates show v-TSH levels of 6-10 mU/L, a second repeat test may not be necessary; however, further studies are required to set a threshold for retesting.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31442229</pmid><doi>10.1371/journal.pone.0220240</doi><tpages>e0220240</tpages><orcidid>https://orcid.org/0000-0002-9813-1134</orcidid><orcidid>https://orcid.org/0000-0001-9179-1247</orcidid><oa>free_for_read</oa></addata></record>
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identifier ISSN: 1932-6203
ispartof PloS one, 2019-08, Vol.14 (8), p.e0220240-e0220240
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1932-6203
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source MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS)
subjects Biology and Life Sciences
Birth weight
Blood tests
Congenital anomalies
Congenital diseases
Contrast agents
Contrast media
Drug dosages
Drugs
Endocrinology
Exposure
Female
Genetic disorders
Gestation
Gestational Age
Glycoproteins
Health risks
Health screening
Hormones
Hospitals
Humans
Hypothyroidism
In vitro fertilization
Infant, Newborn
Infant, Premature - metabolism
Infants
Intensive care
Iodine
Levels
Levothyroxine
Low birth weight
Male
Measurement
Medical records
Medical screening
Medical tests
Medicine
Medicine and Health Sciences
Multiple births
Neonates
Newborn babies
Newborn infants
Pediatrics
People and Places
Physiological aspects
Pituitary hormones
Pregnancy
Premature babies
Premature infants
Risk analysis
Risk Factors
Thyroid
Thyroid gland
Thyroid-stimulating hormone
Thyrotropin
Thyrotropin - metabolism
Thyroxine
Thyroxine - pharmacology
Time Factors
title How can the occurrence of delayed elevation of thyroid stimulating hormone in preterm infants born between 35 and 36 weeks gestation be predicted?
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