ÇOK DÜŞÜK DOĞUM AĞIRLIKLI YENİDOĞANLARDA KONJENİTAL HİPOTİROİDİ VE PREMATÜRE RETİNOPATİSİ İLİŞKİSİNİN ARAŞTIRILMASI

Year 2018, Volume: 20 Issue: 3, 232 - 240, 30.12.2018

Ufuk Çakır Cüneyt Tayman Mehmet Büyüktiryaki

https://doi.org/10.24938/kutfd.396667

Cited By: 1

Abstract

Amaç: Prematüre
retinopatisi (PR), çocukluk çağında körlüğe neden olabilen başlıca prematürelerin
retinasında meydana gelen vazoproliferatif bir hastalıktır. Çalışmamızda çok
düşük doğum ağırlıklı (ÇDDA) prematürelerde konjenital hipotiroidinin (KH)
PR’si üzerine etkisi ve PR için risk faktörlerine bakılması amaçlanmıştır.

Gereç ve Yöntem:
Çalışma
51 aylık dönem boyunca yatan ÇDDA bebeklerde geriye dönük tıbbi kayıtların
değerlendirilmesi neticesinde gerçekleştirildi. Hastalar KH tanısı ve lazer
fotokoagülasyon tedavisi gerektiren PR olmasına göre gruplara ayrıldı.

Bulgular: Çalışmaya 621 hasta dahil edildi. Bunlar arasında, 5.
gün tiroid fonksiyon testi (TFT) sonucu olan, postnatal 1. ayda hem sağ kalan
hem TFT sonucu olan hem de PR muayenesi yapılabilen 534 hasta ile çalışma
sonlandırıldı. Konjenital hipotiroidi olan grupta (n=23) PR oranı %26,1 (n=6),
KH olmayan grupta (n=511) PR oranı %10,9 (n=56) olarak tespit edildi.

Konjenital
hipotiroidi olan ve olmayan gruplar arasında PR açısından anlamlı fark tespit
edilmedi (p=0.077). Prematüre retinopatisi için risk faktörleri başlıca, düşük
gebelik haftası, doğum ağırlığı, düşük 1. ve 5. dakika Apgar skoru, uzun
mekanik ventilasyon ve oksijen destek süresi, respiratuvar distres sendromu,
intraventriküler kanama, bronkopulmoner displazi, hemodinamik anlamlı patent
duktus arteriosus ve geç neonatal sepsis olarak bulunmuştur. PR’i olan grupta
serbest tiroksin (sT4) düzeyi daha düşük, tiroid stimülan hormon (TSH) düzeyi
daha yüksek bulunmuştur (sırasıyla, p=0.002; 0.047).

Sonuç: KH’nin PR üzerine etkisi bulunmamıştır. Ancak,
PR’si üzerine prematüreliğin getirdiği diğer riskler daha etkili bulunmuştur.
PR’si olan infantlarda sT4 daha düşük, TSH daha yüksek bulunmuştur. Tiroid
hormonlarının anjiyogenezis üzerine etkisi olduğundan, PR ve tiroid hormonları
ilişkisi açısından daha başka çalışmalara ihtiyaç vardır.

Keywords

konjenital hipotiroidi, prematüre, prematüre retinopatisi, Çok düşük doğum ağırlığı, tiroid disfonksiyonu

Evaluation of the Relationship Between Congenital Hypothyroidism and Retinopathy of Prematurity in Very Low Birth Weight Newborns

Abstract

Objective: Retinopathy of prematurity (ROP) is a
vasoproliferative disease that mainly occurs in retinas of premature infants,
and causes blindness in childhood. The aim of this study was to evaluate the
risk factors for PR and the effect of congenital hypothyroidism (CH) on PR in
very low birth weight infants (VLBW) (birth weight <1500 g).

Material and Method: The retrospective study was
conducted by the evaluation of medical records of hospitalized VLBW infants
during the 51 months of follow-up. Patients were divided into groups according
to diagnosed CH, and according to ROP requiring laser photocoagulation therapy.

Results: There were 570 patients of 621 patients
of whom we were able to obtain TFT results on the 5th day of the study. A total
of 534 patients who survived the postnatal 1st month, and on whom we
were able to perform both TFT and ROP examinations were included in the study. The PR rate was 26.1%(n=6) in the group
with congenital hypothyroidism (n=23) and the ROP rate was 10.9%(n=56) in the
non-CH group (n=511). However, there was no statistically significant difference
between the groups in terms of ROP (p=0.077). The risk factors for premature
retinopathy were mainly including low gestational age/birth weight, low 1st
and 5th minute Apgar score, longer duration of mechanical
ventilation and oxygen support, respiratory distress syndrome, intraventricular
hemorrhage, bronchopulmonary dysplasia, hemodynamically significant patent
ductus arteriosus and late neonatalsepsis. In infants with ROP, the levels of
free thyroxine (sT4) were lower and the levels of thyroid stimulating hormone
(TSH) were higher (p=0.002, 0.047, respectively).

Conclusion: CH had no effect on ROP. However, other
risks of prematurity on ROP were found to be more effective. In infants with
ROP, sT4 was lower and TSH was higher. Since thyroid hormones have an effect on
angiogenesis, further studies on the relation between ROP and thyroid hormones
are warranted.

Keywords

Very low birth weight, congenital hypothyroidism, premature, retinopathy of prematurity, thyroid dysfunction

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