Çok Düşük Doğum Ağırlıklı Prematürelerde Konjenital Hipotiroidi İle İntraventriküler Kanama İlişkisinin Değerlendirilmesi

Ufuk Çakır

doi:10.12956/tchd.539041

Research Article

Çok Düşük Doğum Ağırlıklı Prematürelerde Konjenital Hipotiroidi İle İntraventriküler Kanama İlişkisinin Değerlendirilmesi

Year 2019, Volume: 13 Issue: 2, 45 - 49, 26.03.2019

Ufuk Çakır

https://doi.org/10.12956/tchd.539041

Cited By: 1

Abstract

Amaç: Düşük tiroid hormon düzeylerinin kanama, yüksek düzeylerin ise venöz tromboemboli riskini artırdığı bildirilmiştir. Ancak özellikle preterm bebeklerde konjenital hipotiroidizm (KH) ve intraventriküler hemoraji (İVH) arasındaki ilişki bilinmemektedir. Çalışmamızda çok düşük doğum ağırlıklı (ÇDDA) preterm bebeklerde şiddetli intrakraniyal kanama ile KH arasındaki ilişkinin araştırılması amaçlanmıştır.

Gereç ve Yöntemler: Ocak 2013 ile Aralık 2016 tarihleri arasında, yenidoğan yoğun bakım ünitesine yatan ÇDDA hastaların verileri retrospektif olarak kayıt edildi. Hastaların gebelik haftaları (GH), doğum ağırlığı (DA), cinsiyeti, 1. ve 5. dakika Apgar skoru, antenatal steroid uygulaması, annede tiroid hastalığı, kraniyal ultrasonografi bulgusu, tiroid stimülan hormon (TSH) ve serbest tiroksin (sT4) düzeylerini içeren verileri kayıt edildi. Konjenital hipotiroidi olan ve olmayan hastalar demografik özellikler ve ciddi İVK açısından karşılaştırıldı.

Yenidoğan yoğun bakım ünitesine yatırılan ÇDDA bebeklerin verileri retrospektif olarak Ocak 2013 ile Aralık 2016 arasında kaydedildi. Gebelik haftası (GH), doğum ağırlığı (DA), cinsiyet, 1. ve 5. Apgar skoru, antenatal steroid uygulanması, maternal tiroid hastalığı, kraniyal ultrasonografi tetkik raporları ve tiroid uyarıcı hormon (TSH) ve serbest tiroksin (sT4) düzeyleri hastanın tıbbi kayıtlarından elde edildi. Demografik özellikler ve intraventriküler hemoraji, KH olan ve olmayan gruplar arasında karşılaştırıldı.

Bulgular: Çalışmamızda 581 ÇDDA bebeğin 26’sında (% 4.5) KH saptanmıştır. Gebelik haftası (27.3 ± 1.04 hafta) ve DA (978 ± 197 g), KH olan bebekler, KH olmayanlardan (GA 28.1 ± 1.2 hafta, DA 1073 ± 226 g) daha düşüktü (sırasıyla, p <0.00, p = 0.037). KH olan (% 7.7) ve KH (% 6.5) olmayan gruplar arasında şiddetli İVH açısından anlamlı fark yoktu (p = 0.95). Ciddi İVK (evre≥3) grubunda sT4 seviyesi anlamlı olarak düşük bulundu (p = 0.018). Tiroid uyarıcı hormon sonuçları ciddi İVK olan ve olmayan gruplar arasında benzerdi (p = 0.215).

Sonuç: Çalışmamızda ÇDDA prematürelerde KH’nin ciddi İVK riskini artırmadığı sonucuna varıldı. Bununla birlikte, ciddi IVH grubundaki düşük sT4 seviyelerinin, kritik hastalığa ve beyin hasarına karşı hipotalamik yanıtsızlığa bağlı olabileceği düşünülmüştür.

Keywords

Çok düşük doğum ağırlığı, Serebral İntraventiküler kanama, Konjenital hipotiroidi

References

1. Belcari F, Placidi G, Guzzetta A, Tonacchera M, Ciampi M, Bartoli A, et al. Thyroid-stimulating hormone levels in the first days of life and perinatal factors associated with sub-optimal neuromotor outcome in preterm infants. J Endocrinol Invest 2011;34:e308-13.
2. Lee JH, Kim SW, Jeon GW, Sin JB. Thyroid dysfunction in very low birth weight preterm infants. Korean J Pediatr 2015;58:224-9.
3. Heidari Z, Feizi A, Hashemipour M, Kelishadi R, Amini M. Growth development in children with congenital hypothyroidism: the effect of screening and treatment variables-a comprehensive longitudinal study. Endocrine 2016;54:448-59.
4. Baysal BT, Baysal B, Genel F, Erdur B, Ozbek E, Demir K, et al. Neurodevelopmental Outcome of Children with Congenital Hypothyroidism Diagnosed in a National Screening Program in Turkey. Indian Pediatr 2017;54:381-4.
5. Osborn DA, Hunt RW. Prophylactic postnatal thyroid hormones for prevention of morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2007;(1):CD005948.
6. LaFranchi S. Thyroid function in the preterm infant. Thyroid 1999;9:71-8.
7. Hashemipour M, Hovsepian S, Ansari A, Keikha M, Khalighinejad P, Niknam N. Screening of congenital hypothyroidism in preterm, low birth weight and very low birth weight neonates: A systematic review. PediatrNeonatol 2018;59:3-14.
8. Vigone MC, Caiulo S, DiFrenna M, Ghirardello S, Corbetta C, Mosca F, et al. Evolution of thyroid function in preterm infants detected by screening for congenital hypothyroidism. J Pediatr 2014;164:1296-302.
9. Dhital R, Poudel DR, Tachamo N, Gyawali B, Basnet S, Shrestha P, et al. Ischemic Stroke and Impact of Thyroid Profile at Presentation: A Systematic Review and Meta-analysis of Observational Studies. J Stroke Cerebrovasc Dis 2017;26:2926-34.
10. Akirov A, Shochat T, Shechvitz A, Shimon I, Diker-Cohen T, Robenshtok E. Pre-admission TSH levels predict long-term mortality in adults treated for hypothyroidism. Endocrine 2017;58:481-7.
11. Weng CH, Chen YH, Lin CH, Luo X, Lin TH. Thyroid disorders and breast cancer risk in Asian population: a nationwide populationbased case-control study in Taiwan. BMJ Open 2018;8:e020194.
12. Suvarna JC, Fande CN. Serum thyroid hormone profile in critically Ill children. Indian J Pediatr 2009;76:1217-21.
13. Elbers LPB, Fliers E, Cannegieter SC. The influence of thyroid function on the coagulation system and its clinical consequences. J ThrombHaemost 2018;16:634-645.
14. Tan AP, Svrckova P, Cowan F, Chong WK, Mankad K. Intracranial hemorrhage in neonates: A review of etiologies, patterns and predicted clinical outcomes. Eur J Paediatr Neurol 2018;22:690- 717.
15. Guy VV, Johnny D. Pediatric endocrinology. In: Sperling MA, editor. Disorders of the thyroid in the newborn and infant. 4th ed. Philadelphia (PA): Saunders P, 2014:186-208.
16. American Academy of Pediatrics, Rose SR; Section on Endocrinology and Committee on Genetics, American Thyroid Association, Brown RS; Public Health Committee, Lawson Wilkins Pediatric Endocrine Society, et al. Update of newbornscreening and therapy for congenital hypothyroidism. Pediatric 2006;117:2290-303.
17.Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1.500 gm. J Pediatr 1978;92:529–34.
18.Ericson JE, Laughon MM. Chorioamnionitis: implications for the neonate. Clin Perinatol 2015;42:155-65.
19.Männistö T, Mendola P, Reddy U, Laughon SK. Neonatal outcomes and birth weight in pregnancies complicated by maternal thyroid disease. Am J Epidemiol 2013;178:731-40.
20.Hatipoglu N, Büyükkayhan D, Kurtoglu S. Yenidogan Dönemi Tiroid Hastalıkları. Türkiye Klinikleri J Pediatr Sci 2006;2:63-82. 21.Kantor MJ, Leef KH, Bartoshesky L, Getchell J, Paul DA. Admission thyroid evaluation in very-low-birth-weight infants: association with death and severe intraventricular hemorrhage. Thyroid 2003;13:965-9.
22.Paul DA, Leef KH, Stefano JL, Bartoshesky L. Thyroid function in very-low-birth-weight infants with intraventricular hemorrhage. Clin Pediatr (Phila) 2000;39:651-6.
23.Wang F, Pan W, Wang H, Wang S, Pan S, Ge J. Relationship between thyroid function and ICU mortality: a prospective observation study. Crit Care 2012;16:R11.
24.Suvarna JC, Fande CN. Serum thyroid hormone profile in critically III children. Indian J Pediatr 2009;76:1217-21.
25.Kurt A, Aygun AD, Sengul I, Sen Y, Citak Kurt AN, Ustundag B. Serum thyroid hormones levels are significantly decreased in septic neonates with poor outcome. J Endocrinol Invest 2011;34:e92-6.
26.Taşcı Hİ, Erikoğlu M, Toy H, Karaibrahimoğlu A. Course of sepsis in rats with thyroid dysfunction. Turk J Surg 2017;33:175-9.
27.Dembinski J, Arpe V, Kroll M, Bartmann P, Hieronimi G. Thyroid function in healthy and sick very-low-birth-weight infants thyrotropin and free thyroxine levels until the sixth week of age. Biol Neonate 2001;80:210-4.
28.Ryckman KK, Spracklen CN, Dagle JM, Murray JC. Maternal factors and complications of preterm birth associated with neonatal thyroid stimulating hormone. J Pediatr Endocrinol Metab 2014;27:929-38.
29.Paul DA,Leef KH, Voss B, Stefano JL, Bartoshesky L. Thyroxine and illness severity in very low-birth-weight infants. Thyroid 2001;11:871-5.
30.Paul DA, Leef KH, Stefano JL, Bartoshesky L. Low serum thyroxine on initial newborn screening is associated with intraventricular hemorrhage and death in very low birth weight infants. Pediatrics 1998;101:903-7.

Evaluation of the Relationship Between Congenital Hypothyroidism and Intraventricular Hemorrhage in the Very Low Birth Weight Infants

Year 2019, Volume: 13 Issue: 2, 45 - 49, 26.03.2019

Ufuk Çakır

https://doi.org/10.12956/tchd.539041

Cited By: 1

Abstract

References

1. Belcari F, Placidi G, Guzzetta A, Tonacchera M, Ciampi M, Bartoli A, et al. Thyroid-stimulating hormone levels in the first days of life and perinatal factors associated with sub-optimal neuromotor outcome in preterm infants. J Endocrinol Invest 2011;34:e308-13.
2. Lee JH, Kim SW, Jeon GW, Sin JB. Thyroid dysfunction in very low birth weight preterm infants. Korean J Pediatr 2015;58:224-9.
3. Heidari Z, Feizi A, Hashemipour M, Kelishadi R, Amini M. Growth development in children with congenital hypothyroidism: the effect of screening and treatment variables-a comprehensive longitudinal study. Endocrine 2016;54:448-59.
4. Baysal BT, Baysal B, Genel F, Erdur B, Ozbek E, Demir K, et al. Neurodevelopmental Outcome of Children with Congenital Hypothyroidism Diagnosed in a National Screening Program in Turkey. Indian Pediatr 2017;54:381-4.
5. Osborn DA, Hunt RW. Prophylactic postnatal thyroid hormones for prevention of morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2007;(1):CD005948.
6. LaFranchi S. Thyroid function in the preterm infant. Thyroid 1999;9:71-8.
7. Hashemipour M, Hovsepian S, Ansari A, Keikha M, Khalighinejad P, Niknam N. Screening of congenital hypothyroidism in preterm, low birth weight and very low birth weight neonates: A systematic review. PediatrNeonatol 2018;59:3-14.
8. Vigone MC, Caiulo S, DiFrenna M, Ghirardello S, Corbetta C, Mosca F, et al. Evolution of thyroid function in preterm infants detected by screening for congenital hypothyroidism. J Pediatr 2014;164:1296-302.
9. Dhital R, Poudel DR, Tachamo N, Gyawali B, Basnet S, Shrestha P, et al. Ischemic Stroke and Impact of Thyroid Profile at Presentation: A Systematic Review and Meta-analysis of Observational Studies. J Stroke Cerebrovasc Dis 2017;26:2926-34.
10. Akirov A, Shochat T, Shechvitz A, Shimon I, Diker-Cohen T, Robenshtok E. Pre-admission TSH levels predict long-term mortality in adults treated for hypothyroidism. Endocrine 2017;58:481-7.
11. Weng CH, Chen YH, Lin CH, Luo X, Lin TH. Thyroid disorders and breast cancer risk in Asian population: a nationwide populationbased case-control study in Taiwan. BMJ Open 2018;8:e020194.
12. Suvarna JC, Fande CN. Serum thyroid hormone profile in critically Ill children. Indian J Pediatr 2009;76:1217-21.
13. Elbers LPB, Fliers E, Cannegieter SC. The influence of thyroid function on the coagulation system and its clinical consequences. J ThrombHaemost 2018;16:634-645.
14. Tan AP, Svrckova P, Cowan F, Chong WK, Mankad K. Intracranial hemorrhage in neonates: A review of etiologies, patterns and predicted clinical outcomes. Eur J Paediatr Neurol 2018;22:690- 717.
15. Guy VV, Johnny D. Pediatric endocrinology. In: Sperling MA, editor. Disorders of the thyroid in the newborn and infant. 4th ed. Philadelphia (PA): Saunders P, 2014:186-208.
16. American Academy of Pediatrics, Rose SR; Section on Endocrinology and Committee on Genetics, American Thyroid Association, Brown RS; Public Health Committee, Lawson Wilkins Pediatric Endocrine Society, et al. Update of newbornscreening and therapy for congenital hypothyroidism. Pediatric 2006;117:2290-303.
17.Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1.500 gm. J Pediatr 1978;92:529–34.
18.Ericson JE, Laughon MM. Chorioamnionitis: implications for the neonate. Clin Perinatol 2015;42:155-65.
19.Männistö T, Mendola P, Reddy U, Laughon SK. Neonatal outcomes and birth weight in pregnancies complicated by maternal thyroid disease. Am J Epidemiol 2013;178:731-40.
20.Hatipoglu N, Büyükkayhan D, Kurtoglu S. Yenidogan Dönemi Tiroid Hastalıkları. Türkiye Klinikleri J Pediatr Sci 2006;2:63-82. 21.Kantor MJ, Leef KH, Bartoshesky L, Getchell J, Paul DA. Admission thyroid evaluation in very-low-birth-weight infants: association with death and severe intraventricular hemorrhage. Thyroid 2003;13:965-9.
22.Paul DA, Leef KH, Stefano JL, Bartoshesky L. Thyroid function in very-low-birth-weight infants with intraventricular hemorrhage. Clin Pediatr (Phila) 2000;39:651-6.
23.Wang F, Pan W, Wang H, Wang S, Pan S, Ge J. Relationship between thyroid function and ICU mortality: a prospective observation study. Crit Care 2012;16:R11.
24.Suvarna JC, Fande CN. Serum thyroid hormone profile in critically III children. Indian J Pediatr 2009;76:1217-21.
25.Kurt A, Aygun AD, Sengul I, Sen Y, Citak Kurt AN, Ustundag B. Serum thyroid hormones levels are significantly decreased in septic neonates with poor outcome. J Endocrinol Invest 2011;34:e92-6.
26.Taşcı Hİ, Erikoğlu M, Toy H, Karaibrahimoğlu A. Course of sepsis in rats with thyroid dysfunction. Turk J Surg 2017;33:175-9.
27.Dembinski J, Arpe V, Kroll M, Bartmann P, Hieronimi G. Thyroid function in healthy and sick very-low-birth-weight infants thyrotropin and free thyroxine levels until the sixth week of age. Biol Neonate 2001;80:210-4.
28.Ryckman KK, Spracklen CN, Dagle JM, Murray JC. Maternal factors and complications of preterm birth associated with neonatal thyroid stimulating hormone. J Pediatr Endocrinol Metab 2014;27:929-38.
29.Paul DA,Leef KH, Voss B, Stefano JL, Bartoshesky L. Thyroxine and illness severity in very low-birth-weight infants. Thyroid 2001;11:871-5.
30.Paul DA, Leef KH, Stefano JL, Bartoshesky L. Low serum thyroxine on initial newborn screening is associated with intraventricular hemorrhage and death in very low birth weight infants. Pediatrics 1998;101:903-7.

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Details

Primary Language	Turkish
Subjects	Internal Diseases
Journal Section	ORIGINAL ARTICLES
Authors	Ufuk Çakır
Publication Date	March 26, 2019
Submission Date	October 12, 2018
Published in Issue	Year 2019 Volume: 13 Issue: 2

Cite

Vancouver	Çakır U. Çok Düşük Doğum Ağırlıklı Prematürelerde Konjenital Hipotiroidi İle İntraventriküler Kanama İlişkisinin Değerlendirilmesi. Türkiye Çocuk Hast Derg. 2019;13(2):45-9.

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https://doi.org/10.17826/cumj.1171931

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