Congenital hypothyroidism and necrotizing enterocolitis in infants born prematurely

Öz

Background and Aims: Hypothyroidism negatively impacts the gastrointestinal system. Moreover, the effect of congenital hypothyroidism on necrotizing enterocolitis is unknown. This study aimed to determine the effect of congenital hypothyroidism on necrotizing enterocolitis in infants who were born prematurely and had very low birthweight (< 1500 g). Materials and Methods: This retrospective study included infants who were born prematurely and weighed < 1500 g. In addition to the demographic and clinical characteristics of the patients, the
prevalence values of necrotizing enterocolitis between the congenital hypothyroidism and non-congenital hypothyroidism groups were compared. Results of the thyroid function tests were also compared between these groups. Results: A total of 626 premature infants (gestational age, 28.1 ± 1.2 weeks; birthweight, 1056 ± 228 g), including 26 with congenital hypothyroidism and 600 without congenital hypothyroidism, were enrolled in the study. The frequency of necrotizing enterocolitis (stage ≥ 2) was 2.5% (n = 16) among 626 infants. The gestational age and birthweight (27.2 ± 0.9 weeks and 1007 ± 208 g, respectively) of the congenital hypothyroidism group were significantly lower than those in the non-congenital hypothyroidism group (28.1 ± 1.2 weeks and 1075 ± 221 g, respectively) (p < 0.001, p = 0.035, respectively). The incidence of necrotizing enterocolitis was comparable between the congenital hypothyroidism and non-congenital hypothyroidism groups (3.8% and 2.5%, respectively, p = 0.415). Other demographic and clinical characteristics were also comparable (p > 0.05). In groups with and without necrotizing enterocolitis, no significant difference was detected on the levels of fT4 (1.08 ± 0.35 ng/dL and 1.15 ± 0.26 ng/dL, respectively) and thyroid-stimulating hormone (3.9 ± 2.8 µIU/L and 5.6 ± 4.5 µIU/L; p = 0.326 and p = 0.061, respectively). Conclusions: Our study did not find a relationship between congenital hypothyroidism and necrotizing enterocolitis development in infants who were born prematurely and had a very low birthweight.

Anahtar Kelimeler

• Premature infants
• congenital hypothyroidism
• very low birthweight
• necrotizing enterocolitis

Prematüre bebeklerde konjenital hipotiroidi ve nekrotizan enterokolit ilişkisi

Öz

Giriş ve Amaç: Hipotiroidinin gastrointestinal sistem üzerine olumsuz etkisi vardır. Konjenital hipotiroidinin nekrotizan enterokolit ile ilişkisi bilinmemektedir. Çalışmamızda çok düşük doğum ağırlıklı (< 1500 g) prematürelerde konjenital hipotiroidi ve nekrotizan enterokolit ile ilişkisinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmamıza < 1500 g doğan prematüre bebekler retrospektif olarak dahil edildi. Konjenital hipotiroidi olan ve olmayan gruplar nekrotizan enterokolit gelişimi, demografik ve klinik özellikler açısından karşılaştırıldı. Ayrıca nekrotizan enterokolit olan ve olmayan gruplar tiroid fonksiyon testleri açısından karşılaştırıldı. Bulgular: Çalışmaya 26 konjenital hipotiroidi olan ve 600 konjenital hipotiroidi olmayan toplam 626 prematüre bebek (gestasyon haftası 28.1 ± 1.2 hafta, doğum ağırlığı 1056 ± 228 g) dahil edildi. Altı yüz yirmi altı bebekte nekrotizan enterokolit (evre ≥ 2) sıklığı %2.5 (n = 16) olarak tespit edildi. Konjenital hipotiroidi olan grupta gebelik haftası ve doğum ağırlığı (27.2 ± 0.9 hafta ve 1007 ± 208 g) konjenital hipotiroidi olmayan gruba (28.1 ± 1.2 hafta ve 1075 ± 221 g) göre anlamlı düşük bulundu (sırasıyla, p < 0.001, p = 0.035). Nekrotizan enterokolit gelişim sıklığı konjenital hipotiroidi olan ve olmayan gruplar arasında benzerdi (sırasıyla, %3.8, %2.5, p = 0.415). Diğer demografik ve klinik özellikler açısından gruplar arasında sonuçlar benzer saptandı (p > 0.05). Nekrotizan enterokolit olan ve olmayan gruplarda serbest tiroksin düzeyleri (sırasıyla: 1.08 ± 0.35 ng/dl ve 1.15 ± 0.26 ng/dl) ve tiroid stimülan hormon düzeyleri (sırasıyla: 3.9 ± 2.8 uIU/L ve 5.6 ± 4.5 uIU/L) açısından istatistiksel olarak anlamlı fark tespit edilmedi (sırasıyla, p = 0.326, p = 0.061). Sonuç: Çalışmamızda çok düşük doğum ağırlıklı prematürelerde konjenital hipotiroidi ile nekrotizan enterokolit gelişimi arasında ilişki tespit edilmemiştir.

Anahtar Kelimeler

• Prematüre
• konjenital hipotiroidi
• çok düşük doğum ağırlığı
• nekrotizan enterokolit

Kaynakça

1. 1. Ergenekon E, Tayman C, Özkan H. Türk Neonatoloji Derneği. Nekrotizan enterokolit tanı, tedavi ve korunma rehberi. 2021;1-48.
2. 2. Kurtoğlu K, Özön A, Tekin N, Şıklar Z, Gülcan H, Kara C, Taştekin A, Demir K, Evliyaoğlu O, Koç E. Türk Neonatoloji Derneği. Gebelikte tiroid hastalıklarının yenidoğana etkileri ve TSH yüksekliği olan bebeğe yaklaşım. 2020;1-10.
3. 3. Köse Cetinkaya A, Kahvecioğlu D. Nucleated red blood cell levels in the diagnosis of patients with indirect hyperbilirubinemia. Minerva Pediatr 2021;Apr 15. Epub ahead of print.
4. 4. Yaylali O, Kirac S, Yilmaz M, et al. Does hypothyroidism affect gastrointestinal motility? Gastroenterol Res Pract 2009;2009:529802.
5. 5. Nakazawa N, Sohda M, Ogata K, et al. Thyroid hormone activated upper gastrointestinal motility without mediating gastrointestinal hormones in conscious dogs. Sci Rep 2021;11:9975.
6. 6. Maayan-Metzger A, Itzchak A, Mazkereth R, Kuint J. Necrotizing enterocolitis in full-term infants: case-control study and review of the literature. J Perinatol 2004;24:494-9.
7. 7. Wynn JL, Wong HR, Shanley TP, et al. Time for a neonatal-specific consensus definition for sepsis. Pediatr Crit Care Med 2014;15:523-8.
8. 8. Lubchenco LO, Hansman C, Dressler M, Boyd E. Intrauterine growth as estimated from liveborn birth-weight data at 24 to 42 weeks of gestation. Pediatrics 1963;32:793-800.

9. 9. 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, Foley T, Kaplowitz PB, Kaye CI, Sundararajan S, Varma SK. Update of newborn screening and therapy for congenital hypothyroidism. Pediatrics 2006;117:2290-303.
10. 10. Bell MJ, Ternberg JL, Feigin RD, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978;187:1-7.
11. 11. Korkmaz L, Akın MA, Güneş T, et al. Unusual course of congenital hypothyroidism and route of the L-thyroxine treatment in a preterm newborn. J Clin Res Pediatr Endocrinol 2014;6:177-9.
12. 12. Çakır U, Tayman C. The effect of thyroid functions on osteopenia of prematurity in preterm infants. J Pediatr Endocrinol Metab 2019;32:65-70.
13. 13. Nakazawa N, Sohda M, Ogata K, et al. Thyroid hormone activated upper gastrointestinal motility without mediating gastrointestinal hormones in conscious dogs. Sci Rep 2021;11:9975.
14. 14. Tenore A, Fasano A, Gasparini N, et al. Thyroxine effect on intestinal Cl-/HCO3- exchange in hypo- and hyperthyroid rats. J Endocrinol 1996;151:431-7.
15. 15. Tayman C, Çakır U. Do different blood groups affect the development of necrotizing enterocolitis? Med J SDU 2019;26:382-8.
16. 16. Cakir U, Tayman C, Yarci E, et al. Novel useful markers for follow-up of necrotizing enterocolitis: endocan and interleukin-33. J Matern Fetal Neonatal Med 2020;33:2333-41.
17. 17. Amer T, David R, Oberfield SE. Necrotizing enterocolitis and hypothyroidism in a newborn infant: treatment with intravenous L-thyroxine. Am J Perinatol 1994;11:30-2.
18. 18. Karp WB, Robertson AF, Kanto WP Jr. The effect of hydrocortisone, thyroxine, and phenobarbital on diamine oxidase activity in newborn rat intestine. Pediatr Res 1987;21:368-70.
19. 19. Noel Y, Zak Y, Yurman S, Feldman M. Neonatal hypothyroidism, necrotizing enterocolitis. Do they appear together? Early Human Development 2008;84:121-2.
20. 20. Kuint J, Sack J, Maayan-Metzger A. Early blood thyroxine concentration and necrotizing enterocolitis in premature infants. Acta Paediatr 2008;97:304-7.
21. 21. Yoon SA, Chang YS, Ahn SY, Sung SI, Park WS. Incidence and severity of transient hypothyroxinaemia of prematurity associated with survival without composite morbidities in extremely low birth weight infants. Sci Rep 2019;9:9628.
22. 22. Williams FL, Ogston SA, van Toor H, Visser TJ, Hume R. Serum thyroid hormones in preterm infants: associations with postnatal illnesses and drug usage. J Clin Endocrinol Metab 2005;90:5954-63.