Neonatal Med.  2019 May;26(2):102-110. 10.5385/nm.2019.26.2.102.

Effect of Delayed Elevation of Thyrotropin on Feeding Intolerance in Very Low Birth Weight Infants

• Hyun JK
• Choi SY
• Jung YJ
• Lee JH

• KMID: 2451608
• DOI: http://doi.org/10.5385/nm.2019.26.2.102

Abstract

PURPOSE
We investigated the effect of delayed elevation of thyrotropin (TSH) (deTSH) on gastrointestinal motility in very low birth weight infants (VLBWI).
METHODS
This study retrospectively investigated 228 premature VLBWI aged ≥4 weeks with normal neonatal TSH screening test results and free serum thyroxine levels. Infants with serum TSH levels ranging from 5 to 10 µIU/mL were categorized as the deTSH group (n=76), when TSH was measured at 4 (n=53), 8 (n=20), or 12 (n=3) weeks of age. Serum TSH levels in the control group (n=152) were <5 µIU/mL. Multivariate logistic regression analysis was used to determine the risk factors for the development of deTSH. Covariance analysis was used to analyze the relationship between deTSH and gastrointestinal motility.
RESULTS
The mean gestational age and birth weight were 29.11±2.25 weeks and 1,157.4±218.0 g, respectively. Risk factors affecting deTSH were dopamine administration (odds ratio [OR], 8.71; 95% confidence interval [CI], 1.80 to 42.05; P=0.007) and operation time (OR, 6.95; 95% CI, 1.43 to 33.75; P=0.016) when the cumulative operating time was ≥1 hour. The mean±standard deviation (SD) duration of a nil per os (NPO) status was significantly higher in the deTSH (99.57±134.99 hours) than in the control group (37.25±59.02 hours) (P from analysis of covariance [ANCOVA]=0.001). The mean±SD duration (33.84±22.34 days) of total parenteral nutrition (TPN) was considerably longer in the deTSH group than in the control group (27.68±13.08 days) (P from ANCOVA=0.003).
CONCLUSION
Clinicians must consider deTSH in VLBWI showing feeding intolerance with a prolonged NPO and TPN status.

Keyword

Infant, very low birth weight; Thyrotropin; Dopamine; Parenteral nutrition

MeSH Terms

Birth Weight
Dopamine
Gastrointestinal Motility
Gestational Age
Humans
Infant*
Infant, Very Low Birth Weight*
Logistic Models
Mass Screening
Parenteral Nutrition
Parenteral Nutrition, Total
Retrospective Studies
Risk Factors
Thyrotropin*
Thyroxine
Dopamine
Thyrotropin
Thyroxine

Figure

• 

  Figure 1. Flowchart showing the study population. This study enrolled 382 premature infants. We excluded 154 infants with history of maternal thyroid disease and/or congenital anomalies, those with hypothyroxinemia, those with congenital hypothyroidism, and those who died. The infants were categorized into two groups on the basis of their serum thyrotropin levels. GA, gestational age; BW, birth weight; TSH, thyroid stimulating hormone; FT4, free thyroxine 4; TFT, thyroid function test.

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