Maternal thyroid dysfunction and neonatal thyroid problems.

Aim. To investigate obstetric features of pregnant women with thyroid disorders and thyroid function tests of their newborn infants. Methods. Women with hypothyroidism and having anti-thyroglobulin (ATG) and anti-thyroid peroxidase (anti-TPO) antibodies were assigned as group I, women with hypothyroidism who did not have autoantibodies were assigned as group II, and women without thyroid problems were assigned as group III. Results. Pregnant women with autoimmune hypothyroidism (group I) had more preterm delivery and their babies needed more frequent neonatal intensive care unit (NICU) admission. In group I, one infant was diagnosed with compensated hypothyroidism and one infant had transient hyperthyrotropinemia. Five infants (23.8%) in group II had thyroid-stimulating hormone (TSH) levels >20 mIU/mL. Only two of them had TSH level >7 mIU/L at the 3rd postnatal week, and all had normal free T4 (FT4). Median maternal TSH level of these five infants with TSH >20 mIU/mL was 6.6 mIU/mL. In group III, six infants (6.5%) had TSH levels above >20 mIU/mL at the 1st postnatal week. Conclusion. Infants of mothers with thyroid problems are more likely to have elevated TSH and higher recall rate on neonatal thyroid screening. Women with thyroid disorders and their newborn infants should be followed closely for both obstetrical problems and for thyroid dysfunction.

Does transient hypothyroxinemia influence metabolic bone disease of prematurity?

OBJECTIVE: To investigate the relationship between Metabolic Bone Disease (MBD) and Transient Hypothyroxinemia of Prematurity (THOP). METHOD: One hundred twenty-four infants, born in Marmara University Hospital with a gestational age ≤34 weeks, were enrolled. Clinical features were recorded. Serum TSH, free T4, total T4, calcium, phosphorus and total Alkaline Phosphatase (ALP) levels were determined in the first and third postnatal weeks. MBD was defined as a phosphorus level <4.5 mg/dl and/or ALP >900 IU/l. THOP was defined as a serum free and/or total thyroxine level lower than -1 SD for gestational age at the 7th postnatal day. RESULT: THOP was diagnosed in nineteen (15.3%) patients. MBD was diagnosed in 52 (41.9%) at the 3rd month. Low birth weight, low gestational age and prolonged parenteral nutrition were associated with MBD. Multivariate analysis documented a significant relationship solely between MBD and gestational age. CONCLUSION: The risk of MBD does not increase significantly in babies with THOP.

Iron deficiency anemia in late-preterm infants.

Iron deficiency anemia is a common problem in newborn infants. The American Academy of Pediatrics recommends iron prophylaxis at 4 months of age for term infants. There is no specific recommendation for iron prophylaxis in late-preterm infants. We aimed to establish the optimum time for iron prophylaxis in late-preterm infants. Thirty-eight late-preterm (Group 1) and 38 term (Group 2) infants born on the same day were enrolled in the study. Hemoglobin, ferritin and reticulocyte values at birth, 2nd month and 4th month were assessed. The cord ferritin, hemoglobin and reticulocyte levels did not differ significantly between groups. However, at the 2nd month, median ferritin and hemoglobin values were lower in late-preterm infants than term infants (145 mg/dl vs. 195 mg/dl, p=0.001 and 10.1 g/dl vs. 11.6 g/dl, p<0.001, respectively). Median ferritin levels were lower at the 4th month in latepreterm infants than term infants, but this difference was not significant after exclusion of three late- preterm infants who required iron therapy (49 mg/dl vs. 62 mg/dl, p=0.2). There was a tendency of higher frequency of anemia in late-preterm infants at 4 months (42.8% vs. 21.1%), but this was statistically insignificant (p=0.07). At the 2nd month of age, the median ferritin and hemoglobin levels of late-preterm infants were lower than those of term infants. Further studies with larger sample sizes are required to determine the need for earlier supplementation of iron in late-preterm infants.

Screening criteria for retinopathy of prematurity in developing countries.

PURPOSE: Retinopathy of prematurity (ROP) is a serious problem which potentially can lead to blindness. The objective of this study is to detect the incidence of ROP and the number of preterm babies requiring treatment for ROP in our center and to establish the screening criteria for our country. METHODS: A total of 801 babies with a gestational age less than 37 weeks were screened for ROP. Babies with a gestational age (GA) less than 32 weeks (n=348) were assigned as group 1. Babies with a GA between 32 and 34 weeks (n=335) were assigned as group 2 and between 35 and 37 weeks (n=98) were assigned as group 3. Clinical features and ROP screening results of the cases were documented. RESULTS: In group 1, ROP was detected in 176 (50.9%) babies, 41 (11.8%) of whom were treated with laser/cryotherapy. In group 2, 83 (25%) cases of ROP were detected, and 11 of them (3.1%) required therapy. In group 3, 9 (9.1%) infants were diagnosed with ROP, and none of them required treatment. Clinical factors associated with ROP in group 1 were gestational age, birthweight, duration of ventilation, duration of oxygen supplementation, sepsis, and bronchopulmonary dysplasia. CONCLUSIONS: In developing countries, the criteria for ROP screening programs should be designed according to local conditions. In our country, screening all premature babies with a gestational age less than 34 weeks or a birthweight less than 1850 g appears to be appropriate.