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A practical gestational age-based algorithm for timely detection of hypothyroidism in premature infants

Journal of Perinatology (2024)Cite this article

Subjects

Abstract

Objectives

To assess utility and accuracy of a gestational age-based screening targeting premature infants to detect congenital hypothyroidism.

Study design

A prospective cohort study was conducted in infants <35 weeks’ gestational age with clinical outcomes at 2–3 years of age. Patients received newborn screenings at 24 hours and 10–14 days of life. Free T4 (FT4) and thyroid-stimulating hormone (TSH) levels were measured at one month of life and repeated based on algorithm by corrected gestational age.

Results

Among infants <35 weeks gestation (n = 938), the incidence of hypothyroidism requiring treatment was 1:58. TSH levels at one month of age was predictive of treatment (AUC 0.96, 95% CI 0.88–1). The optimal TSH threshold of 8 mIU/L (8 µU/ml) increased the specificity to 0.97 and sensitivity to 0.88. Following initiation of treatment for hypothyroidism during NICU hospitalization, 43.8% (n = 7) were diagnosed with permanent congenital hypothyroidism.

Conclusions

Our study supports a gestational age-based screening algorithm for early detection of hypothyroidism in premature infants.

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Data availability

Proposals should be directed to Avni.R.Shah@uth.tmc.edu. To gain access, data requestors will need to sign a data access agreement. Data are available for 5 years at a third-party website.

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Author information

Authors and Affiliations

  1. Division of Pediatric Endocrinology, Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA

    Avni N. Shah

  2. Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA

    Wen Li

  3. Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), University of Texas Health Science Center at Houston, Houston, TX, USA

    Wen Li

  4. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA

    Denise Zheng, Sana Lalani & Tina O. Findley

  5. Department of Psychiatry, Case Western Reserve University - University Hospitals, Cleveland, OH, USA

    Denise Zheng

  6. Department of Pediatrics, University of Wisconsin – Madison, Madison, WI, USA

    Dinushan C. Kaluarachchi

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  1. Avni N. Shah
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  6. Tina O. Findley
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Contributions

ANS, TOF contributed to the study’s conception, design, investigation, drafted, and revised the final manuscript. WL performed data curation, statistical analysis, drafted, and revised the manuscript. SL and DZ contributed to the study’s design, performed data curation, and reviewed the manuscript. DCK supervised, edited, and revised the manuscript. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Avni N. Shah.

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Competing interests

Dinushan Kaluarachchi, MBBS serves as a consultant for ONY Biotech, Inc. Wen Li was partially supported by UL1TR003167.

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Shah, A.N., Li, W., Zheng, D. et al. A practical gestational age-based algorithm for timely detection of hypothyroidism in premature infants. J Perinatol (2024). https://doi.org/10.1038/s41372-024-01985-5

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  • DOI: https://doi.org/10.1038/s41372-024-01985-5

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