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Hyperthyroxinemia at birth: a cause of idiopathic neonatal hyperbilirubinemia?

World Journal of Pediatrics 2018年第3期14卷 247-253页

作者： Irena Ulanovsky tatiana Smolkin Shlomo Almashanu tatiana mashiach Imad R.Makhoul Department of Neonatology Ruth Rappaport Children's HospitalRambam Medical CenterRambam Health Care CampusBat-Galim3109601 HaifaIsrael Rappaport Faculty of Medicine Technion-Israel Institute of TechnologyHaifaIsrael National Newborn Screening Program Public Health ServicesMinistry of HealthTel HashomerIsrael Department of Epidemiology Rambam Medical CenterHaifaIsrael

Background Some neonates develop idiopathic hyperbilirubinemia (INHB) requiring phototherapy, yet with no identifi able causes. We searched for an association between abnormal thyroid levels after birth and INHB. Methods Of 5188 neonates, 1681 (32.4%) were excluded due to one or more risk factors for hyperbilirubinemia. Total thyroxine (TT4) and thyroid stimulating hormone values were sampled routinely at 40-48 hours of age and measured in the National Newborn Screening Program. Results Of the 3507 neonates without known causes for hyperbilirubinemia, 61 (1.7%) developed INHB and received phototherapy. Univariate analyses found no signifi cant association between mode of delivery and INHB (vacuum-delivered neonates were a priori excluded). Nonetheless, in cesarean-delivered (CD) neonates, two variables had signifi cant asso-ciation with INHB: TT4 ≥ 13 μg/dL and birth at 38-38.6 weeks. In vaginally delivered (VD) born neonates, INHB was associated with weight loss > 7.5% up to 48 hours of age. Multivariate logistic regression analysis showed a strong eff ect of mode of delivery on possible signifi cant association with INHB. In CD neonates, such variables included: TT4 ≥ 13 μg/dL [P = 0.025, odds ratio (OR) 5.49, 95% confi dence interval (CI) 1.23-24.4] and birth at 38-38.6 weeks (P = 0.023, OR 3.44, 95% CI 1.19-9.97). In VD neonates, weight loss > 7.5% (P = 0.019, OR 2.1, 95% CI 1.13-3.83) and 1-min Apgar score 7.5% in VD neonates. We herein highlight some acknowledged risk factors for neonatal hyperbilirubinemia, and thus minimize the rate of INHB.

关键词： Hyperbilirubinemia Neonate Phototherapy Thyroid hormone

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