Clinical Features Of Neonates And Mothers On The Thyroid Stimulating Hormone Level

Objective:To investigate the clinical features of neonates and mothers on the screening result of congenital hypothyroidism,and to provide a basis for the diagnosis of congenital hypothyroidism.Methods:From January 2016 to November 2017,a total of 9936 live births were delivered at the Tianjin Tanggu Obstetrics and Gynecology Hospital.After the family's consent was signed,all the neonates were collected the normal heel blood for neonatal thyroid stimulating hormone screening.In this study,206 cases of neonates with positive thyroid stimulating hormone screening were included,and 206 cases of neonates with negative thyroid stimulating hormone screening were randomly selected over the same period as the normal control group according to 1:1 ratio.The TSH initial screening method refers to the"Technical Specification for Neonatal Disease Screening(2010 Edition)".After full birth lactation,within 3 to 7 days after birth,regular collected the neonatal heel blood with aseptic technique,drop and fully penetrate into the filter paper,and blood cards were collected and sent to the Tianjin Women and Children Health Care Center by the specialist.Blood thyroid stimulating hormone was tested by immunofluorescence method,TSH?9 mIU/L means neonatal screening positive,the information was sent to our center immediately,and then collected the heel blood and tested again.If the result of thyroid stimulating hormone is still higher than the value,the neonate was indicated as congenital hypothyroidism suspicious,and then recalled for congenital hypothyroidism diagnosis.Congenital hypothyroidism diagnosis method was collected neonatal fasting venous blood and centrifuged,automatic chemiluminescence immune analyzer was used to determine thyroid stimulating hormone,free triiodothyronine(FT3)and free thyroxine(FT4).Refer to the diagnostic criteria for congenital hypothyroidism of the European academy of pediatric endocrinology in 2014.When thyroid stimulating hormone is increased,both free triiodothyronine and free thyroxine are decreased,then the diagnosis is congenital hypothyroidism.When thyroid stimulating hormone is increased,both free triiodothyronine and free thyroxine are normal,and the diagnosis is hyperthyrotropinemia(HT).The data is statistically analyzed using SPSS 21.0 software.The Shapero-Wilk test was used for continuous variable and the normal distribution.The normal data is described as mean±standard deviation(x±s),an independent sample t test is used.If the data is not normal distribution,it is described as the median(P25,P75),and Mann-Whitney U rank sum test analysis is used.Disaggregated data are expressed in the number of cases(%),and?~2 test or Fisher's exact test is used.Multiple factors analysed the influence on neonatal thyroid stimulating hormone levels by neonates and mother's complications,and P<0.05 was treated as statistically significant.Results:1.There were 206 cases of neonates with heel blood thyroid stimulating hormone positive,the positive rate was 2.07%,and the average thyroid stimulating hormone was(10.07±1.58)mIU/L.The clinical data analysis of the two groups of neonates showed that the positive thyroid stimulating hormone screening neonates'body weight was(3277±536.60)g,which was significantly lower than the normal neonate with thyroid stimulating hormone screening(t=2.08,P<0.05),but there was no statistically significant difference in the sex,gestational age,preterm birth and expired birth of the newborn(P>0.05).Further analysis showed that the proportion of low birth weight infants(16.99%)with positive thyroid stimulating hormone screening was significantly higher than that with normal screening(5.83%,?~2=12.14,P<0.05),there was no significant difference in giant weight ratio between the two groups(4.37%vs.6.80%,?~2=0.59,P>0.05).2.There were 3 complications of 206 cases with thyroid stimulating hormone screening positive neonates'mothers,72 cases of anemia(34.95%),56 cases of gestational diabetes(27.18%)and 26 cases of thyroid disease(12.62%).Thyroid disease included 11 cases of hypothyroidism(5.34%),9 cases of subclinical hypothyroidism(4.37%),2 cases of hyperthyroidism(0.97%).However,random samples of 206 mothers of normal newborns with heel blood thyroid stimulating hormone screening,64 cases of anemia(31.07%),41 cases of gestational diabetes(19.90%)and 12 cases of thyroid diseases(5.83%).Thyroid diseases included 3cases of hypothyroidism(1.46%),8 cases of subclinical hypothyroidism(3.88%)and 1 case of hyperthyroidism(0.49%).The clinical data of two groups analysis showed that the rate of hypothyroidism,and the level of thyroid stimulating hormone were higher in the thyroid stimulating hormone positive group,and lower free triiodothyronine and free thyroxine levels than normal thyroid stimulating hormone screening group(P<0.05).In addition,there was no statistical difference between two groups of mothers with anemia,gestational diabetes,subclinical hypothyroidism and hyperthyroidism,and hemoglobin,fasting glucose(P>0.05).3.There were 8 cases were confirmed as congenital hypothyroidism in 206 cases of thyroid stimulating hormone screening positive neonates,and the test rate was1/1242.Average thyroid stimulating hormone in venous blood of congenital hypothyroidism neonatal venous blood was(13.53±4.11)mIU/L,and average free triiodothyronine was(2.20±0.23)pmol/L;and average free thyroxine was(6.20±2.53)pmol/L.Although the body weight of the 8 cases diagnosed with congenital hypothyroidism was in the normal range,but still lower than the normal neonatal.The rate of hypothyroidism in the congenital hypothyroidism group was 37.50%,significantly higher than that in the normal neonatal group(4.04%),and the thyroid stimulating hormone level was higher,free triiodothyronine and free thyroxine levels were lower(P<0.05).There was no statistically significant difference in the ratio of sex,gestational age,maternal subclinical hypothyroidism and hyperthyroidism between the congenital hypothyroidism group and the normal neonates(P>0.05).Conclusion:1.Neonatal low body weight and mother with hypothyroidism significantly affect the screening and diagnose of congenital hypothyroidism.We should pay special attention to these people,and to avoid missed diagnosis of congenital hypothyroidism.2.For low birth weight infants with positive TSH screening in heel blood,it is necessary to test neonatal thyroid function again.