| Objective:To retrospectively analyze the screening results and treatment follow-up of neonatal congenital hypothyroidism(CH)in Zhengzhou city from 2013 to 2019,and to explore the early predictors of CH classification for the prevention of CH and treatment to provide a reasonable basis for further research on CH in Zhengzhou City to provide reliable data.Method:1.Analysis of CH screening results in Zhengzhou City from 2013 to 2019: The disease screening data of neonates who were born and diagnosed with CH from January 1,2013 to December 31,2019 in Zhengzhou were retrospectively analyzed,as well as the treatment and follow-up of the children after diagnosis.The basic information(date of birth,gender,gestational age,birth weight,thyroid color Doppler ultrasound results,etc.)of children with CH were counted,and Excel and SPSS 25.0 were used for descriptive statistical analysis of the data.2.Analysis of the treatment effect of CH children and the predictors of CH classification:2.1 Statistics of CH children diagnosed at the Neonatal Disease Screening Center of Zhengzhou Obstetrics and Gynecology Hospital Affiliated to Henan University from January 1,2014 to December 31,2018.The children were divided into three groups: group 1(101 cases in the 0<Day≤15 group),group 2(170cases in the 15<Day≤30 group),and group 3(21 cases in the 30<Day≤60 group).The levels of thyroid function items(thyrotropin,free thyroxine,free triiodothyronine)at 6 months,12 months,and 24 months of age were compared among the three groups,and the values of height,weight and developmental screening test(DST)results at 12 months of age were compared.2.2 Children who meet the following criteria enter the study: From January 1,2014 to December31,2016,the patients were diagnosed at the Neonatal Disease Screening Center of Zhengzhou Obstetrics and Gynecology Hospital Affiliated to Henan University,and were treated with levothyroxine sodium(L-T4)tablets and followed up for 2 years.According to the results of follow-up for half a year after drug discontinuation,the children were divided into two types: permanent hypothyroidism(PCH)and temporary hypothyroidism(TCH).The L-T4 dose in the first year of treatment was compared and analyzed.At the same time,the L-T4 dose and TSH at the time of diagnosis were combined to analyze the early prediction effect of the two in differentiating CH types.Result:Part 1: Analysis of CH screening results in Zhengzhou City from 2013 to 20191.From 2013 to 2019,835,591 newborns in Zhengzhou were screened for CH,and 602 cases were diagnosed.The incidence of CH was 1/1405,compared with the incidence rate of 1/3337 in Henan Province and the national incidence rate of 1/2034,there are statistical significance.2.The number of newborns who participated in CH screening fluctuated year by year,the year with the highest incidence was 2014(1/882),and the year with the lowest incidence was 2013(1/2907).3.Among the 602 cases of CH diagnosed in Zhengzhou,the number of cases in cold seasons(autumn and winter)is higher than that in warm seasons(spring and summer).4.Among the children diagnosed with CH,337 were boys and 265 were girls,with a ratio of about1.3:1.The incidence of CH in boys and girls was 1/1323 and 1/1508,respectively,with a statistically significant difference.The incidence of CH in low birth weight infants was 1/115,which was higher than that in normal birth weight infants and macrosomia.The incidence of CH in children with gestational age <37weeks was 1/134,which was higher than that in children with gestational age ≥37 weeks.5.79.05% of children diagnosed with CH were moderate;70.63% of children with CH had normal color Doppler ultrasound results.Part 2: Analysis of treatment effect in children with CH and discussion of predictors of CH classification1.Three groups(0<Day≤15,15<Day≤30,30<Day≤60)had no significant differences in the three items of thyroid function at the age of 6 months,12 months and 24 months(P>0.05).2.Compared with group 1(0<Day≤15)and group 2(15<Day≤30),there was no significant difference in the height and weight of boys and girls at 12 months of age(P>0.05).3.Within 2 months after birth,there were no significant differences in the scores of exercise,social adaptation,and intellectual ability,as well as in developmental age,among the three groups of children with different treatment timings(P>0.05).4.There was no significant difference between the children with permanent hypothyroidism and temporary hypothyroidism in terms of birth season and age at the time of initial administration(P>0.05).There were statistically significant differences in gender,gestational age,birth weight,TSH at diagnosis,FT4 at diagnosis,and initial dose(P<0.05).5.The serum TSH level of the children at the time of diagnosis of CH(optimal cut-off value:20.174UIU/L;AUC,0.860;sensitivity,98.3%;specificity,61.2%)and L-T4 dose in the 12 th month after diagnosis(best cutoff value: 17.75ug/d;AUC,0.879;sensitivity,75.9%;specificity,87.8%)can be used to differentiate between two different types of CH(PCH and TCH).There was no statistically significant difference in the area under the ROC curve of the two applications(P=0.467).The combined prediction accuracy of the two(0.919±0.021)was higher than that of TSH alone at the time of diagnosis level(0.860±0.026,P=0.005)or L-T4 dose in the 12 th month after diagnosis(0.879±0.028,P=0.028).Conclusion:1.Reducing the number of premature infants and low birth weight infants reduces the incidence of CH.2.Combining a variety of clinical data is helpful to accurately determine the severity of the disease in children with CH.3.After the diagnosis of CH,treatment should be started within 2 months of birth.4.Combined application of L-T4 dose at 12 months after birth and TSH level at diagnosis can predict the classification of permanent hypothyroidism and temporary hypothyroidism. |
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