The Causal Relationship Between Over Incidence of Necrotizing Enterocolitis (NEC) and Hypothyroidism Elena NUEL MD, Erez NADIR MD, Shmuel YURMAN MD, Michael FELDMAN MD Department of Neonatology Hillel Yaffe Medical Center Hadera, Israel
Background: l l l NEC of large and small intestines, is an emergency situation in the newborn's digestive systems. Currently the etiology is unknown, and treatment is far from effective. Former research confirmed that thyroid gland hormones are essential for normal nervous system's development in fetus and infant.
Infant with Necrotizing Enterocolitis (NEC)
Background, continued l Hypothyroidism causing a decrease in electrical and mechanical activity in the digestive system may in turn cause a decrease of peristalsis; ileus; meteorism of the stomach and the lessening of blood to the intestinal lining. l Immediately after birth, thyroxin and thyrotropin levels change significantly. 80% of premature infants during their first 3 -8 weeks are in state of Transient Hypothyroxinemia (TH). The lower the week of birth, the increase in TSH is smaller as are the levels of T 4 and T 3
Infant with congenital hypothyroidism
Gross pathology of neonatal necrotizing enterocolitis. Close up of intestine of infant showing necrosis and pneumatosis intestinalis. Autopsy
Methods: Retrospective study including: l Hospitalized newborn patient files from Hillel Yaffe between 1995 – 2005 l Patient files from 2 additional hospitals (Liniado, Netanya and B’nai Tsion, Haifa) between 2001 -2005
Methods, continued Inclusion criteria: l Newborns defined by Bell's Classification as NEC levels 2 -3 l 71 infants with diagnosis at discharge of NEC from 3 neonatal units l 28 were excluded due to: • • • 16 NEC grade I 10 missing thyroid functioning test 2 died d/t NEC before blood sampling
The 43 cases included: l Gestational age between 24 -42 weeks
Breakdown of the birth weight of cases in our study l Birth weight between 730 -3825 grams.
Methods, continued: l l The results of TSH levels and FT 4 taken from the National Newborn Survey Normal levels of FT 4 >5 ng/dl Normal level of TSH < 20 m. U/L Historical control: • • Hypothyroidism incidence 1: 3500 at birth Transient hypothyroxinemia in premature infants between 58 -84%
Results l 18 (41. 8%) had poorly functioning thyroid glands: • • 15 (34. 9%) had TH 3 (6. 9%) had true congenital hypothyroidism
Results True congenital hypothyroidism
Conclusions: l In our study group, TH incidence was lower than previously reported. l However, we found the incidence of congenital Hypothyroidism, statistically significantly higher than historical control.
Conclusion, continued: l This study raises the possibility that thyroid gland dysfunction may be greater among infants suffering of NEC grades II-III l A multi-center study may resolve this enigma
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