新生儿高促甲状腺素血症治疗决策及其影响因素OA

Objective To investigate the treatment decision-making and influencing factors of neonatal hyperthyrotropinemia(HT),and to provide evidence for treatment indication assessment and timing selection.Methods A total of 103 neonates with HT who were hospitalized in the Department of Neonatology,Shanxi Bethune Hospital,from June 1,2014 to June 1,2024 were enrolled.According to whether levothyroxine(L-T4)treatment was required,the patients were divided into a spontaneous recovery group(patients whose thyroid function returned to normal spontaneously)and a treatment group(patients requiring drug therapy to achieve normalization).Multivariate Logistic regression analysis was performed to identify treatment decision-making factors and influencing factors.Receiver operating characteristic(ROC)curves and the area under the curve(AUC)were used to evaluate predictive value.Results Compared with the spontaneous recovery group,neonates in the treatment group had lower birth weight,higher initial screening thyroid-stimulating hormone(TSH)concentrations,and higher proportions of respiratory distress history,cesarean delivery,and maternal hypothyroidism during pregnancy,with statistically significant differences(Z/χ2 values ranging from-3.582 to 8.005,P<0.05).Multivariate Logistic regression analysis showed that higher initial screening TSH concentration,cesarean delivery,and maternal hypothyroidism during pregnancy were independent risk factors for requiring L-T4 treatment in neonates with HT(OR=1.351,4.673,and 6.688,respectively,P<0.05),whereas higher birth weight was a protective factor(OR=0.213,P<0.05).ROC curve analysis demonstrated that the AUCs of birth weight,initial screening TSH concentration,and their combined prediction were 0.699,0.728,and 0.874,respectively;the corresponding specificities were 0.759,0.862,and 0.793,and the sensitivities were 0.703,0.581,and 0.865,respectively.Conclusion Neonates with HT whose thyroid function normalized spontaneously tended to have higher birth weight and lower initial screening TSH concentrations.The combination of these two indicators may serve as a reference for medication decision-making.In addition,close follow-up should be emphasized for neonates delivered by cesarean section and those born to mothers complicated with hypothyroidism during pregnancy,and levothyroxine treatment should be administered when necessary.