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Hyperthyroxinemia at birth: a cause of idiopathic neonatal hyperbilirubinemia?

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Abstract

Background

Some neonates develop idiopathic hyperbilirubinemia (INHB) requiring phototherapy, yet with no identifiable 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 significant association between mode of delivery and INHB (vacuum-delivered neonates were a priori excluded). Nonetheless, in cesarean-delivered (CD) neonates, two variables had significant association 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 effect of mode of delivery on possible significant association with INHB. In CD neonates, such variables included: TT4 ≥ 13 µg/dL [P = 0.025, odds ratio (OR) 5.49, 95% confidence 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 < 9 (P < 0.001, OR 3.8, 95% CI 1.83–7.9), but not TT4, showed such an association.

Conclusions

INHB was significantly associated with birth on 38–38.6 week and TT4 (≥ 13 µg/dL) in CD neonates, and with a weight loss > 7.5% in VD neonates. We herein highlight some acknowledged risk factors for neonatal hyperbilirubinemia, and thus minimize the rate of INHB.

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Authors and Affiliations

  1. Department of Neonatology, Ruth Rappaport Children’s Hospital, Rambam Medical Center, Rambam Health Care Campus, Bat-Galim, 3109601, Haifa, Israel

    Irena Ulanovsky, Tatiana Smolkin & Imad R. Makhoul

  2. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

    Irena Ulanovsky, Tatiana Smolkin & Imad R. Makhoul

  3. National Newborn Screening Program, Public Health Services, Ministry of Health, Tel Hashomer, Israel

    Shlomo Almashanu

  4. Department of Epidemiology, Rambam Medical Center, Haifa, Israel

    Tatiana Mashiach

Authors
  1. Irena Ulanovsky
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  2. Tatiana Smolkin
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  3. Shlomo Almashanu
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  4. Tatiana Mashiach
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  5. Imad R. Makhoul
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Contributions

IRM proposed the project and wrote the paper. IU and TS contributed equally to this study and are first coauthors. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Imad R. Makhoul.

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Ethical approval

This study was approved by The Helsinki Committee. The informed consents were obtained from newborns’ parents.

Conflict of interest

The authors declare that they have no competing interests.

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Ulanovsky, I., Smolkin, T., Almashanu, S. et al. Hyperthyroxinemia at birth: a cause of idiopathic neonatal hyperbilirubinemia?. World J Pediatr 14, 247–253 (2018). https://doi.org/10.1007/s12519-017-0113-7

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  • DOI: https://doi.org/10.1007/s12519-017-0113-7

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