Context: Delayed TSH elevation (dTSH) is defined as elevated TSH in the second neonatal screen following normal TSH in the initial screen. A second screen in recommended for low-birth weight (BW) and preterm infants. We aimed to identify risk factors for the development of dTSH among newborns in the neonatal intensive care unit (NICU.(
Design, Setting and Patients: A retrospective chart review of neonates with dTSH was conducted in eight NICUs. Two controls were selected for each patient, matched for gender and gestational age (GA). The patients and controls were compared for maternal parameters, treatment in the NICU, procedures in the NICU and syndromes, malformations and a wide range of clinical emergencies.
Results: Three-hundred newborns were included in this study: 100 patients with dTSH and 200 matched controls. By Univariate analysis, twelve risk factors were significantly more common in the patients than the controls: caesarean section, mechanical ventilation, pneumothorax, patent ductus arteriosus (PDA), packed-cells administration and cefotaxime, vancomycin, fluconazole, dopamine, ibuprofen, furosemide and insulin treatment. The duration of treatment and dosage of the seven drugs were similar between the patients and controls. A stepwise logistic regression multivariate analysis revealed four risk factors that were associated with dTSH: PDA and administration of vancomycin, furosemide and insulin. The odds ratios of this risk factors ranged from 2.4 to 4.9.
Conclusions: The risk factors that are associated with dTSH have no common pathogenic pathway, and they reflect the severity of the clinical condition of the newborns in the NICU.
