Transient hypothyroxinemia of prematurity and histological chorioamnionitis

Background: Transient hypothyroxinaemia of prematurity (THOP) is a common condition of preterm infants whose causes remain unclear. We tested the hypothesis that THOP is associated with histological chorioamnionitis (HCA). Methods: Whole blood T-4 and TSH concentrations on day 4 and at 40 weeks' postmenstrual age (rtx-T4 and rtx-TSH), placental histology and illness severity were prospectively evaluated in 155 very low birth weight (VLBW) infants. Results: HCA-positive infants showed significantly decreased blood total T-4 concentrations on day 4, as compared to the HCA-negative population (P < 0.0001), along with comparable TSH, rtx-T-4, and rtx-TSH blood concentrations. None of the infants showed evidence of hypothyroidism during the study. A total T-4 <= 4.4 mu g/dL on postnatal day 4 identified HCA-positive newborns with 90.8%, sensitivity, 94.7%, specificity, 96.7% positive predictive and 85.7% negative predictive values. HCA ( OR: 32.19; 95% CI: 8.95 - 115.64), birth weight <= 880 g ( OR: 4.1; 1.15 - 14.64), and RDS ( OR: 3.71, 95% CI: 1.13 - 12.25) were independently associated with evidence of hypothyroxinaemia on day 4. Conclusion: Our findings indicate a previously unrecognized relationship between HCA and THOP, hence suggesting a predominant role for a fetal systemic inflammatory response syndrome in the pathogenesis of THOP.