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Effect of Delayed Elevation of Thyrotropin on Feeding Intolerance in Very Low Birth Weight Infants

Purpose: We investigated the effect of delayed elevation of thyrotropin (TSH) (deTSH) on gastrointestinal motility in very low birth weight infants (VLBWI). Methods: This study retrospectively investigated 228 premature VLBWI aged ≥4 weeks with normal neonatal TSH screening test results and free serum thyroxine le­ vels. Infants with serum TSH levels ranging from 5 to 10 μIU/mL were categorized as the deTSH group (n=76), when TSH was measured at 4 (n=53), 8 (n=20), or 12 (n=3) weeks of age. Serum TSH levels in the control group (n=152) were <5 μIU/mL. Multi­ variate logistic regression analysis was used to determine the risk factors for the de­ velopment of deTSH. Covariance analysis was used to analyze the relationship between deTSH and gastrointestinal motility. Results: The mean gestational age and birth weight were 29.11±2.25 weeks and 1,157.4±218.0 g, respectively. Risk factors affecting deTSH were dopamine administra­ tion (odds ratio [OR], 8.71; 95% confidence inter val [CI], 1.80 to 42.05; P=0.007) and operation time (OR, 6.95; 95% CI, 1.43 to 33.75; P=0.016) when the cumulative operat­ ing time was ≥1 hour. The mean±standard deviation (SD) duration of a nil per os (NPO) status was significantly higher in the deTSH (99.57±134.99 hours) than in the control group (37.25±59.02 hours) (P from analysis of covariance [ANCOVA]=0.001). The mean±SD duration (33.84±22.34 days) of total parenteral nutrition (TPN) was considerably longer in the deTSH group than in the control group (27.68±13.08 days) (P from ANCOVA=0.003). Conclusion: Clinicians must consider deTSH in VLBWI showing feeding intolerance with a prolonged NPO and TPN status.