Nonthyroidal illnesses syndrome in full-term newborns with sepsis

We included 28 NT with sepsis divided into 2 groups according to the time of normalization of serum and clinical indicators of infection: group A(A), 16 NT with improvement in up to 8 days; and group B(B), 12 NT improvement after 8 days. Among the 28 NT, 15 NT progressed to septic shock, with 5 NT group A and 10 NT in group B. NT were excluded when they showed severe sepsis and asphyxia, and congenital malformations, as well as those whose mothers had thyroid disease and IUGR.

Results

17 NT (60.7%) presented NTIS. Low T3 was observed in NTIS in 10 NT (58.8%), and low T4 and T3 in 5 NT (29.5%), all of them with septic shock. Two NT showed mixed changes (11.7%). After sepsis was cured, there was no hormonal change, except in 3 NT. Administration of dopamine, furosemide, and corticosteroids did not affect the results.

Conclusions

This study indicates that nonthyroidal illness syndrome may be transiently present during sepsis in full-term newborns, especially in cases of prolonged sepsis. Low T3 can occur without changes in reverse T3 (different from adults), and low T4 and T3 occur mainly in patients with septic shock. Arch Endocrinol Metab. 2015;59(6):528-34

Full-term newborn; thyroidal hormone; sepsis; septic shock

Data	Group	Median	Standard deviation	Mean	Standard error	Range	P
Weight grams	A	3514	1062.7	3450	200.83	1740 – 6500
Weight grams	B	3303	935.7	3342	132.24	1740 – 6500	0.16
Age days	A	24.7	15.62	21.5	2.95	5 – 66
Age days	B	35.12	24.35	31	3.44	5 – 65	0.13
Temperature > 38.5ºC	A	38.7	0.34	38.5	0.13	38.5 – 39.3
Temperature > 38.5ºC	B	38.6	0.32	38.5	0.18	38.5 – 39.4	0.40
Temperature < 36.0ºC	A	35.5	0.17	35.5	0.08	35.3 – 35.8
Temperature < 36.0ºC	B	35.6	0.20	35.7	0.09	35.4 – 35.8	0.20
Heart rate	A	186.5	7.42	186.0	1.20	184 – 190
Heart rate	B	191.6	7.08	190.5	3.70	182 – 203	0.15
Respiratory rate	A	66.9	14.1	65.0	3.32	43 – 90
Respiratory rate	B	66.3	13.1	69.0	4.58	44 – 88	0.45
Leukocytosis	A	25010	3808.7	22500	1956.2	21700 – 32100
Leukocytosis	B	25792	5313.7	25800	1458.0	20900 – 42490	0.75
Leukopenia	A	3485	1110.2	3485	785.0	2700 – 4270
Leukopenia	B	*	*	*	*	*
	A	0.45	0.38	0.28	0.15	0.14 – 1.50
	B	0.20	0.33	0.16	0.004	0.15 – 0.40	0.20
Reactive protein C	A	74.2	83.83	38.40	25.0	12.60 – 260.20
Reactive protein C	B	108,4	70,89	57,70	27,0	13,20 – 261,10	0.18

Hormone variable	Median ± standard deviation
Hormone variable	Group A (1)		Group B (2)		Cure (3)		P
Sepsis in newborns with low T3
T3 (nmol/L)		0.86 ± 0.12		0.64 ± 0.126	2.59 ± 0.32		1 vs 2: > 0.05 2 vs 3: < 0.001 1 vs 3: < 0.001
T4 (nmol/L)		140.1 ± 37.3		133.7 ± 68.4	160.81 ± 31.78		1 vs 2: > 0.05 2 vs 3: > 0.05 1 vs 3: > 0.05
Reverse T3 (ng/dL)		144.34 ± 66.9		79.48 ± 9.6	119.12 ± 48.1		1 vs 2: > 0.05 2 vs 3: > 0.05 1 vs 3: > 0.05
TSH (mUI/L)		0.043 ± 0.04		0.044 ± 0.01	0.042 ± 0.04		1 vs 2: > 0.05 2 vs 3: > 0.05 1 vs 3: > 0.05
Sepsis in newborns with low T4 and T3
T4 (nmol/L)		221.36 ± 0.0		70.2 ± 6.4		184.68 ± 10.29		1 vs 2: > 0.05 2 vs 3: < 0.001 1 vs 3: < 0.001
T3 (nmol/L)		0.75 ± 0.01		0.64 ± 0.14		2.26 ± 0.12		1 vs 2: > 0.05 2 vs 3: < 0.001 1 vs 3: < 0.001
Reverse T3 (ng/dL)		114.5 ± 3.5		80.46 ± 2.9		76.0 ± 1.3		1 vs 2: > 0.05 2 vs 3: > 0.05 1 vs 3: < 0.01
TSH (mUI/L)		0.084 ± 0.0		0.03 ± 0.13		0.28 ± 0.06		1 vs 2: > 0.05 2 vs 3: > 0.05 1 vs 3: > 0.05
Sepsis in newborns with mixed change
T4 (nmol/L)		103.5 ± 0.01		204.3 ± 6.43		130.21 ± 7.72		1 vs 2: < 0.01 2 vs 3: > 0.05 1 vs 3: > 0.05
T3 (nmo/L)		2.04 ± 0.0		7.34 ± 0.0		2.20 ± 0.69		1 vs 2: > 0.05 2 vs 3: > 0.05 1 vs 3: > 0.05
Reverse T3 (ng/dL)		76.5 ± 0.0		125.5 ± 0.0		61.0 ± 0.0		* Few cases
TSH (mUI/L)		0.56 ± 0.0		0.77 ± 0.00		0.43 ± 0.04		1 vs 2: > 0.05 2 vs 3: > 0.05 1 vs 3: > 0.05

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[1] Correspondence to: Maria Helena Baptista Nunes da Silva. Rua Crasso, 378. 05043-010 – São Paulo, SP, Brasil.dramariahelena@gmail.com