Ufuk CAKIR, CÜNEYT TAYMAN, Mehmet BÜYÜKTİRYAKİ

ÇOK DÜŞÜK DOĞUM AĞIRLIKLI YENİDOĞANLARDA KONJENİTAL HİPOTİROİDİ VE PREMATÜRE RETİNOPATİSİ İLİŞKİSİNİN ARAŞTIRILMASI

Amaç: Prematüre retinopatisi (PR), çocukluk çağında körlüğe neden olabilen başlıca prematürelerin retinasında meydana gelen vazoproliferatif bir hastalıktır. Çalışmamızda çok düşük doğum ağırlıklı (ÇDDA) prematürelerde konjenital hipotiroidinin (KH) PR’si üzerine etkisi ve PR için risk faktörlerine bakılması amaçlanmıştır.Gereç ve Yöntem: Çalışma 51 aylık dönem boyunca yatan ÇDDA bebeklerde geriye dönük tıbbi kayıtların değerlendirilmesi neticesinde gerçekleştirildi. Hastalar KH tanısı ve lazer fotokoagülasyon tedavisi gerektiren PR olmasına göre gruplara ayrıldı.Bulgular: Çalışmaya 621 hasta dahil edildi. Bunlar arasında, 5. gün tiroid fonksiyon testi (TFT) sonucu olan, postnatal 1. ayda hem sağ kalan hem TFT sonucu olan hem de PR muayenesi yapılabilen 534 hasta ile çalışma sonlandırıldı. Konjenital hipotiroidi olan grupta (n=23) PR oranı %26,1 (n=6), KH olmayan grupta (n=511) PR oranı %10,9 (n=56) olarak tespit edildi.Konjenital hipotiroidi olan ve olmayan gruplar arasında PR açısından anlamlı fark tespit edilmedi (p=0.077). Prematüre retinopatisi için risk faktörleri başlıca, düşük gebelik haftası, doğum ağırlığı, düşük 1. ve 5. dakika Apgar skoru, uzun mekanik ventilasyon ve oksijen destek süresi, respiratuvar distres sendromu, intraventriküler kanama, bronkopulmoner displazi, hemodinamik anlamlı patent duktus arteriosus ve geç neonatal sepsis olarak bulunmuştur. PR’i olan grupta serbest tiroksin (sT4) düzeyi daha düşük, tiroid stimülan hormon (TSH) düzeyi daha yüksek bulunmuştur (sırasıyla, p=0.002; 0.047).Sonuç: KH’nin PR üzerine etkisi bulunmamıştır. Ancak, PR’si üzerine prematüreliğin getirdiği diğer riskler daha etkili bulunmuştur. PR’si olan infantlarda sT4 daha düşük, TSH daha yüksek bulunmuştur. Tiroid hormonlarının anjiyogenezis üzerine etkisi olduğundan, PR ve tiroid hormonları ilişkisi açısından daha başka çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

konjenital hipotiroidi, prematüre, prematüre retinopatisi, Çok düşük doğum ağırlığı, tiroid disfonksiyonu

Evaluation of the Relationship Between Congenital Hypothyroidism and Retinopathy of Prematurity in Very Low Birth Weight Newborns

Objective: Retinopathy of prematurity (ROP) is a vasoproliferative disease that mainly occurs in retinas of premature infants, and causes blindness in childhood. The aim of this study was to evaluate the risk factors for PR and the effect of congenital hypothyroidism (CH) on PR in very low birth weight infants (VLBW) (birth weight <1500 g).Material and Method: The retrospective study was conducted by the evaluation of medical records of hospitalized VLBW infants during the 51 months of follow-up. Patients were divided into groups according to diagnosed CH, and according to ROP requiring laser photocoagulation therapy.Results: There were 570 patients of 621 patients of whom we were able to obtain TFT results on the 5th day of the study. A total of 534 patients who survived the postnatal 1st month, and on whom we were able to perform both TFT and ROP examinations were included in the study. The PR rate was 26.1%(n=6) in the group with congenital hypothyroidism (n=23) and the ROP rate was 10.9%(n=56) in the non-CH group (n=511). However, there was no statistically significant difference between the groups in terms of ROP (p=0.077). The risk factors for premature retinopathy were mainly including low gestational age/birth weight, low 1st and 5th minute Apgar score, longer duration of mechanical ventilation and oxygen support, respiratory distress syndrome, intraventricular hemorrhage, bronchopulmonary dysplasia, hemodynamically significant patent ductus arteriosus and late neonatalsepsis. In infants with ROP, the levels of free thyroxine (sT4) were lower and the levels of thyroid stimulating hormone (TSH) were higher (p=0.002, 0.047, respectively). Conclusion: CH had no effect on ROP. However, other risks of prematurity on ROP were found to be more effective. In infants with ROP, sT4 was lower and TSH was higher. Since thyroid hormones have an effect on angiogenesis, further studies on the relation between ROP and thyroid hormones are warranted.

Keywords:

Very low birth weight, congenital hypothyroidism, premature, retinopathy of prematurity, thyroid dysfunction,

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