BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis ...BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis and heart failure has rarely been observed in cases of pediatric patients with CH pathology.Here,we explored the etiological relationship between CH,heart failure,and refractory lactic acidosis to reflect the importance of thyroid function screening in neonates with heart disease.CASE SUMMARY A 33-day-old extremely premature female infant presented with tachypnea,respiratory distress,recurrent infections,and abdominal distension postnatal.On admission to our facility,she had cardiomegaly,hepatomegaly,and lactic acidosis(revealed on blood gas analysis),with lactate progressively rising to 25 mmol/L.Chest radiographs showed pulmonary congestion,while echocardiography revealed cardiac enlargement,left ventricular wall thickening,and pericardial effusion.Initial management aimed at correcting acidosis and treating heart failure proved ineffective.After reassessment,thyroid function tests showed significantly decreased triiodothyronine,free triiodothyronine,thyroxine,and free thyroxine levels,with a significantly increased thyroidstimulating hormone level,confirming a CH diagnosis.Levothyroxine was administered,resulting in rapid correction of lactic acidosis and gradual improvement of thyroid function and systemic symptoms,culminating in full recovery and discharge.We also reviewed the relevant literature on thyroid and cardiac dysfunctions in order to explore their deeper association.CONCLUSION This case links CH-induced heart failure with refractory lactic acidosis,urging prompt thyroid screening in affected neonates to reduce mortality.展开更多
目的:分析脑损伤早产儿脑血流动力学变化及早产儿脑损伤的相关影响因素。方法:选择2018年6月至2022年12月在江苏大学附属医院分娩的胎龄小于37周的单胎早产儿80例,其中脑损伤组27例,无脑损伤组53例。对比两组早产儿的脑血流动力学变化情...目的:分析脑损伤早产儿脑血流动力学变化及早产儿脑损伤的相关影响因素。方法:选择2018年6月至2022年12月在江苏大学附属医院分娩的胎龄小于37周的单胎早产儿80例,其中脑损伤组27例,无脑损伤组53例。对比两组早产儿的脑血流动力学变化情况,分析早产儿脑损伤的危险因素。结果:脑损伤组的动脉血流助力指数(RI)和动脉血流搏动指数(PI)高于无脑损伤组,而动脉舒张期血流速度(Vd)、动脉收缩期血流速度峰值(Vs)、动脉血流平均速度(Vm)则明显低于无脑损伤组(P均<0.05)。差异性分析结果表明,与无脑损伤组比较,早产儿脑损伤组胎龄、出生时体重、机械通气、高危因素、1 min及5 min Apgar评分、酸中毒及血糖水平差异有统计学意义(P<0.05);多因素Logistic回归分析结果表明,上述指标均为早产儿脑损伤的影响因素。结论:脑血流动力学相关指标为临床诊断早产儿脑损伤提供一定的依据,关注相关影响因素可及时预防和减少脑损伤发生率。展开更多
文摘BACKGROUND Congenital hypothyroidism(CH)is a common condition in both preterm and term infants characterized by either thyroid gland absence or hypofunctionality.The clinical association of refractory lactic acidosis and heart failure has rarely been observed in cases of pediatric patients with CH pathology.Here,we explored the etiological relationship between CH,heart failure,and refractory lactic acidosis to reflect the importance of thyroid function screening in neonates with heart disease.CASE SUMMARY A 33-day-old extremely premature female infant presented with tachypnea,respiratory distress,recurrent infections,and abdominal distension postnatal.On admission to our facility,she had cardiomegaly,hepatomegaly,and lactic acidosis(revealed on blood gas analysis),with lactate progressively rising to 25 mmol/L.Chest radiographs showed pulmonary congestion,while echocardiography revealed cardiac enlargement,left ventricular wall thickening,and pericardial effusion.Initial management aimed at correcting acidosis and treating heart failure proved ineffective.After reassessment,thyroid function tests showed significantly decreased triiodothyronine,free triiodothyronine,thyroxine,and free thyroxine levels,with a significantly increased thyroidstimulating hormone level,confirming a CH diagnosis.Levothyroxine was administered,resulting in rapid correction of lactic acidosis and gradual improvement of thyroid function and systemic symptoms,culminating in full recovery and discharge.We also reviewed the relevant literature on thyroid and cardiac dysfunctions in order to explore their deeper association.CONCLUSION This case links CH-induced heart failure with refractory lactic acidosis,urging prompt thyroid screening in affected neonates to reduce mortality.
文摘目的:分析脑损伤早产儿脑血流动力学变化及早产儿脑损伤的相关影响因素。方法:选择2018年6月至2022年12月在江苏大学附属医院分娩的胎龄小于37周的单胎早产儿80例,其中脑损伤组27例,无脑损伤组53例。对比两组早产儿的脑血流动力学变化情况,分析早产儿脑损伤的危险因素。结果:脑损伤组的动脉血流助力指数(RI)和动脉血流搏动指数(PI)高于无脑损伤组,而动脉舒张期血流速度(Vd)、动脉收缩期血流速度峰值(Vs)、动脉血流平均速度(Vm)则明显低于无脑损伤组(P均<0.05)。差异性分析结果表明,与无脑损伤组比较,早产儿脑损伤组胎龄、出生时体重、机械通气、高危因素、1 min及5 min Apgar评分、酸中毒及血糖水平差异有统计学意义(P<0.05);多因素Logistic回归分析结果表明,上述指标均为早产儿脑损伤的影响因素。结论:脑血流动力学相关指标为临床诊断早产儿脑损伤提供一定的依据,关注相关影响因素可及时预防和减少脑损伤发生率。
