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Abstract
Introduction: The incidence of neonatal sepsis in India is 38 per 1000 live births. Many authorsfound an association between altered thyroid hormone levels and septic shock in neonates and itmay be of prognostic importance in septic shock treatment. This study has been conducted to findthe relationship between thyroid profile and septic shock in neonates and also to compare thethyroid profile in survivor and non-survivor groups of septic shock patients. Methods: Thisanalytical prospective cohort study was conducted in the NICU of a tertiary care teaching institutionin central India. Full-term neonates with late-onset sepsis were included in this study and estimationof thyroid hormones (TSH, T3, T4, fT3, and fT4) was performed. These neonates were divided intothose with and without septic shock patients and levels of thyroid hormones were correlatedbetween these patients to find significant relations. The Vasoactive-Inotropic Score (VIS) score wascalculated. Results: A total of 195 full-term neonates were included in the study. The mean value ofTSH, T3, T4, fT3, and fT4 among neonates with septic shock were 5.27 μg/ml, 80.01 ng/dl, 6.36μg/dl, 1.40 pg/ml, and 1.40 μg/dl, respectively while the values were 5.29 μg/ml, 94.4 ng/dl, 7.25μg/dl, 1.84 pg/ml, and 1.43 μg/dl, respectively in septic neonates without shock. This difference wasstatistically significant except for TSH (p>0.05). The mean value of TSH, T3, T4, fT3, and fT4 amongseptic shock survivors were 5.27 μg/ml, 80.01 ng/dl, 6.36 μg/dl, 1.40 pg/ml, and 1.40 μg/dl and inseptic shock non-survivors were 2.40 μg/ml, 37.33 ng/dl, 3.86 μg/dl, 0.99 pg/ml, and 0.84 μg/dl,respectively (p<0.0001). Only T3 was found to be significantly co-related with VIS in septic shock inall the groups (<0.001). Conclusion: Our study suggests that TSH, T3, T4, fT3, and fT4 levels aresignificantly low in patients suffering from the septic shock which may vary in the case of TSH. Also,there is a significant decrease in thyroid profile among septic shock non-survivors as compared tosurvivors.
Highlights
The incidence of neonatal sepsis in India is 38 per 1000 live births
We found that the mean levels of Thyroid Stimulating Hormone (TSH), T3, T4, fT3, and fT4 were lower in septic shock patients than that of without septic shock and the difference was statistically significant except for TSH which is quite similar to the findings of a study done by Yildizdas D et al [21]. where they found that the levels of T3, T4, fT3, fT4 levels of children with septic shock were significantly lower than those of sepsis without shock and control
In the above-mentioned studies, none of the studies has included all of the five markers (TSH, T3, fT3, T4, and fT4) and correlated them to septic shock; whereas, we have found that there is a significant decrease in the thyroid profile (TSH, T3, fT3, T4, and fT4) among septic shock survivors as compared to nonsurvivors
Summary
The incidence of neonatal sepsis in India is 38 per 1000 live births. Many authors found an association between altered thyroid hormone levels and septic shock in neonates and it may be of prognostic importance in septic shock treatment. This study has been conducted to find the relationship between thyroid profile and septic shock in neonates and to compare the thyroid profile in survivor and non-survivor groups of septic shock patients. Full-term neonates with late-onset sepsis were included in this study and estimation of thyroid hormones (TSH, T3, T4, fT3, and fT4) was performed. These neonates were divided into those with and without septic shock patients and levels of thyroid hormones were correlated between these patients to find significant relations. Neonatal sepsis is a common disease affecting several tissues through pro- and anti-inflammatory responses in the organism [1] It is characterized by signs and symptoms of infection with or without accompanying bacteremia in the first month of life. Septic shock is a clinical syndrome with suspected infection with signs of decreased perfusion including patients with decreased mental status, prolonged capillary refill time >3 sec or flash capillary refill, diminished or bounding peripheral pulses, mottled, cool extremities, and decreased urine output of
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