Neonatal Screening for Congenital Hypothyroidism in Preterm Infants: Is a Targeted Strategy Required?

Background: Premature infants are at higher risk of developing congenital hypothyroidism (CH) but the neonatal screening strategy for this population is still debatable. The purpose of this retrospective study is to describe the results of a screening program for CH in a preterm infant cohort.Materials and Methods: All preterm newborns who underwent neonatal screening in the Italian region of Piedmont in the period January 2019-December 2021, were included in this retrospective cohort study. The first thyrotropin (TSH) measurement was performed at 72 hours, whereas the second at 15 days of life. Infants with TSH >20 mUI/L at first detection and >6 mUI/L at second were recalled for a full evaluation of thyroid function.Results: During the study period, 5930 preterm newborns were screened. Based on birthweight (BW), the mean TSH was 2.08 +/- 0.15 for BW <1000 g, 2.01 +/- 0.02 for BW 1001-1500 g, 2.28 +/- 0.03 for BW 1501-2499 g, and 2.41 +/- 0.03 mUI/L in normal-weight newborns (p < 0.005) at the first detection, with a significant difference observed at the second measurement (p < 0.005). Based on gestational age, the mean TSH at first detection was 1.71 +/- 0.09 mUI/L for extremely preterm babies and 1.87 +/- 0.06, 1.94 +/- 0.05, and 2.42 +/- 0.02 mUI/L for very preterm, moderately, and late preterm infants (p < 0.005), respectively. Significant between-group differences of TSH measurements were also at the second and third detections (p < 0.005 and p = 0.01). The 99% reference range in this cohort overlapped with the recommended TSH cutoffs for screening recall (8 mUI/L for first detection and 6 mUI/L for second detection). CH incidence was 1:156. Of the 38 patients diagnosed with CH, a eutopic gland was present in 30 (87.9%), with CH transient in 29 (76.8%).Conclusions: We observed no significant difference in the recall rate between preterm and at term infants screened in this study. Our current screening strategy therefore appears effective in avoiding misdiagnosis. CH screening approaches vary among countries. Development and testing of a uniform multinational screening strategy is needed.