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To the Editor.
We read with interest the article by Paul and associates. Their retrospective study of a large population of premature infants shows an association between low total T4 values and death intraventricular hemorrhage.1 However, for methodologic reasons interpretation of these results is difficult, and in our opinion the message remains unclear.
Impaired thyroid function and other endocrinologic abnormalities are frequent in severe disease.2 Cerebral hypoperfusion/hypoxemia contribute to the development of intracranial hemorrhage (ICH), but may also compromise hypothalamic-pituitary function without ICH. Hypothyroxinemia within the first weeks of life may impair neurologic development.3 ,4 Thyroid hormones in healthy premature infants follow a pattern distinctively different from that observed in term newborns. Free T4 and T3levels decline within 7 to 10 days of postnatal age and normalize within 6 to 8 weeks. Nonelevated thyrotropin-levels probably reflect tertiary hypothyroidism and delayed maturation of the hypopituitary-hypothalamic axis in premature infants.5–7Hypothyroxenemia …
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