{"id":110382,"date":"2018-03-11T10:36:24","date_gmt":"2018-03-11T10:36:24","guid":{"rendered":""},"modified":"2018-03-11T10:36:24","modified_gmt":"2018-03-11T10:36:24","slug":"estado-tiroide-y-hemodinamico-en-el-recien-nacido-de-peso-extremadamente-bajo-evaluacion-sistematica-del-impacto-de-la-funcion-tiroidea-y-el-suplemento-hormonal-precoz-sobre-la-circulacion-sistemica","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/pediatria\/estado-tiroide-y-hemodinamico-en-el-recien-nacido-de-peso-extremadamente-bajo-evaluacion-sistematica-del-impacto-de-la-funcion-tiroidea-y-el-suplemento-hormonal-precoz-sobre-la-circulacion-sistemica\/","title":{"rendered":"\u00abestado tiroide y hemodin\u00e1mico en el reci\u00e9n nacido de peso extremadamente bajo: evaluaci\u00f3n sistem\u00e1tica del impacto de la funci\u00f3n tiroidea y el suplemento hormonal precoz sobre la circulaci\u00f3n sist\u00e9mica y cerebral\u00bb"},"content":{"rendered":"

Tesis doctoral de Ruth Solana Gracia <\/strong><\/h2>\n

Antecedentes: la hipotiroxinemia transitoria es frecuente en los reci\u00e9n nacidos menores de 30 semanas de gestaci\u00f3n y se asocia a problemas del neurodesarrollo. diferentes estudios han examinado el beneficio del suplemento hormonal tiroideo (sht) administrado precozmente tras el nacimiento a los reci\u00e9n nacidos de peso extremadamente bajo (rnpeb). Sin embargo, las hormonas tiroideas ejercen m\u00faltiples acciones cardiovasculares que no han sido sistem\u00e1ticamente evaluadas. objetivos: analizar prospectivamente el perfil hormonal tiroideo del rnpeb, con y sin sht, y explorar el impacto del estado tiroideo sobre la hemodin\u00e1mica sist\u00e9mica y cerebral. m\u00e9todos: se realiz\u00f3 un estudio prospectivo de cohortes en dos fases sobre la poblaci\u00f3n de reci\u00e9n nacidos menores de 28 semanas de gestaci\u00f3n ingresados en las primeras 24 horas de vida en la unidad de neonatolog\u00eda. En la primera fase-2005\/2006-, se reclutaron 33 pacientes pertenecientes al ensayo cl\u00ednico internacional thop supplementation (c\u00f3digo 1 r01 ns45109-01 a1), que fueron asignados aleatoriamente y mediante doble ciego a 6 grupos de intervenci\u00f3n, 4 de los cuales incluyeron la administraci\u00f3n combinada de triyodotironina (t3) -1 \u00c2\u00bfg\/kg\/dia, 14 d\u00edas- y tetrayodotironina (t4) -8 y 16 \u00c2\u00bfg\/kg\/dia, 6 semanas; en bolo o infusi\u00f3n continua-. En la segunda fase-2008\/2009-, se reclutaron 22 pacientes de similares caracter\u00edsticas, ninguno de los cuales recibi\u00f3 sht. Se realizaron controles seriados de niveles s\u00e9ricos hormonales tiroideos, ecocardiograf\u00eda estructural y funcional, con medici\u00f3n de flujo de vena cava superior (fvcs), y espectroscop\u00eda cercana al infrarrojo de resoluci\u00f3n espacial (nir-srs) cerebral a lo largo de las primeras 8 semanas. resultados: la administraci\u00f3n combinada de t3 y t4 a las dosis empleadas produjo supresi\u00f3n de los niveles de tsh. Los pacientes que recibieron sht presentaron mayor frecuencia cardiaca y gasto cardiaco durante la primera semana de vida respecto a los pacientes sin sht. Los efectos hemodin\u00e1micos inducidos por el sht se objetivaron en las primeras horas tras iniciar el suplemento hormonal. El perfil evolutivo del gasto cardiaco y fvcs se asoci\u00f3 positivamente a los niveles s\u00e9ricos de t3, en tanto que la resistencia vascular se asoci\u00f3 negativamente con dicha hormona. A nivel cerebral, observamos una disminuci\u00f3n del \u00edndice de oxigenaci\u00f3n tisular y aumento de la extracci\u00f3n fraccionada de ox\u00edgeno a los 7 d\u00edas de vida, en ambos grupos. evolutivamente, este patr\u00f3n se mantuvo \u00fanicamente en los pacientes con sht. Los efectos del sht sobre la circulaci\u00f3n-oxigenaci\u00f3n cerebral se observaron precozmente, y difirieron en funci\u00f3n del modo de administraci\u00f3n del suplemento hormonal \u00c2\u00bfbolo o infusi\u00f3n continua-. conclusiones: el sht seg\u00fan nuestro protocolo de estudio produce cambios en la circulaci\u00f3n sist\u00e9mica y cerebral del rnpeb. Los cambios en la hemodin\u00e1mica sist\u00e9mica reproducen el perfil evolutivo de los niveles sericos de t3. El modo de administraci\u00f3n de t4 determina el efecto sobre la circulaci\u00f3n-oxigenaci\u00f3n cerebral. palabras clave: reci\u00e9n nacido con peso al nacer extremadamente bajo, hipotiroxinemia, s\u00edndromes del enfermo eutiroideo, tiroxina, hemodin\u00e1mica, ecocardiograf\u00eda, espectroscopia infrarroja corta. background: transient hypothyroxinemia is common among infants born before 30 weeks gestation and associates neurodevelopmental impairment. Thyroid hormone supplementation (ths) given early during the neonatal period to the extremely low birth weight (elbw) infant could be beneficial. However, thyroid hormones play an important role on the cardiovascular system that has not been systematically evaluated. objective: to explore the thyroid hormones serum levels profile in the elbw infant and to determine the impact of thyroid hormone status and ths on the systemic and cerebral hemodynamics. methods: we conducted a prospective cohort study encompassing two periods of time at a tertiary neonatal unit. During the first period-2005\/2006-, thirty three infants less than 28 weeks gestation pertaining to the international thop supplementation study (code 1 r01 ns45109-01 a1), a randomized, blind clinical trial, were enrolled. patients were assigned to 6 different intervention groups, four of them including combined administration of triiodothyronine (t3) -1 \u00c2\u00bfg\/kg\/d, 14 days- and tetraiodothyronine (t4) -8 y 16 \u00c2\u00bfg\/kg\/d, 6 weeks; bolus or continuous infusion-. During the second period -2009\/2010-, twenty two consecutively born infants of similar clinical characteristics were enrolled, none of them receiving ths. Serial thyroid hormone serum levels, structural and functional echocardiography including superior vena cava flow (svcf) estimation, and cerebral near infrared-spatially resolved spectroscopy monitoring (nir-srs) were performed during the first 8 weeks of postnatal life. results: t3 and t4 combined administration induced suppression of tsh. Both, heart rate and cardiac output were higher in patients on ths as compared to those without. The hemodynamic effects of ths were observed shortly after intervention started. Developmental profile of cardiac output and svcf on the one hand, and vascular resistance on the other, were positively and negatively associated with t3 serum levels, respectively. A decrease in cerebral tissue oxygenation index and an increase in fractional oxygen extraction were observed during the first week irrespective of intervention. Beyond this time, this pattern persisted only in infants receiving ths. ths also showed acute effects on cerebral circulation that appeared shortly after start of treatment but differed according to mode of administration \u00c2\u00bfbolus or continuous infusion-. conclusions: according to our study protocol, ths causes changes in systemic and cerebral circulation in the elbw infant. Trends in systemic hemodynamics mirror those of t3 serum levels. Mode of t4 administration is determinant of its effects on cerebral circulation-oxygenation. key words: extremely low birth weight infant, hypothyroxinemia, euthyroid sick syndromes, thyroxine, hemodynamics, echocardiography, near-infrared spectroscopy.<\/p>\n

 <\/p>\n

Datos acad\u00e9micos de la tesis doctoral \u00ab\u00abestado tiroide y hemodin\u00e1mico en el reci\u00e9n nacido de peso extremadamente bajo: evaluaci\u00f3n sistem\u00e1tica del impacto de la funci\u00f3n tiroidea y el suplemento hormonal precoz sobre la circulaci\u00f3n sist\u00e9mica y cerebral\u00bb<\/strong>\u00ab<\/h3>\n
    \n
  • T\u00edtulo de la tesis:<\/strong>\u00a0 \u00abestado tiroide y hemodin\u00e1mico en el reci\u00e9n nacido de peso extremadamente bajo: evaluaci\u00f3n sistem\u00e1tica del impacto de la funci\u00f3n tiroidea y el suplemento hormonal precoz sobre la circulaci\u00f3n sist\u00e9mica y cerebral\u00bb <\/li>\n
  • Autor:<\/strong>\u00a0 Ruth Solana Gracia <\/li>\n
  • Universidad:<\/strong>\u00a0 Aut\u00f3noma de Madrid<\/li>\n
  • Fecha de lectura de la tesis:<\/strong>\u00a0 19\/07\/2011<\/li>\n<\/ul>\n

     <\/p>\n

    Direcci\u00f3n y tribunal<\/h3>\n
      \n
    • Director de la tesis<\/strong>\n
        \n
      • Fernando Caba\u00f1as Gonz\u00e1lez<\/li>\n<\/ul>\n<\/li>\n
      • Tribunal<\/strong>\n
          \n
        • Presidente del tribunal: jos\u00e9 Quero jim\u00e9nez <\/li>\n
        • salvador Salcedo abizanda (vocal)<\/li>\n
        • Jos\u00e9 Mar\u00eda Jimenez bustos (vocal)<\/li>\n
        • Manuel S\u00e1nchez luna (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

           <\/p>\n","protected":false},"excerpt":{"rendered":"

          Tesis doctoral de Ruth Solana Gracia Antecedentes: la hipotiroxinemia transitoria es frecuente en los reci\u00e9n nacidos menores de 30 semanas […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"categories":[161],"tags":[87650,17490,7519,48565,220386,122824],"class_list":["post-110382","post","type-post","status-publish","format-standard","hentry","category-pediatria","tag-fernando-cabanas-gonzalez","tag-jose-maria-jimenez-bustos","tag-jose-quero-jimenez","tag-manuel-sanchez-luna","tag-ruth-solana-gracia","tag-salvador-salcedo-abizanda"],"_links":{"self":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/110382","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/comments?post=110382"}],"version-history":[{"count":0,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/posts\/110382\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/media?parent=110382"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/categories?post=110382"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.deberes.net\/tesis\/wp-json\/wp\/v2\/tags?post=110382"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}