1. The Causal Relationship Between Over Incidence of Necrotizing Enterocolitis (NEC) and Hypothyroidism
Elena NUEL MD, Erez NADIR MD, Shmuel YURMAN MD, Michael FELDMAN MD
Department of Neonatology
Hillel Yaffe Medical Center
Hadera, Israel

2. Background:
NEC of large and small intestines, is an emergency situation in the newborn's digestive systems.
Currently the etiology is unknown, and treatment is far from effective.
Former research confirmed that thyroid gland hormones are essential for normal nervous system's development in fetus and infant.

3. Infant with Necrotizing Enterocolitis (NEC)

4. Background, continued
Hypothyroidism causing a decrease in electrical and mechanical activity in the digestive system may in turn cause a decrease of peristalsis; ileus; meteorism of the stomach and the lessening of blood to the intestinal lining.
Immediately after birth, thyroxin and thyrotropin
levels change significantly. 80% of premature infants during their first 3-8 weeks are in state of Transient Hypothyroxinemia (TH). The lower the week of birth, the increase in TSH is smaller as are the levels of T4 and T3

5. Infant with congenital hypothyroidism

6. Gross pathology of neonatal necrotizing enterocolitis
Gross pathology of neonatal necrotizing enterocolitis. Close up of intestine of infant showing necrosis and pneumatosis intestinalis. Autopsy
Close up of intestine of infant showing necrosis and pneumatosis intestinalis. Autopsy

7. Methods: Retrospective study including:
Hospitalized newborn patient files from Hillel Yaffe between 1995 – 2005
Patient files from 2 additional hospitals (Liniado, Netanya and B’nai Tsion, Haifa) between

8. Methods, continued Inclusion criteria:
Newborns defined by Bell's Classification as NEC levels 2-3
71 infants with diagnosis at discharge of NEC from 3 neonatal units
28 were excluded due to:
16 NEC grade I
10 missing thyroid functioning test
2 died d/t NEC before blood sampling

9. The 43 cases included:
Gestational age between weeks

10. Breakdown of the birth weight of cases in our study
Birth weight between grams.

11. Methods, continued:
The results of TSH levels and FT4 taken from the National Newborn Survey
Normal levels of FT4 >5 ng/dl
Normal level of TSH < 20 mU/L
Historical control:
Hypothyroidism incidence 1:3500 at birth
Transient hypothyroxinemia in premature infants between 58-84%

12. Results 18 (41.8%) had poorly functioning thyroid glands:
15 (34.9%) had TH
3 (6.9%) had true congenital hypothyroidism

13. True congenital hypothyroidism
Results
True congenital hypothyroidism

14. Conclusions:
In our study group, TH incidence was lower than previously reported.
However, we found the incidence of congenital Hypothyroidism, statistically significantly higher than historical control.

15. Conclusion, continued:
This study raises the possibility that thyroid gland dysfunction may be greater among infants suffering of NEC grades II-III
A multi-center study may resolve this enigma