The goal of this study was to determine the quality of these disinfectants’ effects on thyroid function and neurological scores in premature newborns aged 28 to 36 gestational weeks (GW).
This cohort study was conducted from October 2020 to September 2021 among 28–36 GW preterm infants at the neonatal care unit of Jiangnan University Hospital. We divided this 12 month period into two consecutive 6 month periods. Composite iodine disinfectants and alcohol are used for skin and umbilical cord disinfection of preterm infants, respectively. Urinary iodine concentration (UIC), thyroid hormone levels, and neonatal behavioral and neurological assessment (NBNA) scores were determined in both groups.
A total of 126 patients were included in the study, 65 in the iodine exposed group and 61 in the alcohol group. The second UIC and the incidence of serum T4≤5 ug/dL and TSH≥10 mIU/L in the iodine exposed group were significantly higher than those in the alcohol group (p<0.05). The first NBNA score was lower in the iodine exposed group than in the alcohol group (p<0.05). However, whether it has clinical significance remains to be explored. There was a linear relationship between the two NBNA scores (iodine exposure group, R2=0.344; alcohol group, R2=0.227). No sepsis or other adverse outcomes occurred in the two groups of preterm infants after disinfection with different disinfectants.
Iodine-containing disinfectants seem to have the potential to cause an increased rate of thyroid dysfunction and a decreased neurological score and should be evaluated in further studies.
Funding source: Program First "Double Hundred" Top Talent of Wuxi Medical and Health System
Award Identifier / Grant number: BJ2020042
Research funding: This work was funded by Wuxi Health Commission under the project Program First “Double Hundred” Top Talent of Wuxi Medical and Health System (BJ2020042).
Author contributions: All authors have accepted responsibility for the entire content of this submitted manuscript and approved submission. Tianxiao Li and Xiaofan Jiang contributed equally to the article.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
Conflict of interest statements: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
1. Ares, S, Quero, J, de Escobar, GM. Iodine balance, iatrogenic excess, and thyroid dysfunction in premature newborns. Semin Perinatol 2008;32:407–12. https://doi.org/10.1053/j.semperi.2008.09.006.Search in Google Scholar
2. Ares, S, Quero, J, Morreale de Escobar, G. Neonatal iodine deficiency: clinical aspects. J Pediatr Endocrinol Metab 2005;18:1257–64. https://doi.org/10.1515/jpem.2005.18.s1.1257.Search in Google Scholar
3. LaFranchi, SH. Thyroid function in preterm/low birth weight infants: impact on diagnosis and management of thyroid dysfunction. Front Endocrinol 2021;12:666207. https://doi.org/10.3389/fendo.2021.666207.Search in Google Scholar
5. Kanike, N, Davis, A, Shekhawat, PS. Transient hypothyroidism in the newborn: to treat or not to treat. Transl Pediatr 2017;6:349–58. https://doi.org/10.21037/tp.2017.09.07.Search in Google Scholar PubMed PubMed Central
6. Zhang, L, Teng, W, Liu, Y, Li, J, Mao, J, Fan, C, et al.. Effect of maternal excessive iodine intake on neurodevelopment and cognitive function in rat offspring. BMC Neurosci 2012;13:121. https://doi.org/10.1186/1471-2202-13-121.Search in Google Scholar PubMed PubMed Central
7. Farebrother, J, Zimmermann, MB, Andersson, M. Excess iodine intake: sources, assessment, and effects on thyroid function. Ann N Y Acad Sci 2019;1446:44–65. https://doi.org/10.1111/nyas.14041.Search in Google Scholar PubMed
8. Rath, CP, Thomas, M, Sullivan, D, Kluckow, M. Does the use of an iodine-containing contrast agent to visualise the PICC tip in preterm babies cause hypothyroidism? A randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2019;104:F212–F4. https://doi.org/10.1136/archdischild-2017-314665.Search in Google Scholar PubMed
9. Williams, FL, Watson, J, Day, C, Soe, A, Somisetty, SK, Jackson, L, et al.. Thyroid dysfunction in preterm neonates exposed to iodine. J Perinat Med 2017;45:135–43. https://doi.org/10.1515/jpm-2016-0141.Search in Google Scholar PubMed
10. Valizadeh, M, Moezzi, F, Khavassi, Z, Movahedinia, M, Mazloomzadeh, S, Mehran, L. Influence of topical iodine-containing antiseptics used during delivery on recall rate of congenital hypothyroidism screening program. J Pediatr Endocrinol Metab 2017;30:973–8. https://doi.org/10.1515/jpem-2016-0164.Search in Google Scholar PubMed
11. Yilmaz, D, Teziç, HT, Zorlu, P, Firat, S, Bilaloğlu, E, Kutlu, AO. Single dose povidone-iodine on thyroid functions and urinary iodine excretion. Indian J Pediatr 2003;70:675–7. https://doi.org/10.1007/bf02724261.Search in Google Scholar
12. Liu, L, Jiang, T. Hypothyroidism in preterm infants. Chin J Neonatol 2019;34:151–4.Search in Google Scholar
13. Bao, XL, Yu, RJ, Li, ZS, Zhang, BL. Twenty-item behavioral neurological assessment for normal newborns in 12 cities of China. Chin Med J 1991;104:742–6.Search in Google Scholar
14. Hossain, MM, Jones, JM, Dey, S, Carr, GJ, Visscher, MO. Quantitation of baby wipes lotion transfer to premature and neonatal skin. Food Chem Toxicol 2015;84:106–14. https://doi.org/10.1016/j.fct.2015.08.014.Search in Google Scholar
15. Oltarzewski, M, Szymborski, J. Neonatal hypothyroid screening in monitoring of iodine deficiency and iodine supplementation in Poland. J Endocrinol Invest 2003;26:27–31.Search in Google Scholar
16. Domenech Martinez, E, Barroso Guerrero, F. Utilidad del programa de cribado neonatal del hipotiroidismo congénito para la valoración de la deficiencia de yodo en Canarias [Utility of congenital hypothyroidism screening in neonates for monitoring iodine deficit disorders in the Canary Islands (Spain)]. An Pediatr 2003;58:357–63. https://doi.org/10.1016/s1695-4033(03)78070-9.Search in Google Scholar
17. Brown, RS, Bloomfield, S, Bednarek, FJ, Mitchell, ML, Braverman, LE. Routine skin cleansing with povidone-iodine is not a common cause of transient neonatal hypothyroidism in North America: a prospective controlled study. Thyroid 1997;7:395–400. https://doi.org/10.1089/thy.1997.7.395.Search in Google Scholar PubMed
18. Li, M, Eastman, CJ. Neonatal TSH screening: is it a sensitive and reliable tool for monitoring iodine status in populations? Best Pract Res Clin Endocrinol Metabol 2010;24:63–75. https://doi.org/10.1016/j.beem.2009.08.007.Search in Google Scholar PubMed
19. Valizadeh, M, Nazeri, P, Fazli, F, Mohammadian, F, Kalantari, S, Kamali, K, et al.. Application of povidone-iodine at delivery significantly increases maternal urinary iodine but not neonatal thyrotropin in an area with iodine sufficiency. J Pediatr Endocrinol Metab 2017;30:967–72. https://doi.org/10.1515/jpem-2017-0087.Search in Google Scholar PubMed
20. Nili, F, Hantoushzadeh, S, Alimohamadi, A, Shariat, M, Rezaeizadeh, G. Iodine-containing disinfectants in preparation for caesarean section: impact on thyroid profile in cord blood. Postgrad Med 2015;91:681–4. https://doi.org/10.1136/postgradmedj-2015-133540.Search in Google Scholar PubMed
21. Aitken, J, Williams, FL. A systematic review of thyroid dysfunction in preterm neonates exposed to topical iodine. Arch Dis Child Fetal Neonatal Ed 2014;99:F21–8. https://doi.org/10.1136/archdischild-2013-303799.Search in Google Scholar PubMed
22. Drover, SSM, Villanger, GD, Aase, H, Skogheim, TS, Longnecker, MP, Zoeller, RT, et al.. Maternal thyroid function during pregnancy or neonatal thyroid function and attention deficit hyperactivity disorder: a systematic review. Epidemiology 2019;30:130–44. https://doi.org/10.1097/ede.0000000000000937.Search in Google Scholar PubMed PubMed Central
23. Williams, FLR, Lindgren, A, Watson, J, Boelen, A, Cheetham, T. Thyroid function in preterm infants and neurodevelopment at 2 years. Arch Dis Child Fetal Neonatal Ed 2020;105:504–9. https://doi.org/10.1136/archdischild-2018-316742.Search in Google Scholar PubMed
24. Tan, LO, Tan, MG, Poon, WB. Lack of association between hypothyroxinemia of prematurity and transient thyroid abnormalities with adverse long term neurodevelopmental outcome in very low birth weight infants. PLoS One 2019;14:e0222018. https://doi.org/10.1371/journal.pone.0222018.Search in Google Scholar PubMed PubMed Central
26. Wassie, MM, Smithers, LG, Zhou, SJ. Association between newborn thyroid-stimulating-hormone concentration and neurodevelopment and growth: a systematic review. Biol Trace Elem Res 2022;200:473–87. https://doi.org/10.1007/s12011-021-02665-7.Search in Google Scholar PubMed
© 2022 Walter de Gruyter GmbH, Berlin/Boston