Association of Unexplained Feeding Intolerance with Congenital Hypothyroidism in Preterm Neonates: A Missing Link

Abstract

Objective: This study investigates the association between unexplained feeding intolerance (FI) and congenital
hypothyroidism (CH) in otherwise healthy preterm neonates.
Methodology: This descriptive study was conducted in the Neonatology Department, Fatima Memorial Hospital,
Lahore to assess the association between thyroid function and feeding intolerance in 102 preterm neonates.
Maternal, neonatal, and feeding variables were recorded, and data were analyzed using SPSS version 16.0. Categorical variables were expressed as frequencies and percentages, while continuous variables were summarized as mean ± SD or median (IQR) based on distribution. Fisher’s exact test, Student’s t-test, and Mann–Whitney U test were applied as appropriate.
Results: Of the 102 preterm neonates with FI, 37.3% had CH. FI characteristics such as type of feed, time to establish
full feeding, and abdominal distention (isolated or combined with increased gastric residue or reflux) were
significantly associated with hypothyroidism (p < 0.005). Significant risk factors for CH including APGAR score at 5
minutes (p < 0.001), jaundice (p < 0.001), patent ductus arteriosus (p = 0.006), duration of hospital stay (p = 0.002),
parity (p < 0.001), chorioamnionitis (p = 0.024) and antepartum hemorrhage (p = 0.002).
Conclusion: Approximately one-third of preterm neonates with FI were diagnosed with hypothyroidism. Abdominal
distention, whether isolated or associated with increased gastric residue or reflux, was the most prominent feature
of FI linked to CH. Parity, antepartum hemorrhage, chorioamnionitis, low APGAR scores, jaundice, and hsPDA, were
significantly associated with CH.
Key words: Abdominal Distention; Feeding Intolerance; Hypothyroidism; NICU; Prematurity; Reflux, vomiting