Has Triiodothyronine Treatment of Children after Cardiopulmonary Bypass Surgery Any Long-Term Effects?
Bibliographic record
Abstract
trolled trial (98 treated vs. 95 placebo; <1 year old), which showed that T3 repletion appeared safe but did not have beneficial effects for the entire study population. In secondary analysis adjusted for age, a subgroup of infants younger than 5 months seemed to have some benefit (a shorter time to extubation and a lower inotrope score), while treatment showed some detrimental effect on the cardiac output of infants older than 5 months. Consequently, whether T3 supplementation after cardiac surgery brings definitive benefits in infants still remains an open question, and randomized controlled trials including stratification by age are needed. Beyond the immediate postoperative period, whether T3 treatment after CBP surgery has either a positive or a negative effect on long-term neurodevelopment is not a trivial question. Adverse neurological outcomes are common in children with congenital heart disease, and some factors may be modifiable [9] . Consideration of a possible role of thyroid supplementation is important because hyperthyroidism [10, 11] or transient hypothyroidism [12] (this latter point being more controversial [13] ) in infancy are associated with poorer neurocognitive outcomes. Surgery requiring cardiopulmonary bypass (CBP) induces nonthyroidal illness syndrome (NTIS) in adults and children. While adult patients generally show isolated low triiodothyronine (T3), children and infants present with a more global depression of the thyrotrope axis (decreased TRH, TSH and thyroid hormones), resulting in low T3 after CBP surgery. Experimental data suggest that low T3 is an adaptive mechanism induced by the activation of deiodinase type 3, which reduces the metabolic demand to the hypoxic heart [1] . However, low T3 has been associated with poorer postoperative outcomes in pediatric patients [2] . The effect of triiodothyronine supplementation on early postoperative outcomes has been assessed in a number of pilot randomized controlled trials conducted in pediatric patients and have suggested some short-term benefit of T3 supplementation [3–6] . Limitations of these randomized controlled trials included a limited number of patients with an inherent lack of power, different inclusion criteria, different ages, differences in the T3 dose and regimen, and different outcome measures. These studies did not permit strong determination of whether perioperative T3 supplementation was beneficial or harmful, especially for infants <1 year old (see Cochrane Reviews and its 2007 update [7] ). In 2010, Portman et al. [8] published a larger randomized conPublished online: May 13, 2015 HORMONE RESEARCH IN PAEDIATRICS
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".