Influence of topical iodine-containing antiseptics used during delivery on recall rate of congenital hypothyroidism screening program

2017 ◽  
Vol 30 (9) ◽  
Author(s):  
Majid Valizadeh ◽  
Farzaneh Moezzi ◽  
Zohreh Khavassi ◽  
Mohammad Movahedinia ◽  
Seideh Mazloomzadeh ◽  
...  
Keyword(s):  
Phase I ◽  
Congenital Hypothyroidism ◽  
Phase Ii ◽  
Screening Program ◽  
Recall Rate ◽  
Local Hospital ◽  
Screening Programs ◽  
Blood Specimens ◽  
Heel Prick ◽  
Tsh Levels

AbstractBackground:The proportion of newborns recalled during neonatal screening programs for congenital hypothyroidism (CH) varies substantially by country and may be higher in settings where povodine iodine (PVP-I) is used during delivery. We assessed this hypothesis by substituting PVP-I for chlorhexidine (CHL) and evaluated the reduction in the recall rate of the Irainian newborn screening program.Methods:This study investigated 2282 neonates of mothers admitted to a local hospital for delivery between December 2012 and October 2013. We measured thyorid stimulating hormone (TSH) levels in heel-prick blood specimens of infants, aged between 3 and 5 days, born to mothers who received PVP-I (phase I) and those who received CHL after withdrawal of PVP-I from obstetric procedures (phase II). Then we compared the median TSH levels and the recall rate based on a TSH level ≥5 mU/L.Results:Of 2282 cases, 1094 infants were born to mothers exposed to PVP-I during phase I (PVP-I group) and 1188 ones were born to mothers exposed to chlorhexidine in phase II (CHL group); 6.56% of the PVP-I group and 1.91% of the CHL group were recalled later during screening (p<0.001). The median TSH level was significantly higher in the PVP-I group compared to the CHL group (1.35 vs. 1.00, p<0.001).Conclusions:Replacement of iodine-containing antiseptics by iodine-free ones, during delivery resulted in a significant reduction in the recall rate of the Iranian screening program for CH.

scholarly journals Pilot Neonatal Screening Program for Central Congenital Hypothyroidism: Evidence of Significant Detection

2017 ◽  
Vol 88 (3-4) ◽  
pp. 274-280 ◽  
Author(s):  
Débora Braslavsky ◽  
Maria Virginia Méndez ◽  
Laura Prieto ◽  
Ana Keselman ◽  
Rosa Enacan ◽  
...  
Keyword(s):  
Congenital Hypothyroidism ◽  
Neonatal Screening ◽  
Screening Program ◽  
Recall Rate ◽  
Free T4 ◽  
Screening Programs ◽  
Screening Study ◽  
Term Newborns ◽  
Neonatal Screening Program ◽  
Congenital Hypopituitarism

Background/Aim: Congenital hypothyroidism (CH) is a heterogeneous entity. Neonatal screening programs based on thyrotropin (TSH) determination allow primary CH diagnosis but miss central CH (CCH). CCH causes morbidity, alerts to other pituitary deficiencies, and is more prevalent than previously thought. We aimed at developing a pilot neonatal screening program for CCH detection. Patients and Methods: A prospective 2-year pilot neonatal screening study based on simultaneous dried blood specimen TSH and thyroxine (T4) measurements was implemented in term newborns aged 2–7 days. Those with T4 ≤4.5 µg/dL (–2.3 SDS) and TSH <10 mIU/L were recalled (suspicious of CCH) and underwent clinical and biochemical assessment performed by expert pediatric endocrinologists. Results: A total of 67,719 newborns were screened. Primary CH was confirmed in 24 (1: 2,821). Forty-four newborns with potential CCH were recalled (recall rate 0.07%) at a mean age of 12.6 ± 4.8 days. In this group, permanent CCH was confirmed in 3 (1: 22,573), starting L-T4 treatment at a mean age of 12.3 ± 6.6 days; 14 boys showed T4-binding globulin deficiency (1: 4,837); 24 had transient hypothyroxinemia (21 non-thyroidal illness and 3 healthy); and 3 died before the confirmation stage. According to initial free T4 measurements, CCH patients had moderate hypothyroidism. Conclusions: Adding T4 to TSH measurements enabled the identification of CCH as a prevalent condition and contributed to improving the care of newborns with congenital hypopituitarism and recognizing other thyroidal disorders.

scholarly journals Congenital Hypothyroidism: An Audit and Study of Different Cord Blood Screening TSH Values in a Tertiary Medical Centre in Malaysia

2015 ◽  
Vol 2015 ◽  
pp. 1-6
Author(s):  
Sze Lyn Jeanne Wong ◽  
Muhammad Yazid Jalaludin ◽  
Azriyanti Anuar Zaini ◽  
Nurshadia Samingan ◽  
Fatimah Harun
Keyword(s):  
Cord Blood ◽  
Congenital Hypothyroidism ◽  
Screening Program ◽  
Recall Rate ◽  
Medical Centre ◽  
Asian Countries ◽  
Predictive Values ◽  
Screening Programs ◽  
Premature Babies ◽  
Blood Screening

Mothers are often discharged within 24 hours in most Asian countries. Therefore, our screening programs for congenital hypothyroidism (CH) must consider the value of cord blood TSH. Our objectives were to compare the incidence of CH, positive predictive values, and recall rates using different cord blood TSH values. We also reviewed the results of the second-screening program for premature babies. 99.7% (n=25,757) of all newborns were screened from 1st January 2009 to 31st December 2013. Babies with cord blood TSH > 25 mIU/L or 20–25 mIU/L and FT4<20 pmol/L were recalled for a repeat venous TSH and FT4 on days 3–5 of life to confirm CH. Twenty-two babies were confirmed to have CH, an incidence of 1:1170. Five were premature. Eleven term babies had cord blood TSH>30 mIU/L and six had values 25.1–30 mIU/L. Lowering the recall cut-off value to 20 mIU/L would double the recall rate from 0.63% (n=163) to 1.3% (n=340) with no additional cases detected, whereas using 30 mIU/L would have missed 35% of cases. The incidence of CH was similar, 1:1515, when using either cut-off 20 mIU/L or cut-off 25 mIU/L but lower, 1:2380, when using 30 mIU/L. We recommend the screening cord blood TSH cut-off should be 25 mIU/L and screening for premature babies should be continued.

scholarly journals Universal Implementation of Newborn Screening in India

2020 ◽  
Vol 6 (2) ◽  
pp. 24 ◽  
Author(s):  
Thomas Mookken
Keyword(s):  
Newborn Screening ◽  
Congenital Hypothyroidism ◽  
Universal Screening ◽  
Screening Program ◽  
Developed Countries ◽  
Screening Programs ◽  
Successful Program ◽  
Personal Experiences ◽  
High Incidence ◽  
Glucose 6 Phosphate Dehydrogenase

Newborn screening is a successful program in many developed countries. In India, the benefits of dried blood spot screening have been recognized and that screening is slowly gaining traction. There are significant issues standing in the way of universal implementation of a newborn screening program in India: awareness, cost, advocacy, public policy, and politics. Three regional screening programs, Chandigarh, Goa, and Kerala could serve as models for other programs in India. The data for this commentary were based on personal experiences from managing public newborn screening programs, searches on PubMed and Google, and personal interactions with experts in the field. The overwhelming recommendation is to universally screen for congenital hypothyroidism in India, because it is easy and inexpensive to treat, with excellent outcomes. It would also be beneficial to consider screening universally for glucose-6-phosphate dehydrogenase deficiency due to its high incidence and ease of treatment. Finally, sickle cell disease should be screened in those areas in India where it is prevalent due to the costs associated with universal screening. Achieving universal screening is a challenge, and it is very difficult to predict when every baby born in India will be screened for at least congenital hypothyroidism.

scholarly journals The Impact of Iodine Status on the Recall Rate of the Screening Program for Congenital Hypothyroidism: Findings from Two National Studies in Iran

Nutrients ◽  
2017 ◽  
Vol 9 (11) ◽  
pp. 1194 ◽  
Author(s):  
Ladan Mehran ◽  
Shahin Yarahmadi ◽  
Davood Khalili ◽  
Pantea Nazeri ◽  
Hossein Delshad ◽  
...  
Keyword(s):  
Congenital Hypothyroidism ◽  
Screening Program ◽  
Recall Rate ◽  
Iodine Status ◽  
National Studies ◽  
The Impact

Blood-spot thyrotropin radioimmunoassay in a screening program for congenital hypothyroidism.

1979 ◽  
Vol 25 (6) ◽  
pp. 933-938 ◽  
Author(s):  
W A Sadler ◽  
C P Lynskey
Keyword(s):  
Congenital Hypothyroidism ◽  
Screening Program ◽  
Rank Correlation ◽  
Dried Blood Spots ◽  
Recall Rate ◽  
Factors Affecting ◽  
Blood Spots ◽  
Highly Sensitive ◽  
Blood Spot ◽  
Assay Conditions

Abstract We describe a highly sensitive and precise radioimmunoassay for thyrotropin in dried blood spots on filter paper cards. In a screening program for congenital hypothyroidism, blood-spot thyrotropin concentrations are measured in infants whose blood-spot thyroxine concentrations are in the lower 10%, and this strategy has reduced the recall rate from 1.7% (thyroxine assay alone) to 0.17%. Thyrotropin assay samples consist of discs 4.5-mm in diameter, containing about 6 microL of blood, punched from blood spots. By appropriate attention to assay conditions, a mean least-detectable thyrotropin concentration equivalent to 2.5 milliunits/L plasma has been achieved. Concomitant measurement of thyrotropin by plasma and blood-spot assays in 91 subjects yielded a Spearman rank correlation coefficient of 0.9732. An analysis of variance of the distribution volume of thyrotropin in blood spots and a covariance analysis of factors affecting blood-spot thyroxine results are presented.

Abstract W P384: De-Depress: Detection of Post Stroke Depression in the Outpatient Setting; the Interim Analysis

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Daniel Ackerman ◽  
Diana L Tzeng ◽  
Maria C Pineda
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Screening Program ◽  
Historical Control ◽  
Screening Tools ◽  
Depression Screening ◽  
Post Stroke ◽  
Post Stroke Depression ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Stroke is a major contributor to death and disability. For those who survive the initial incident, post stroke depression (PSD) represents a significant modifiable contributor to morbidity and mortality. The incidence of PSD is estimated between 9-50%, and may be higher as some prior studies have excluded those with communicative or cognitive impairments. We hypothesize that a depression screening program will significantly increase the rate of PSD detection and treatment, and can be implemented at a minimum of cost. Our primary objective is to evaluate the effectiveness and feasibility of initiating a depression screening program in the outpatient clinic of a comprehensive stroke center. Methods: This study is designed as a cross-sectional interventional prospective study with a historical control; divided into two phases. Phase I served as the control, wherein data was derived from a retrospective chart review of all patients newly presenting during 2013 with a diagnosis of ischemic stroke. Those already taking antidepressants or with a known mood disorder were excluded. Phase II began in 3/2014 with the initiation of a depression screen (via two validated screening tools, the Patient Health Questionaire-9 (PHQ-9), and the Aphasia Depression Rating Scale (ADRS)), and is ongoing at this time. Odds ratio, relative risk and absolute risk of a diagnosis of PSD will be calculated using a 2x2 table and the CHI-Squared method and compared with the historical control established in Phase I as well as expected norms. Interim Results: During Phase I, 591 new patient charts were reviewed with 268 qualifying for analysis. A diagnosis of PSD occurred in 13 patients (4.9%). The mean time from stroke to follow up was 5.75 months (1.85 in those diagnosed with PSD and 5.95 in those not diagnosed). Conclusion: Phase I of the De-Depress trial confirms a prevalence of PSD of 4.9% in the outpatient population of the cerebrovascular clinic at a comprehensive stroke center. We hypothesize that this is a result of under-recognition of this common condition, and will evaluate in phase II the effect of a simple depression screening program, implemented at a minimum of cost in time and resources.

scholarly journals Thyroid stimulating hormone levels in cord blood are not influenced by non-thyroidal mothers' diseases

2000 ◽  
Vol 118 (5) ◽  
pp. 144-147 ◽  
Author(s):  
Laura Sterian Ward ◽  
Ilda Shizue Kunii ◽  
Rui Monteiro de Barros Maciel
Keyword(s):  
Cord Blood ◽  
Congenital Hypothyroidism ◽  
Dried Blood Spots ◽  
Thyroid Stimulating Hormone ◽  
Assay Sensitivity ◽  
Screening Programs ◽  
Blood Spots ◽  
Significant Difference ◽  
Tsh Levels ◽  
Stimulating Hormone

CONTEXT: Screening programs not only offer the opportunity to trace and treat almost all cases of congenital hypothyroidism but also mean large savings to the health system. However, carefully planned strategies are necessary to extend their benefits and reduce costs. OBJECTIVE: To determine the possible influence of maternal diseases that affect maternal-fetal placenta dynamics on primary thyroid stimulating hormone (TSH) screening for congenital hypothyroidism. DESIGN: Prospective non-randomized clinical trial with at least 3 months of follow-up. SETTING: A public university referral center [CAISM/Hospital das Clínicas, Faculty of Medicine, University of Campinas, Campinas, SP]. PARTICIPANTS: 415 neonates divided into 5 groups: eighty-three infants born from cardiac mothers; 98 from mothers that had toxemia; 54 of the mothers had diabetes mellitus; 40 were HIV positive and 140 had no diseases. INTERVENTION: All newborns had cord blood samples collected on filter paper at birth. MAIN MEASUREMENTS: TSH was measured from dried blood spots using a homemade immunofluorescence assay (sensitivity in dried blood spots = 0.1 mU/L). RESULTS: There was no significant difference in the mean TSH levels among the 5 groups. Moreover, TSH levels were around 5 mU/L in 48% of the newborns, indicating that our region is severely deficient in iodine. CONCLUSIONS: Our results indicate that primary TSH screening programs using cord blood are not affected by maternal diseases. We suggest that, besides its technical advantages over heel punctures with T4 primary approaches, neonatal screening using primary cord blood TSH may also be used as a monitoring tool for evaluation and control of iodine deficiency disorders (IDD).

Descriptive Epidemiology of Missed Cases of Phenylketonuria and Congenital Hypothyroidism

PEDIATRICS ◽  
1986 ◽  
Vol 78 (4) ◽  
pp. 553-558
Author(s):  
Candy Holtzman ◽  
William E. Slazyk ◽  
José F. Cordero ◽  
W. Harry Hannon
Keyword(s):  
Congenital Hypothyroidism ◽  
Neonatal Screening ◽  
Telephone Survey ◽  
Screening Program ◽  
Descriptive Epidemiology ◽  
Screening Programs ◽  
Specimen Collection ◽  
True Number ◽  
Laboratory Procedures

We conducted a structured telephone survey of state public health laboratory directors of neonatal screening programs to determine the extent of the problem of missed cases of phenylketonuria (PKU) and congenital hypothyroidism. A total of 76 missed cases were reported—43 PKU and 33 congenital hypothyroidism. We looked at the following characteristics of the missed cases: the stage at which the miss occurred, which included specimen collection, laboratory procedures, or follow-up; the size of the program; the type of screening program; the age of the infant at the time of screening; and any legal action that resulted from the miss. The 76 missed cases probably represent an underascertainment of the true number, yet we believe that our data provide an overview of some of the problems associated with mass neonatal screening. There was one missed case of PKU for every 70 cases detected, and one missed case of congenital hypothyroidism for every 120 cases detected; in other words, two congenital hypothyroidism cases were missed for every 1 million infants screened. Regarding the stage of screening in which the miss occurred, 14% occurred during specimen collection, 45% during the laboratory procedures stage, 16% during follow-up, 11% were the result of biologic variation, and in 14% the stage could not be identified. We conclude that neonatal screening programs have been highly successful but that there may be additional safeguards to be developed, tested, and implemented when practical.

scholarly journals The incidence of congenital hypothyroidism (CH) in Guangxi, China and the predictors of permanent and transient CH

2017 ◽  
Vol 6 (8) ◽  
pp. 926-934 ◽  
Author(s):  
Chunyun Fu ◽  
Shiyu Luo ◽  
Yingfeng Li ◽  
Qifei Li ◽  
Xuehua Hu ◽  
...  
Keyword(s):  
Newborn Screening ◽  
Congenital Hypothyroidism ◽  
Screening Program ◽  
Prolonged Treatment ◽  
Newborn Screening Program ◽  
Blood Samples ◽  
Autonomous Region ◽  
Early Differentiation ◽  
Guangxi Zhuang Autonomous Region ◽  
Tsh Levels

Background The incidence of congenital hypothyroidism (CH) differs significantly among different ethnicities and regions, and early differentiation of transient CH is important to avoid unnecessary prolonged treatment with L-T4. Objective To investigate the incidence of CH based on the newborn screening program in Guangxi Zhuang Autonomous Region, China, and to analyze the predictors that might allow for an early differentiation between permanent (P) and transient (T) CH. Design and methods Data from newborn screening program over a seven-year period (January 2009 to January 2016) at Guangxi Maternal and Child Health Hospital are analyzed. Blood samples were collected on filter paper between 3 and 7 days after birth, and TSH level was measured by time-resolved fluorescence assay. Individuals with increased TSH (TSH ≥ 8 IU/L) levels detected by newborn screening were recalled for further evaluation. Serum TSH, FT3 and FT4 were determined by electrochemiluminescence assay using venous blood samples. Diagnosis of CH is based on elevated TSH levels (>10 IU/L) and decreased FT4 levels (<12 pmol/L). Patients with elevated TSH levels and normal FT4 levels were diagnosed as hyperthyrotropinemia. Permanent or transient CH was determined by using the results of thyroid function tests after temporary withdrawal of L-T4 therapy at approximately 2–3 years of age. Results Among 1,238,340 infants in the newborn screening program, 14,443 individuals were recalled for reevaluation (re-call rate 1.18%), 911 and 731 individuals were subsequently determined to have hyperthyrotropinemia and CH respectively; thus, a prevalence of 1:1359 and 1:1694 for hyperthyrotropinemia and CH. Of the 731 patients with CH, 161 patients were diagnosed with permanent CH (PCH), and 159 patients were diagnosed with transient CH (TCH), the other 411 patients are too young to determine their subtypes. Patients with PCH required an increasing dose of L-T4 during the first few years, whereas patients with TCH required a decreased dose of L-T4. The TSH levels at diagnosis and the dose of L-T4 used were significantly higher in PCH cases than in transient cases. The FT4 levels at diagnosis were significantly lower in PCH cases than in TCH cases. The TSH levels at diagnosis, FT4 levels at diagnosis and L-T4 doses at 90 days were evaluated as predictors for differentiating PCH and TCH, and their accuracy at their respective optimal cutoffs were determined to be 60.6%, 66.7% and 93.9%, respectively. Conclusions The CH incidence in Guangxi Zhuang Autonomous Region is slightly higher (1:1694) compared to the worldwide levels (1/2000–1/4000). The PCH and TCH ratio is close to 1; thus, the estimated PCH incidence is 1/3388, which is similar to reported worldwide average incidence (1/3000). The L-T4 dose required at 90 days (>30 μg/day) has the highest predictive value for PCH. Earlier differentiation of PCH and TCH helps to determine appropriate treatment course.

scholarly journals A Newborn Falsely Suspected of Congenital Hypothyroidism due to Mutated Thyroxine-Binding Globulin with Low Binding Affinity

2021 ◽  
pp. 1-5
Author(s):  
Rutger C.C. Hengeveld ◽  
Monique Albersen ◽  
Michael A.H. Hadders ◽  
Ilse Hellinga ◽  
Hennie Bikker ◽  
...  
Keyword(s):  
Congenital Hypothyroidism ◽  
Neonatal Screening ◽  
Screening Program ◽  
Sequencing Analysis ◽  
Free T4 ◽  
Gene Encoding ◽  
Central Hypothyroidism ◽  
Thyroxine Binding Globulin ◽  
Screening Programs ◽  
Dna Sequencing Analysis

<b><i>Introduction:</i></b> Neonatal screening programs for congenital hypothyroidism (CH) have been implemented worldwide to facilitate early diagnosis and treatment. The Dutch neonatal CH screening is primarily based on the measurement of thyroxine (T4). When T4 is low, an additional thyroxine-binding globulin (TBG) measurement is performed to reduce the number of false-positive screening results due to harmless TBG deficiency. Here, we present a case of a rare functional TBG deficiency leading to a false suspicion of CH. <b><i>Case Presentation:</i></b> Neonatal screening in this patient revealed a decreased T4, normal TSH, and normal TBG concentration, suggesting central CH. However, free T4 was normal. DNA sequencing analysis revealed a novel, hemizygous mutation (c.139G&#x3e;A) in <i>SERPINA7</i>, the gene encoding TBG, resulting in the substitution of the conserved amino acid alanine to threonine at position 27. Crystal structure analyses showed that this substitution has a detrimental effect on binding of T4 to TBG. <b><i>Conclusions:</i></b> The novel <i>SERPINA7</i> variant in this patient led to a false suspicion of central hypothyroidism in the Dutch T4-based neonatal screening program. It is important to recognize patients with such TBG defects to prevent unnecessary additional testing and treatment.

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