Congenital hypothyroidism: Screening, diagnosis, management, and outcome

Abstract

Screening for neonatal jaundice may allow early detection and treatment of severe cases and thus help prevent kernictrus. Aim: This pilot study aims to evaluate the effectiveness as well as the practicality of screening for neonatal jaundice at the same time of the Egyptian obligatory thyroid screening program among a sample of non-hospitalized newborns. Subjects and Methods: A population of 3834 term and near-term newborns delivered at El Galaa Teaching Hospital, Cairo, Egypt, was screened for neonatal jaundice at its Maternal Child Health Center within the 1st week of life at the time of thyroid screening (3rd-7th day postnatal). A transcutaneous bilirubinometer (BiliCheck, Respironics, Philips) was used, and bilirubin levels were plotted on the hour-specific bilirubin nomogram. Accordingly, parents were either given a specific date for rescreening or were immediately referred for appropriate intervention. Results: The mean Transcutaneous bilirubin (TcB) measurement was 16.1 mg/dl in 1.9% of the studied newborns placing them in the high-risk zone and requiring immediate referral for serum bilirubin +/- phototherapy. In addition, 3.3% of cases had a mean TcB of 14.4 mg/dl (high-intermediate zone) requiring close follow-up. The TcB levels in the remaining babies placed them either in the low or low-intermediate risk zones of the bilirubin nomogram. All babies in the intermediate zone (n = 440) were advised to return for repeat TcB within 48 h. Of 155 babies attending rescreening, 1 case was in the high-risk zone with TcB of 17.2 mg/dl. By the end of the study, 1.2% of all the tested babies had required admission for phototherapy. Conclusion: The already established thyroid screening program offers a golden opportunity for concomitant screening for neonatal jaundice and the detection and management of missed cases of severe hyperbilirubinemia. However the set timing (3-7 days of life) might be quite late for hemolytic cases who develop severe hyperbilirubinemia early., Copyright © 2017 Journal of Clinical Neonatology , Published by Wolters Kluwer - Medknow.