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Sarathi V, Nikith S. Prevalence of Congenital Hypothyroidism in India: Mapping and Critical Appraisal. Indian J Endocrinol Metab 2024; 28:98-99. [PMID: 38533278 PMCID: PMC10962764 DOI: 10.4103/ijem.ijem_73_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/06/2023] [Accepted: 08/09/2023] [Indexed: 03/28/2024] Open
Affiliation(s)
- Vijaya Sarathi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Whitefield, Bengaluru, Karnataka, India
| | - Siddu Nikith
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Whitefield, Bengaluru, Karnataka, India
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Patel S, Verma N, Padhi P, Shah S, Nanda R, Mohapatra E. An Approach to Re-evaluate the Reference Cutoff of the Parameters of Newborn Screening: An Observational Study. Cureus 2023; 15:e45139. [PMID: 37842412 PMCID: PMC10570011 DOI: 10.7759/cureus.45139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Background Unless a cutoff level of the parameters of newborn screening (NBS) is defined, a screening test's results would end in high recall rates and apprehensive parents. The study aimed to establish a cutoff level of the healthy term newborns. Materials and methods The study was a retrospective observational data analysis on a cohort of 1158 term newborns who underwent NBS in our institute. The percentile distribution of the NBS parameters was computed and the 99th percentile value was considered the new cutoff. For lower values, such as neonatal glucose 6-phosphate dehydrogenase (nG6PD) and neonatal biotinidase (nBIOT), low percentile values were regarded as new cutoff value. Results Neonatal thyroid stimulating hormone (nTSH), nG6PD, neonatal immunoreactive trypsinogen (nIRT), and nBIOT showed a wide variation in the distribution. Most newborns had neonatal galactose (nGAL), nIRT, and nBIOT values above the median. The 99th percentile value of nTSH was 14.5 mIU/L, and that of neonatal 17-hydroxyprogesterone (n17-OHP) was 43.7 nmol/L. The 1.0th percentile value for nG6PD was decreased to 2.18 IU/gHb. The new cutoff values for nBIOT, nIRT, neonatal phenylketonuria (nPKU) and nGAL were 48.59 U, 95.3 µg/L, 2.3 mg/dL and 15.9 mg/dL. The mean and median nTSH values did not significantly differ (p=0.99) in the first five days of birth. On the contrary, the study population depicted considerably raised levels of n17-OHP on day 3, followed by a sharp decrease (p=0.029). Similarly, nIRT displayed significant differences in the first five days (p=0.017). Conclusion Using the 99th percentile values of the NBS parameters as the new cutoff levels might be beneficial in terms of the recall rates and cost burden.
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Affiliation(s)
- Suprava Patel
- Biochemistry, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Neharani Verma
- Biochemistry, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Phalguni Padhi
- Neonatology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Seema Shah
- Biochemistry, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Rachita Nanda
- Biochemistry, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Eli Mohapatra
- Biochemistry, All India Institute of Medical Sciences, Raipur, Raipur, IND
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Anne RP, Rahiman EA. Congenital hypothyroidism in India: A systematic review and meta-analysis of prevalence, screen positivity rates, and etiology. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2022; 5:100040. [PMID: 37383660 PMCID: PMC10305877 DOI: 10.1016/j.lansea.2022.100040] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Background Congenital hypothyroidism (CH) is the leading cause of preventable mental retardation, which is currently not universally screened in India. Knowledge of the country-specific prevalence of the disease can guide in establishing a universal screening program. Methods We performed a systematic review and meta-analysis to assess the prevalence, screen positivity rates, compliance to recall and etiology of CH in India. The databases of PubMed, Embase, Google scholar and IMSEAR were searched on 1st October 2021. All observational studies reporting at least one of the outcomes of interest were included. Two reviewers independently extracted the data and appraised the quality of studies using the Joanna Briggs tool for prevalence studies. Estimates were pooled using a random-effects model with double arcsine transformation (MetaXL software). PROSPERO database registration number was CRD42021277523. Findings Of the 2 073 unique articles retrieved, 70 studies were eligible for inclusion. The prevalence of CH (per 1 000 neonates screened) was 0·97 (95% confidence intervals/CI: 0·9, 1·04) in non-endemic areas (54 studies and 819 559 neonates), 79 (95% CI: 72, 86) in endemic areas (3 studies, 5 060 neonates), 50 (95% CI: 31, 72) in neonates born to mothers with thyroid disorders, and 14 (95% CI: 8, 22) in preterm neonates. At thyroid stimulation hormone cut-off of 20 mIU/L, the screen positivity rates were 5·6% (95% CI: 5·4%, 5·9%) for cord blood samples and 0·19% (95% CI: 0·18%, 0·2%) for postnatal sample. About 70% (95% CI: 70, 71) of screen positive neonates were retested with diagnostic tests. Among neonates with permanent hypothyroidism, thyroid dysgenesis 56·6% (95% CI: 50·9%, 62·2%) was more common than dyshormonogenesis 38·7% (95% CI: 33·2%, 44·3%). Interpretation The prevalence of congenital hypothyroidism in India is higher than global estimates. Screen positivity rate was higher for cord blood screening when compared to postnatal screening. Compliance with confirmatory testing was higher for cord blood screening. Funding The study was not funded by any source.
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Affiliation(s)
- Rajendra Prasad Anne
- Corresponding author at: Department of Pediatrics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, 508126, Telangana, India.
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Raveendran A, Chacko TJ, Prabhu P, Varma R, Lewis LE, Rao P, Shetty PP, Mallimoggala YSP, Hedge A, Nayak DM, Moorkoth S, Moorkoth S. Need and Viability of Newborn Screening Programme in India: Report from a Pilot Study. Int J Neonatal Screen 2022; 8:26. [PMID: 35466197 PMCID: PMC9036214 DOI: 10.3390/ijns8020026] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/05/2022] [Accepted: 03/10/2022] [Indexed: 02/01/2023] Open
Abstract
India, a country with the second largest population in the world, does not have a national newborn screening programme as part of its health policy. With funding support from the Grand Challenges Canada, a pilot newborn screening programme was implemented for the Udupi district of South India to study the need and viability of a national programme in India. Six disorders were selected for the study based on the availability of funding and recommendation from pediatricians in the district. Here, we report the observed incidence during the study. A cost-effectiveness analysis of implementing newborn screening in India was performed. It is evident from our analysis that the financial loss for the nation due to these preventable diseases is much higher than the overall expenditure for screening, diagnosis, and treatment. This cost-effectiveness analysis justifies the need for a national newborn screening programme in India.
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Affiliation(s)
- Arya Raveendran
- Department of Pharmaceutical Quality Assurance, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, India; (A.R.); (T.J.C.); (P.P.); (R.V.)
| | - Teena Joseph Chacko
- Department of Pharmaceutical Quality Assurance, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, India; (A.R.); (T.J.C.); (P.P.); (R.V.)
| | - Priya Prabhu
- Department of Pharmaceutical Quality Assurance, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, India; (A.R.); (T.J.C.); (P.P.); (R.V.)
| | - Raghava Varma
- Department of Pharmaceutical Quality Assurance, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, India; (A.R.); (T.J.C.); (P.P.); (R.V.)
| | - Leslie Edward Lewis
- Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India;
| | - Pragna Rao
- Department of Biochemistry, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India; (P.R.); (P.P.S.); (Y.S.P.M.)
| | - Prajna P. Shetty
- Department of Biochemistry, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India; (P.R.); (P.P.S.); (Y.S.P.M.)
| | - Yajna S. Phaneendra Mallimoggala
- Department of Biochemistry, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India; (P.R.); (P.P.S.); (Y.S.P.M.)
| | - Asha Hedge
- Department of Pediatrics, Melaka Manipal Medical College, Manipal Academy of Higher Education, Manipal 576104, India; (A.H.); (D.M.N.)
| | - Dinesh M. Nayak
- Department of Pediatrics, Melaka Manipal Medical College, Manipal Academy of Higher Education, Manipal 576104, India; (A.H.); (D.M.N.)
| | - Sudeep Moorkoth
- Chesterfield Royal Hospital NHS Trust, Calow, Chesterfield S44 5BL, UK;
| | - Sudheer Moorkoth
- Department of Pharmaceutical Quality Assurance, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, India; (A.R.); (T.J.C.); (P.P.); (R.V.)
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Utility of the New Indian Society of Paediatric and Adolescent Endocrinology (ISPAE) Guidelines for Congenital Hypothyroidism Screening in a High Risk Unit. Indian J Pediatr 2021; 88:1075-1079. [PMID: 33215310 DOI: 10.1007/s12098-020-03555-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/22/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To study the new ISPAE guidelines in neonates with congenital hypothyroidism and present authors' experience in managing these neonates. METHODS A retrospective review of all babies who were screened for congenital hypothyroidism in the institution over a period of 5 y was conducted. Details pertaining to maternal risk factors, neonatal risk factors, screening TSH, venous TSH and details of etiological evaluation including: ultrasound thyroid, technetium 99m scintigraphy and anti thyroid peroxidase antibody estimation were retrieved. The cases were assessed using the new ISPAE guidelines. RESULTS During the study period, 8107 babies were screened for congenital hypothyroidism, 83 cases had confirmed disease and 47 had established etiology. There is a fair correlation between screening TSH and venous TSH (r = 0.7, p < 0.05). The estimated incidence of congenital hypothyroidism in present series is 1 in 97 cases. Out of the 83 cases, 36 (43.3%), 16 (19.2%) and 31 (37.3%) cases had screening TSH >20 μIU/mL, 6-20 μIU/mL and < 6 μIU/mL, respectively. Out of the 47 babies with screening TSH <20 μIU/mL, 23 (48.9%), 25 (53.1%) and 12 (25.5%) cases had prematurity, maternal thyroid disease and illness, respectively, as risk factors (some babies had more than one risk factor). Of the 83 cases, all of them had venous TSH >10 μIU/mL and five cases had low Free T4 (<1.1 ng/dl). Thus, none of the cases with congenital hypothyroidism were missed on the new ISPAE guidelines. CONCLUSION The new ISPAE guidelines for neonatal screening for congenital hypothyroidism are very useful and applicable in Indian neonates.
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Paul PG, Rebekah G, Korula S, Kumar M, Bondu JD, Palany R, Simon A, Mathai S. Optimizing Cord Blood Thyroid Stimulating Hormone Cutoff for Screening of Congenital Hypothyroidism-Experience from Screening 164,000 Newborns in a Tertiary Hospital in India. Indian J Endocrinol Metab 2021; 25:348-353. [PMID: 35136744 PMCID: PMC8793950 DOI: 10.4103/ijem.ijem_220_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/28/2021] [Accepted: 09/08/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In our institution, we have an ongoing newborn thyroid screening (NBS) program since July 2001. In the initial 9 months, we used cord blood thyroid-stimulating hormone (TSH) (CBTSH) cutoff of 20 mIU/L and thereafter the cutoff was increased to 25 mIU/L. Our objective was to evaluate whether a CBTSH cutoff of 25 mIU/L is sensitive and cost-effective in NBS of congenital hypothyroidism (CH). MATERIALS AND METHODS All in-born babies are screened and those with CBTSH ≥25 mIU/L are recalled for confirmatory TSH/T4/FT4 tests. CH is confirmed with elevated TSH and low T4/FT4. Those with CBTSH 20-24.99 mIU/L were recalled for confirmatory tests in initial period of our NBS and prospectively between January and August 2017. Statistical analysis was done to derive positive predictive value and sensitivity to diagnose CH for each CBTSH between 20 and 30 mIU/L. RESULTS A total of 164,163 neonates were screened from July 2001 to August 2017. Of the 2352 babies with CBTSH ≥25-30 mIU/L, 1763 returned for retesting and 5 confirmed as CH (4 gland-in-situ and 1 absent uptake on nuclear scan). Of the 14,742 screened during the study period, 195 of the 293 babies with CBTSH 20-24.99 mIU/L returned for retesting and none diagnosed as CH. A CBTSH of 25 mIU/L has 99.2% sensitivity and 97.5% specificity. A lower screen TSH cutoff 20 mIU/L would result in recall of additional 300 babies/year with no definite improvement in sensitivity. CONCLUSIONS Our data justify the continuation of using screen TSH cutoff of 25 mIU/L while using cord blood for NBS in our population. With a diverse and large population, it is important that we use feasible regional screen cutoffs for optimal use of our resources.
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Affiliation(s)
- Praveen G. Paul
- Division of Paediatric Endocrinology, Department of Paediatrics, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sophy Korula
- Division of Paediatric Endocrinology, Department of Paediatrics, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Manish Kumar
- Department of Neonatology, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Joseph D. Bondu
- Department of Clinical Biochemistry, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Raghupathy Palany
- Department of Paediatric Endocrinology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Anna Simon
- Division of Paediatric Endocrinology, Department of Paediatrics, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Sarah Mathai
- Division of Paediatric Endocrinology, Department of Paediatrics, Christian Medical College Hospital, Vellore, Tamil Nadu, India
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Rai R, Singh DK, Bhakhri BK. Transient hypothyroxinemia of prematurity and its risk factors in an extramural neonatal intensive care unit. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:723-729. [PMID: 33909379 PMCID: PMC10065390 DOI: 10.20945/2359-3997000000360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective Thyroid functions in preterm newborns may be altered in the first week of life. Hypothyroxinemia has been commonly reported in these babies, which could be due to the immaturity of the hypothalamic pituitary thyroid axis or acute illness. It could have a long-term impact on the developing brain of these babies. We conducted this study to estimate the incidence of transient hypothyroxinemia of prematurity (THOP) and to determine its risk factors. Methods We analyzed thyroid stimulating hormone (TSH) and free T4 levels of 64 preterm neonates admitted in the neonatal intensive care unit. TSH and free T4 levels were measured in the first week and then at 14-21 days of life to estimate the incidence of THOP and determine its risk factors. We also estimated the incidence of congenital hypothyroidism (CH) and delayed TSH elevation in CH. Risk analysis was conducted using simple and multiple logistic regression, and numerical data was compared using the Mann Whitney U test and t test. Results THOP was seen in 25% of the preterm babies. Caesarean delivery, presence of one or more morbidities, mechanical ventilation, birth weight ≥ 1,500 g, and gestational age ≥ 32 weeks were identified as risk factors for THOP based on simple logistic regression. In multiple regression, mechanical ventilation and gestational age ≥ 32 weeks were significantly associated with THOP. CH was seen in 2 (3.1%) babies, and 1 of these cases had delayed TSH elevation. Conclusion Thyroid abnormalities are common in preterm admitted neonates. Mechanical ventilation is an independent risk factor for development of THOP.
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Affiliation(s)
- Ruchi Rai
- Department of Neonatology (Maternal Reproductive Health), Super Speciality Pediatric Hospital and Postgraduate Teaching Institute, Noida, UP, India,
| | - Dharmendra Kumar Singh
- Department of Pediatrics, Super Speciality Pediatric Hospital and Postgraduate Teaching Institute, Noida, UP, India
| | - Bhanu Kiran Bhakhri
- Department of Pediatrics, Super Speciality Pediatric Hospital and Postgraduate Teaching Institute, Noida, UP, India
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Venugopalan L, Rajan A, Prasad HK, Sankaran A, Murugesan G, Ramanathan S. Impact of maternal thyroid disease on neonatal thyroid status. J Pediatr Endocrinol Metab 2021; 34:237-241. [PMID: 33048836 DOI: 10.1515/jpem-2020-0349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/23/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Prevalence of Maternal and congenital hypothyroidism is on the rise. To present the thyroid stimulating hormone screening results in babies born to hypothyroid mothers and assess the burden, aetiology of hypothyroidism in these babies. METHODS All antenatal mothers attending our hospital during the study period were enrolled into the study. Group I includes 249 term babies born to hypothyroid mothers and group II comprises 2154 newborns born to mothers who are euthyroid. Heel prick thyroid stimulating hormone was done for all newborns on day 3 for both groups. Confirmatory venous testing was done for all for babies in group I and screen positives belonging to group II. Evaluation and therapy done as per standard guidelines. RESULTS Thyroid stimulating hormone values in the two groups are presented. There was significant correlation between peak maternal thyroid stimulating hormone and neonatal day 3 heel prick in group I (r=0.7, P<0.05). The prevalence of positive screening test in groups I and II was 3.8 and 1.03% (p<0.05) whereas corresponding values for confirmed disease was 4.3 and 0.6%, respectively (p<0.05). Aetiological evaluation revealed both transient hypothyroidism (33.3%) and permanent hypothyroidism (66.6%). CONCLUSION 4.3% of babies born to hypothyroid mothers develop congenital hypothyroidism; aetiology being both transient and permanent. A venous test by 3 weeks is helpful in these babies to improve case identification.
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Affiliation(s)
- Lakshmi Venugopalan
- Department of Neonatology, Mehta Multispeciality Hospitals India pvt Ltd., Chetpet, Chennai, India
| | - Aishwarya Rajan
- Department of Paediatrics, Mehta Multispeciality Hospitals India pvt Ltd., Chetpet, Chennai, India
| | - Hemchand K Prasad
- Department of Paediatric Endocrinology and Diabetes, Mehta Multispeciality Hospitals India pvt Ltd., Chetpet, Chennai, India
| | - Anupama Sankaran
- Department of Paediatrics, Mehta Multispeciality Hospitals India pvt Ltd., Chetpet, Chennai, India
| | - Gnanabalan Murugesan
- Department of Neonatology, Mehta Multispeciality Hospitals India pvt Ltd., Chetpet, Chennai, India
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Kommalur A, Devadas S, Kariyappa M, Sabapathy S, Benakappa A, Gagandeep V, Veranna Sajjan S, Krishnapura Lakshminarayana S, Dakshayani B, Devi Chinnappa G. Newborn Screening for Five Conditions in a Tertiary Care Government Hospital in Bengaluru, South India-Three Years Experience. J Trop Pediatr 2020; 66:284-289. [PMID: 31821472 DOI: 10.1093/tropej/fmz067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Newborn screening is the need of the hour in a developing country like India as there is paucity of data from studies conducted in government hospitals with large sample size. The purpose of the study is to estimate incidence rate and recall rates for five conditions screened in the neonatal period namely congenital hypothyroidism, congenital adrenal hyperplasia, glucose-6-phosphate dehydrogenase (G6PD) deficiency, galactosemia and phenyl ketonuria (PKU). METHODS The study was conducted at VaniVilas Hospital attached to Bangalore Medical College and Research Institute. A retrospective analysis of the results of newborn screening programme during a 3-year period between January 2016 and December 2018 was done. There were 47 623 livebirths during this period out of which 41 027 babies were screened (coverage-86% of total livebirths). Heelprick samples after 48 h of life and prior to discharge were analysed by quantitative assessment. Neonates having positive screening results were recalled by telephonic call for repeat screening and confirmatory tests. RESULTS G6PD deficiency was the most common disorder with an incidence of 1:414, followed by congenital hypothyroidism and Congenital Adrenal Hyperplasia with an incidence of 1:2735 and 1:4102, respectively. Galactosemia and PKU were found to be rare in our population. The overall average recall rate was 0.6% which meant that 24 normal newborns were recalled for testing for one confirmed case. The recall rate was relatively higher for galactosemia and G6PD deficiency which was at 0.25% each compared to the other conditions where it was below 0.05%. CONCLUSION The results of the study emphasize the need for universal newborn screening especially in all government hospitals with large birth cohorts.
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Affiliation(s)
- Anitha Kommalur
- Department of Pediatrics, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - Sahana Devadas
- Department of Pediatrics, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - Mallesh Kariyappa
- Department of Pediatrics, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - Sarala Sabapathy
- Department of Pediatrics, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - Asha Benakappa
- Department of Pediatrics, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - Vijayalaxmi Gagandeep
- Department of Pediatrics, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - Sushma Veranna Sajjan
- Department of Pediatrics, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | | | - B Dakshayani
- Department of Pediatrics, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - Gayathri Devi Chinnappa
- Department of Pediatrics, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
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Correspondence. Indian Pediatr 2019. [DOI: 10.1007/s13312-019-1670-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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An Optimal Capillary Screen Cut-off of Thyroid Stimulating Hormone for Diagnosing Congenital Hypothyroidism: Data from a Pilot Newborn Screening Program in Delhi. Indian Pediatr 2019. [DOI: 10.1007/s13312-019-1515-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kapoor S, Thelma BK. Status of Newborn Screening and Inborn Errors of Metabolism in India. Indian J Pediatr 2018; 85:1110-1117. [PMID: 29736696 DOI: 10.1007/s12098-018-2681-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 04/05/2018] [Indexed: 10/17/2022]
Abstract
Inborn errors of metabolism (IEM) are a heterogeneous group of genetic disorders that cause significant neonatal and infant mortality. Expanded newborn screening which detects these disorders at birth is the standard preventive strategy in most countries. Prospective studies to evaluate the impact of these in the Indian population are lacking. The imminent need to address this lacuna warrants a review of available pan India data, as well as efforts for a carefully conducted prospective assessment of the burden of IEM. Published data on IEM in the Indian population comprising universal prospective screening and screening in selected subgroups (patients admitted to pediatric/neonatal ICUs, patients with developmental delay/mental retardation) was collected through a systematic search. The primary focus was to get an estimate of the disease burden in the Indian population. A true prevalence of IEM in India is not available. The systematic review identifies and stratifies the various situations where IEM are found. Data collected by universal screening of the low risk population is essential to identify the true prevalence of IEM in India.
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Affiliation(s)
- Seema Kapoor
- Division of Genetics and Metabolism, Department of Pediatrics, Lok Nayak Hospital and Maulana Azad Medical College, New Delhi, India.
| | - B K Thelma
- Department of Genetics, University of Delhi, South Campus, New Delhi, India.
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Normative Data for Thyroid Stimulating Hormone for Screening of Congenital Hypothyroidism. Indian J Pediatr 2018; 85:941-947. [PMID: 29479653 DOI: 10.1007/s12098-017-2550-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 11/17/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To generate normative data for thyroid stimulating hormone (TSH) levels in heel prick samples collected from newborns from 24 h to 7 d of age. METHODS Five regional laboratories were designated as the testing laboratories. Dried blood spots (DBS) from babies (> or = 34 wk of gestation) were collected by heel prick at least after 24 h and within seven days after birth. TSH estimation was done using time resolved fluoroimmunoassay. Values above 20mIU/L were labelled as presumptive positive. Hour interval specific normative data was categorized at 6 h intervals. Another category placed was division into 24-72 h category, 73-96 h and 99-168 h. Percentile charts were calculated across these specified intervals. RESULTS Samples analysed were 104,006 collected cumulatively from the 5 centers. Of the total samples analysed for TSH, 92.8% had values less than 5 mIU/l. When TSH values were interpreted with respect to time, a steady decrease with time was observed. Of the babies' samples, 48,839 were collected between 24 and 48 h, 23,983 between 49 to 72 h and 30,883 were collected after 72 h. The mean TSH concentration demonstrated a steady decline from 24 h to 168 h. It is apparent that 10 mIU/l is the 97.5th percentile value even when corrected for gender, birth weight and age at sampling. Thus 10 mIU/l seems to be the right cutoff beyond which a second sample should be sought. CONCLUSIONS This is the largest series reported with a broader population mix with representations of both urban (including slums) as well as a rural population. As this study excluded preterm babies, the utility of cut offs generated is not applicable to this subset and also to critically sick neonates. However, this study gives a true representation of the normative values for majority of the newborns born at term with weight appropriate for the gestation.
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Desai MP, Sharma R, Riaz I, Sudhanshu S, Parikh R, Bhatia V. Newborn Screening Guidelines for Congenital Hypothyroidism in India: Recommendations of the Indian Society for Pediatric and Adolescent Endocrinology (ISPAE) - Part I: Screening and Confirmation of Diagnosis. Indian J Pediatr 2018; 85:440-447. [PMID: 29380252 DOI: 10.1007/s12098-017-2575-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 12/13/2017] [Indexed: 12/29/2022]
Abstract
UNLABELLED The Indian Society for Pediatric and Adolescent Endocrinology has formulated locally relevant Clinical Practice Guidelines for newborn screening, diagnosis and management of primary congenital hypothyroidism (CH). RECOMMENDATIONS Screening should be done for every newborn using cord blood, or postnatal blood, ideally at 48 to 72 h of age. On this screen sample, neonates with TSH > 20 mIU/L serum units (or >34 mIU/L for samples taken between 24 to 48 h of age) should be recalled for confirmation. For screen TSH > 40 mIU/L, immediate confirmatory venous T4/FT4 and TSH, and for milder elevation of screen TSH, a second screening TSH at 7 to 10 d of age, should be taken. Preterm and low birth weight infants should undergo screening at 48-72 h postnatal age. Sick babies should be screened at least by 7 d of age. Venous confirmatory TSH >20 mIU/L before age 2 wk and >10 mIU/L after age 2 wk, with low T4 (<10 μg/dL) or FT4 (<1.17 ng/dL) indicate primary CH and treatment initiation. Imaging is recommended by radionuclide scintigraphy and ultrasonography after CH is biochemically confirmed but treatment should not be delayed till scans are performed. Levothyroxine is commenced at 10 to 15 μg/kg in the neonatal period. Serum T4/FT4 is measured at 2 wk and TSH and T4/FT4 at 1 mo, then 2 monthly till 6 mo, 3 monthly from 6 mo-3 y and every 3-6 mo thereafter. Babies with the possibility of transient congenital hypothyroidism should be re-evaluated at age 3 y, to assess the need for lifelong therapy.
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Affiliation(s)
- M P Desai
- Division of Pediatric Endocrinology, Bai Jerbai Wadia Hospital for Children, Institute of Child Health & Research Centre, Parel, Mumbai, India
| | - R Sharma
- Division of Pediatric Endocrinology, Department of Pediatrics, All India Institute of Medical Sciences, Room no. 3058, Teaching Block, New Delhi, 110029, India.
| | - I Riaz
- Department of Pediatrics, SAT Hospital, Government Medical College, Thiruvananthapuram, India
| | - S Sudhanshu
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - R Parikh
- Division of Pediatric Endocrinology, Bai Jerbai Wadia Hospital for Children, Institute of Child Health & Research Centre, Parel, Mumbai, India
| | - V Bhatia
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Fu C, Luo S, Li Y, Li Q, Hu X, Li M, Zhang Y, Su J, Hu X, Chen Y, Wang J, Xie B, Luo J, Fan X, Chen S, Shen Y. The incidence of congenital hypothyroidism (CH) in Guangxi, China and the predictors of permanent and transient CH. Endocr Connect 2017; 6:926-934. [PMID: 29074613 PMCID: PMC5704446 DOI: 10.1530/ec-17-0289] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 10/26/2017] [Indexed: 02/01/2023]
Abstract
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.
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Affiliation(s)
- Chunyun Fu
- Department of Genetic MetabolismChildren's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
- Medical Science LaboratoryChildren's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
- Department of pathologyChildren's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Shiyu Luo
- Department of Genetic MetabolismChildren's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Yingfeng Li
- Medical Science LaboratoryChildren's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
- Department of pathologyChildren's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Qifei Li
- Department of Genetic MetabolismChildren's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Xuehua Hu
- Medical Science LaboratoryChildren's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Mengting Li
- Department of Genetic MetabolismChildren's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Yue Zhang
- Department of Genetic MetabolismChildren's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Jiasun Su
- Department of Genetic MetabolismChildren's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Xuyun Hu
- Department of Genetic MetabolismChildren's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Yun Chen
- Department of Genetic MetabolismChildren's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Jin Wang
- Department of Genetic MetabolismChildren's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Bobo Xie
- Department of Genetic MetabolismChildren's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Jingsi Luo
- Department of Genetic MetabolismChildren's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Xin Fan
- Department of Genetic MetabolismChildren's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Shaoke Chen
- Department of Genetic MetabolismChildren's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Yiping Shen
- Department of Genetic MetabolismChildren's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
- Boston Children's HospitalHarvard Medical School, Boston, Massachusetts, USA
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Mehran L, Khalili D, Yarahmadi S, Amouzegar A, Mojarrad M, Ajang N, Azizi F. Worldwide Recall Rate in Newborn Screening Programs for Congenital Hypothyroidism. Int J Endocrinol Metab 2017; 15:e55451. [PMID: 29201074 PMCID: PMC5702453 DOI: 10.5812/ijem.55451] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/03/2017] [Accepted: 04/16/2017] [Indexed: 11/16/2022] Open
Abstract
CONTEXT Neonatal mass screening program for congenital hypothyroidism provides the best tool for prevention of its devastating effects on mental development. Despite the overall success of the screening programs in detecting congenital hypothyroidism and eliminating its sequelae and new developments made in the program design, high recall rate and false positive results impose a great challenge worldwide. Lower recall rate and false positive results may properly organize project expenses by reducing the unnecessary repeated laboratory tests, increase physicians and parents' assurance and cooperation, as well as reduce the psychological effects in families. EVIDENCE ACQUISITION In this review, we assessed the recall rate in different programs and its risk factors worldwide. METHODS Publications reporting the results of the CH screening program from 1997 to 2016 focusing on the recall rate have been searched. RESULTS Recall rates vary from 0.01% to 13.3% in different programs; this wide range may be due to different protocols of screening (use of T4 or TSH or both), different laboratory techniques, site of sample collection, recall cutoff, iodine status, human error, and even CH incidence as affected by social, cultural, and regional factors of the population. CONCLUSIONS It is suggested to implement suitable interventions to reduce the contributing factors by improving the quality of laboratory tests, selecting conservative cut off points, control iodine deficiency, use of iodine free antiseptic during delivery, and use of more specific markers or molecular tests. Applying an age dependent criteria for thyrotropin levels can be helpful in regions with a varied time of discharge after delivery or for preterm babies.
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Affiliation(s)
- Ladan Mehran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Shahin Yarahmadi
- Endocrinology and Metabolic Office, Center for Disease Control, Ministry of Health and Medical Education, Tehran, IR Iran
| | - Atieh Amouzegar
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mehdi Mojarrad
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Nasrin Ajang
- Endocrinology and Metabolic Office, Center for Disease Control, Ministry of Health and Medical Education, Tehran, IR Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Fereidoun Azizi, Professor of Internal Medicine and Endocrinology, Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, IR Iran. Tel: +98-2122432503, Fax: +98-2122402463, E-mail:
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Affiliation(s)
- Madhulika Kabra
- Division of Genetics, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
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Prabhu SR, Mahadevan S, Jagadeesh S, Suresh S. Congenital Hypothyroidism: Recent Indian data. Indian J Endocrinol Metab 2015; 19:436-437. [PMID: 25932408 PMCID: PMC4366791 DOI: 10.4103/2230-8210.152800] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Sudha Rathna Prabhu
- Department of Genetics, Mediscans and Fetal Care and Research Foundation, Chennai, Tamil Nadu, India
| | - Shriraam Mahadevan
- Department of Genetics, Mediscans and Fetal Care and Research Foundation, Chennai, Tamil Nadu, India
| | - Sujatha Jagadeesh
- Department of Genetics, Mediscans and Fetal Care and Research Foundation, Chennai, Tamil Nadu, India
| | - Seshadri Suresh
- Department of Genetics, Mediscans and Fetal Care and Research Foundation, Chennai, Tamil Nadu, India
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Mukhopadhyay K, Balachandran B. Universal newborn screening - is it going to be a reality in India? Indian Pediatr 2014; 51:697-8. [PMID: 25228598 DOI: 10.1007/s13312-014-0484-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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