Newborn screening for congenital hypothyroidism: improvement in short-term follow-up by audit and monitoring
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BMC Research Notes Open Access
RESEARCH NOTE
Newborn screening for congenital hypothyroidism: improvement in short‑term follow‑up by audit and monitoring Hafsa Majid1* , Sibtain Ahmed1, Imran Siddiqui1, Khadija Humayun2, Hussain Karimi3 and Aysha Habib Khan1
Abstract Objective: Newborn screening for congenital hypothyroidism (CH) at our hospital during this study was by measurement of thyroid stimulating hormone (TSH) in serum samples. This audit was conducted over a 2 year period, to determine the compliance of reporting of results greater than the screening cutoffs for serum TSH. Gaps of non-compliance were identified, and re-audit was undertaken after the corrective actions were taken. Results: The critical limit was defined as serum TSH (≥ 20 µIU/ml) following consultation with a pediatric endocrinologist. All results above this limit were reported urgently to physicians. During the audit period, 27,407 tests were performed, 0.7% had a value of ≥ 20 µIU/ml, of those only 62% were reported to the general paediatrician or neonatologist. Reasons for not reporting results included non-availability of contact information, lack of policy awareness by technologists, critical results not highlighted on the computer display, and absence of regular monitoring. Corrective measures were taken, and re-audit was done. During the re-audit period, a total of 22,985 tests was performed, 0.6% had a value of ≥ 20 µIU/ml. Of these, 77% were reported to the general paediatrician or neonatologist. Critical result reporting was improved after the audit, and further enhanced the laboratory service of CH screening. Keywords: Congenital hypothyroidism, Thyroid-stimulating hormones, Newborn screening, Critical results Introduction Newborn screening (NBS) programs are considered the most extensive preventive medicine system and a vital element of public health. The newborns are tested for specific disorders, not symptomatically present at the time of birth, but if remain untreated can permanently impact the health of the baby. The main goal of NBS programs is to reduce morbidity and mortality and improve the health outcomes of newborns. Congenital hypothyroidism (CH) is a disorder which if screened for in every newborn has a high benefit-to-risk ratio, as a cost-effective treatment for it is available, it can lead to mental
*Correspondence: [email protected] 1 Department of Pathology and Laboratory Medicine, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan Full list of author information is available at the end of the article
retardation if not identified and treated within first few weeks of birth. A key-issue in post-analytical quality is represented by the effectiveness of communication of laboratory data, particularly communication of critical test results [1]. The idea of critical values reporting to physicians was first presented by a pathologist, George D. Lundberg, in 1990. It was felt that communicating abnormally high or low laboratory results to the treating physicians can help in initiating t
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