Neurodevelopmental assessment of neonates with congenital hypothyroidism in a tertiary care center

Abstract

Background: Thyroid hormones play a crucial role in early neurodevelopment so that untreated severe congenital hypothyroidism (CH) results in neurological and psychiatric deficits, including intellectual disability, spasticity, and disturbances of gait and coordination. Objective: The aim of this study is to assess the neuromotor and neurocognitive development of babies at 12 months of age who are diagnosed to have CH and initiated on thyroxine treatment at birth. Furthermore, to estimate the occurrence of CH among babies delivered in our hospital through thyroid screening. Study Design: This was a descriptive study. Setting: The study was conducted in Sree Gokulam Medical College Hospital and Research Foundation, a tertiary care center, located in Trivandrum, Kerala. Participants: All babies delivered in the hospital during the study period and neonatal screening was done for CH. Methods: Cord blood was collected as the direct flow of blood from cord, labeled and sent to laboratory from delivery room for analysis (by chemiluminescent assay) of thyroid-stimulating hormone (TSH). Babies with cord blood TSH level ?20 uIU/ml were repeated at 72 h of age for venous TSH and FT4 level. Venous TSH level ?20 uIU/ml with low FT4 (below normal range for age) was considered as abnormal and initiated on treatment before discharge from the hospital. These babies were followed till 12 months of age for neurodevelopmental assessment. Results: The occurrence of CH among babies delivered in our hospital was 0.6 in 100 live births. Neurodevelopmental assessment of babies with CH on follow-up has shown normal neuromotor and neurocognition at 12 months of age with early detection and prompt initiation of L-thyroxine at a higher dose range within 5 days of age. Conclusion: In our study, early detection and initiation of treatment in infants with CH have shown normal neuromotor and neurocognitive development at 12 months of age.