Background: Thyroid disorders in the neonatal period can have serious consequences for growth and development. Neonatal bloodspot screening identifies congenital hypothyroidism. Current guidelines both internationally and in tertiary centres in Ireland have moved towards checking thyroid function tests (TFTs) solely in infants of mothers with hyperthyroidism and those identified on neonatal bloodspot screening. The practice in OLOLH, Ireland was that all infants of mothers with any form of thyroid disease had TFTs checked on day 14.
Objective and hypotheses: We hypothesised that a new evidence based algorithm and guideline for management of neonates born to mothers with thyroid disease would reduce unnecessary TFT testing.
Method: We performed a 12 month retrospective audit of neonates who had TFTs on DOL 14 performed. We then developed a new evidence based algorithm to identify neonates who required TFT testing. We then audited four months of TFT testing post algorithm implementation.
Results: In the initial 12 months audited, 84 neonates were deemed to require TFT testing on DOL14. 78 attended and 6 were lost to follow up. Four of the 84 were picked up on bloodspot screening. 72 TFTs were normal, three normalised on repeat and three were persistently abnormal. All three of these had been identified on neonatal bloodspot screening. As per our new evidence based guideline only 16 of these 84 babies would have required bloods on day 14- 4 from bloodspot screening and 12 due to maternal hyperthyroidism. Re-audit post implementation of the new algorithm revealed only four infants had TFT testing in 4 months, which we extrapulated to approx 12/year- an 81% reduction in TFT sampling, excluding those identified from bloodspot screening.
Conclusion: By implementing a new evidence based guideline and algorithm we have successfully reduced unnecessary TFT testing on neonates.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology