title: Effect of maternal and neonatal factors on cord blood thyroid stimulating hormone.
abstract: BACKGROUND
  Congenital hypothyroidism (CH) is most common preventable cause of mental retardation in children. Cord blood Thyroid Stimulating Hormone (CBTSH) level is an accepted screening tool for CH.
  
  
  OBJECTIVE
  To study CBTSH profile in neonates born at tertiary care referral center and to analyze the influence of maternal and neonatal factors on their levels.
  
  
  METHODS
  Cross retrospective sectional study.
  
  
  METHODS
  Study population included 979 neonates (males = 506 to females = 473). The CBTSH levels were estimated using electrochemiluminescence immunoassay on Cobas analyzer. Kit based cut-offs of TSH level were used for analysis. All neonates with abnormal CBSTH levels, were started on levothyroxine supplementation 10 μg/Kg/day and TSH levels were reassessed as per departmental protocol.
  
  
  RESULTS
  The mean CBTSH was 7.82 μIU/mL (Range 0.112 to 81.4, SD = 5.48). The mean CBTSH level was significantly higher in first order neonates, neonates delivered by assisted vaginal delivery and normal delivery, delivered at term or preterm, neonates with APGAR score <5 and those needing advanced resuscitation after birth. The CBTSH level >16.10 and <1.0 μIU/mL was found in 4.39 % and 1.02 % neonates respectively. The prevalence rate of CBTSH level >16.1 μIU/mL was significantly higher in neonates delivered by assisted vaginal delivery and normal delivery, term and preterm neonates, APAGR score of <5, presence of fetal distress, need for resuscitation beyond initial steps and in those with birth weight of <1.5 Kg. Three neonates were confirmed to have CH after retesting of TSH level.
  
  
  CONCLUSIONS
  The CBTSH estimation is an easy, non-invasive method for screening for CH. The cutoff level of CB TSH (μIU/mL) >16.10 and <1.0 led to a recall of 5.41% of neonates which is practicable given the scenario in our Country. The mode of delivery and perinatal stress factors have a significant impact on CBTSH levels and any rise to be seen in the light of these factors. The prevalence rate of CH after recall was ~3 in 1000 live births.
authors.affiliation: Department of Physiology, MES Medical College, Perinthalmanna, Malappuram, Kerala, India.
authors.forename: Sheetal G
authors.initials: SG
authors.lastname: Lakshminarayana
authors.affiliation: Department of Physiology, MES Medical College, Perinthalmanna, Malappuram, Kerala, India.
authors.forename: Nidhish P
authors.initials: NP
authors.lastname: Sadanandan
authors.affiliation: Department of Pediatrics, MES Medical College, Perinthalmanna, Malappuram, Kerala, India.
authors.forename: A K
authors.initials: AK
authors.lastname: Mehaboob
authors.affiliation: Department of Nephrology, E.M.S. Memorial Co-operative Hospital and Research Centre, Perinthalmanna, Malappuram, Kerala, India.
authors.forename: Lakshminarayana R
authors.initials: LR
authors.lastname: Gopaliah
keywords: Cord blood thyroid stimulating hormone; congenital hypothyroidism; newborn screening