Study to Assess the Prevalence of Congenital Hypothyroidism in New Born and Assess the Effectiveness of Planned Teaching Programme Regarding Hypothyroidism Among Mothers of Neonates Delivered at Military Hospital in Jabalpur City

Introduction

“A baby is something you carry inside you for nine months, in your arms for three years and in your heart till the day you die.”

Congenital hypothyroidism (CH) is the commonest metabolic disorder in the newborn and is one of the major cause of preventable mental retardation. Maldevelopment (aplasia, hypoplasia) and maldescent (ectopic) commonly grouped together as thyroid digenesis are the usual causes of primary congenital hypothyroidism. Worldwide, neonatal screening program for congenital hypothyroidism has significantly reduced the intellectual deficit in hypothyroid children when treated early. Newborn baby screening and thyroid therapy started within two weeks of age can normalize cognitive development. Growth rate and adult height are normal in children with congenital hypothyroidism in whom thyroxin therapy is consistently maintained. There are only minor differences in intelligence, school achievement and neuropsychological tests in adults with congenital hypothyroidism that was treated early with thyroxin compared with control groups of classmates and siblings.

Maternal iodine deficiency affects neuropsychological development and functional abnormalities of the fetus and also indirectly impairs fetal brain development by causing hypothyroidism in both mother and fetus. Maternal iodine deficiency also impairs fetal thyroid function causing increased Thyroid stimulating hormone (TSH) level in the neonate.

Congenital hypothyroidism has been recognized as preventable cause of mental impairment; thus routine screening programs have been implemented in most developed countries. Newborn screening aims at the earliest possible recognition of disorder to prevent the most serious consequences by timely intervention. Screening is not a confirmatory diagnosis; it requires further investigation.

Determination of the incidence of neonatal hypothyroidism by measuring the cord blood thyroxin levels at birth is the most useful and reliable method to assess the risk of brain damage in infants and children growing up in an iodine deficient environment. Elevated serum TSH in the neonate indicates insufficient supply of thyroid hormones to the developing brain and therefore constitutes the only indicator that allows the prediction of possible impairment of mental development at a population level.

Aims

Objectives of this study were to:

1. Determine the incidence of congenital hypothyroidism (CH) in neonates by measuring thyroid stimulating hormone (TSH) in cord blood of newborn in Military hospital, Jabalpur.

2. Find out relation between demographic variables and TSH value of newborn.

3. Assess the pre-test knowledge score of mothers of neonates whose TSH value was >20 Miu/L.

4. Find out effectiveness of planned teaching programme regarding hypothyroidism in neonates among mothers.

5. Find out association of pre-test knowledge among mothers and demographic variables.

Hypotheses

H1 : There will be significant relation between sex, gestational age, mode of delivery, birth weight and TSH value.

H2 : There will be significant difference in the pre-test and post-test knowledge score on hypothyroidism among mothers after a planned teaching programme.

Methods

Research methodology is a way to systematically solve the research problem. (Kothari, C.R. 2006). It contained statement of the problem, objectives of the study, assumptions which have been formulated, tool, methods used for data collection, the statistical method used for analyzing the data and the logic behind it.

• Questionnaire for collection of demographic variables.

• Questionnaire for checking pretest knowledge regarding hypothyroidism among mothers.

• Planned teaching programme for hypothyroidism in children.

• Post-test to measure effectiveness of teaching programme.

Sample consisted of hundred cord blood and ten mothers available at the time of study. Simple random sampling method was used for the selection of samples. The instrument for data collection was immunosorbant assay method, planned teaching programme.

The data obtained was analyzed by using descriptive and inferential statistics in term of frequency, percentage, mean, standard deviation, paired t-test and Chi-square test.

Results

Hundred newborn babies were screened for prevalence of congenital hypothyroidism by measuring cord blood TSH levels. It showed that TSH values vary from 0.23 to 55.59, with mean 8.761, median 6.385, standard deviation (SD) 8.917, IQR 5.05.

Forty-seven female babies’ TSH levels varied from 1.8 to 55.59 miu/L. TSH level of female babies was greater than male babies. The mean, median and SD of male babies’ TSH values were 7.756, 6.25, and 7.037 respectively. The mean, median and SD of female babies’ TSH values were 9.86, 6.41 and 10.51 respectively. Out of 100 babies, 53 were male babies whose TSH values ranged from 0.23 to 43.75

Out of 100 babies born, six were preterm whose TSH varied from 0.4 to 43.75 miu/L, mean 10.482, median 6.035, SD 16.642. In 94 term babies, mean TSH was 8.642 miu/L, median 6.385 and SD 8.353. TSH value of pre term babies was more than term babies which was 10.482 miu/L.

Out of 100 babies, 58 were born by normal vaginal delivery, 40 were caesarian born babies and two were vacuum delivered. The TSH values of normal vaginal delivery babies were more than LSCS babies and vacuum delivery babies. The mean TSH value of FTND, LSCS and vacuum delivery babies were 10.325, 6.552, and 7.42 respectively.

Ten babies were recalled along with mothers and their venous blood was sent for T3, T4, TSH investigations. All the ten babies had TSH levels within normal limits and T4 was also normal. Asymmetrical skewness was observed between TSH and T4=0.2448, correlation coefficient between TSH and T4=0.332.

As the weight of the babies increased, T4 value increased. Out of ten mothers screened, two were found to have hypothyroidism. TSH value was >5 miu/L (ranged 8.88 miu/L - 9.54 miu/L)

Conclusion

The study concluded that sex, mode of delivery, maturity, birth weight are associated with TSH levels in newborn and TSH levels in cord blood. Planned teaching programme on hypothyroidism in newborn is an effective method for providing awareness among mothers to enhance early detection of hypothyroidism related developmental delay. Forty-seven female babies’ TSH levels varied from 1.8 to 55.59 miu/L. TSH level of female babies was greater than male babies. The mean, median and SD of male babies were 7.756, 6.25 and 7.037 respectively.

The mean, median, and SD of female TSH values were 9.86, 6.41 and 10.51 respectively. Hundred newborn babies were screened for prevalence of congenital hypothyroidism by measuring cord blood TSH levels and the results showed that TSH values vary from 0.23 to 55.59 with mean 8.761, median 6.385, SD 8.917, IQR 5.05.

Rajkumar Arvind, Khetriyamiam Gomti et al., 2013 conducted a hospital base study in Institute of Medical science, Imphal, Manipur in which 1000 neonates cord blood was screened.

The mean, median and standard deviation for TSH values of samples were 8.833 mIU/L, 6.824 mIU/L and 7.059 mIU/L respectively. Nearly 29.3% of babies had TSH>10 mIU/L. Only one baby was found to be having CH out of 1000 screened. TSH levels of 47 babies varied between 1.8 to 55.59 miu/L. TSH levels of female babies was greater than male babies. The mean, median and SD of male babies were 7.756, 6.25 and 7.037 respectively. The mean, median, and SD of female TSH values were 9.86, 6.41 and 10.51 respectively. Out of 100 babies born, six were preterm whose TSH varied from 0.4 to 43.75 miu/L, mean 10.482, median 6.035, SD 16.642. In 94 term babies, mean TSH was 8.642 miu/L, median 6.385 and SD 8.353. TSH value of pre-term babies was more than term babies which was 10.482 miu/L.

Out of 100 babies, 58 were born by normal vaginal delivery, 40 were caesarian born babies and two were vacuum delivered. The TSH values of normal vaginal delivery babies were more than LSCS babies and vacuum delivery babies. The mean TSH values of FTND, LSCS and vacuum delivery babies were 10.325, 6.552 and 7.42 respectively.

Ten babies were recalled along with and mother’s venous blood was sent for T3, T4, TSH investigations. All the ten babies had TSH levels within normal limits and T4 was also normal. Asymmetrical skewness was observed between TSH and T4=0.2448, correlation coefficient between TSH and T4=0.332.

As the weight of babies increased, T4 value increased. Arun Kumar Anjali Grover et al., (2001-2003) conducted a study in 130 neonates and concluded that birthweight, gestational age, sex, and mode of delivery interferes with thyroid status in newborn.

Out of 10 mothers screened, two of them were found to have hypothyroidism. TSH value was >5miu/L (ranged between 8.88 miu/L and 9.54 miu/L).

Gayatri R, Lavange S, Raghavan K et al., 2007 conducted a study in India and reported that prevalence of subclinical hypothyroidism among pregnant women is high among Indians.

Conflict of Interest

None.