Aims: All screening programmes in the UK use a primary thyroid stimulating hormone (TSH) screen for congenital hypothyroidism. Recent attention has been paid to aspects of screening, such as the relation between blood spot TSH levels and birth weight or gestational age. The aim of our study was to determine the factors affecting screening neonatal TSH levels. Methods: We conducted a retrospective analysis of blood spot screening TSH levels of all infants screened at a single regional screening laboratory. Results: There were 6498 infants screened during a 12-week period. Screening TSH level showed negative correlation with gestational age and birth weight. Multiple linear regression analysis revealed low birth weight as the only independent factor affecting screening TSH level. Conclusions: Low birth weight infants appear to be at risk of thyroidal dysfunction. Our study showed that there were clinically signifi cant but weak correlation between higher screening TSH levels and low birth weight. The clinical importance of these fi ndings requires larger prospective studies to further elucidate the relevance of these factors affecting TSH screening levels.
Re: Palliation bias is being overlooked in neonatal hypothermia trialsWe thank Ziinu for the comments on our review. We agree that there is a risk of bias when the intervention is unmasked and this may also influence the decision to withdraw intensive care. Indeed, this is one reason why studies have chosen a composite outcome measure that includes rates of disability, but we agree that this does not completely remove the possibility of bias. It is one reason why we advise caution in the interpretation of the reported results and why a metaanalysis of the current studies can only be speculative. The additional data from approximately 600 infants that are being recruited in ongoing studies will help determine the efficacy of therapeutic hypothermia more precisely. We need to await those results before therapeutic hypothermia is considered standard treatment for perinatal asphyxia.
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