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The impact of demographic factors on newborn TSH levels and congenital hypothyroidism screening
Auckland Dist Hlth Board, Newborn Metab Screening Programme, LabPlus, Auckland, New Zealand;Univ Auckland, Liggins Inst, Auckland, New Zealand.ORCID iD: 0000-0003-2895-3279
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Univ Auckland, Liggins Inst, Auckland, New Zealand.ORCID iD: 0000-0003-1226-1956
Auckland Dist Hlth Board, Newborn Metab Screening Programme, LabPlus, Auckland, New Zealand.
Univ Auckland, Liggins Inst, Auckland, New Zealand;Auckland Dist Hlth Board, Starship Childrens Hosp, Auckland, New Zealand.
2019 (English)In: Clinical Endocrinology, ISSN 0300-0664, E-ISSN 1365-2265, Vol. 91, no 3, p. 456-463Article in journal (Refereed) Published
Abstract [en]

Context

Optimal newborn screening thyroid‐stimulating hormone (TSH) cut‐offs are contentious. Analysis of demographic factors that impact screen TSH levels may help explain international variance and provide guidance to screening programmes.

Objective

To determine the influence of demographic factors on newborn screening TSH levels and screening performance parameters.

Design and Setting

National, retrospective population study using blood spot TSH cards from the New Zealand newborn screening programme in 2010‐2015.

Patients

325 685 blood spot cards.

Main Outcome Measures

Likelihood of exceeding specific TSH thresholds (TSH ≥5, ≥10 and ≥15 mIU/L) and group‐specific screening performance parameters.

Results

The likelihood of high TSH levels differed between ethnic groups. Pacific Island infants were more than twice as likely to have high‐normal TSH levels (≥5 and ≥10 mIU/L) and nearly twice as likely to have a positive screen (≥15 mIU/L) as New Zealand Europeans. Māori or Chinese ethnicity, male sex, younger gestational age and greater socio‐economic deprivation scores were also associated with high‐normal TSH levels. At a TSH threshold ≥15 mIU/L, screening sensitivity was lowest (88.89% vs 95.83% overall) and PPV greatest (88.89% vs 62.84%) amongst Asian infants. Early samples were more than three times as likely to reach the screen‐positive threshold and more likely to yield a false‐positive result (PPV 20.00% vs 68.87%, P = 0.004).

Conclusions

Newborn TSH levels are impacted by a number of demographic variables, particularly ethnicity and age at sample collection. Screening performance may be improved through the use of targeted thresholds.

Place, publisher, year, edition, pages
2019. Vol. 91, no 3, p. 456-463
Keywords [en]
congenital hypothyroidism, demographic factors, ethnicity, newborn screening, thyroid-stimulating hormone (TSH)
National Category
Endocrinology and Diabetes Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:uu:diva-394257DOI: 10.1111/cen.14044ISI: 000482453600013PubMedID: 31162702OAI: oai:DiVA.org:uu-394257DiVA, id: diva2:1360109
Available from: 2019-10-11 Created: 2019-10-11 Last updated: 2019-10-11Bibliographically approved

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Derraik, Jose G. B.

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