ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Indian J Pediatr 2018; 85(6):440-447

In 2017, the population of India was estimated at 1.28 billion. With a birth rate of 19/1000, it means that 24.4 million babies are born each year in India. More than half of the births take place at home, in particular in rural India. Assuming an incidence of 1:2500 for congenital hypothyroidism (CH), close to 10,000 babies are born with CH each year in India. These numbers highlight the enormous challenge of designing and implementing a systematic screening for CH in this vast country.

Our colleagues from the Indian Society for Pediatric and Adolescent Endocrinology (ISPAE) should be commended for producing this consensus document that is the first step towards a national screening program for CH. The proposed guidelines take into account specific characteristics of India. First, they suggest that health professionals choose between cord blood screening and postnatal screening (Guthrie card). This is important in a country where many mothers and neonates may not stay close to the hospital long enough to get postnatal screening. Second, they propose that the health professional sends the sample to either a central laboratory, where available, or to a local laboratory. While central laboratories are likely to offer a better overall organization (reflecting the handling of a greater number of samples) and a better quality control, it may be easier and faster to deliver the samples to a local laboratory.

An important characteristic of India is the high number of home deliveries. India would be a perfect candidate for point of care testing of TSH, which consists of measuring TSH at the bedside (home, hospital) using a portable device. However, while in development, the technology of point of care testing of TSH is not yet available. Once it is, it may become the preferred method of testing for countries, such as India, where many babies are delivered at home or where families are difficult to reach.