Background: Local guidelines for infants born to mothers with a history of thyrotoxicosis previously recommended that infants were observed in hospital until thyroid function tests were checked on day 4, with follow up on day 10, causing inconvenience to families and unnecessary cost to services. Following a literature search, our revised local guidelines recommend low-risk infants can be discharged on day 0 without follow up, stratified using maternal TSH-receptor antibody (TRAb) levels in pregnancy and whether siblings have been affected. A re-audit was undertaken to assess the effect of the new guideline.
Method: Infants were identified from the list of mothers who had thyroid disease noted in their maternity records, excluding those who had never been hyperthyroid. Removal of routine day 4 thyroid function tests in the new guideline prevented the previous method of identification. Health records of infants and mothers were reviewed to establish maternal thyroid history, maternal TRAb levels in pregnancy, length of stay, clinic follow up, thyroid function testing and symptomatic thyrotoxicosis in the infant.
Results: Twenty-two infants were identified in a one year period (55% male, 45% female), a significant reduction compared to the original audit (n=57). TRAb results were available on 11/23 (48%) patients, of which six were below 1 IU/l; results did not change the stratification in three infants, increased it in four patients and decreased it in another four. The median (IQR) length of stay reduced from 4 (45) to 2 (14) days (P<0.001). Two patients were incorrectly treated as low risk (primip without TRAb results) and one was incorrectly treated as high risk (unaffected sibling without TRAb results). No infants were symptomatic or required treatment.
Conclusions: Awareness of the option of early discharge has reduced the median length of stay despite risk category being raised in as many patients as it was lowered. Less than half of women had TRAb levels checked, especially where impression in antenatal endocrine was of non-Graves thyrotoxicosis. The reduction in the number of infants suggests the current method of identifying patients may need revising.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes