Endocrine Abstracts

Background: CH has an incidence of 1 per 3500 live births per year. Early diagnosis and treatment are essential to prevent severe morbidity of mental retardation and developmental delay in children. The newborn screening programme has played a major role in management of CH.

Objectives: The aim of the first audit was to identify our practice in management of CH once the newborn screening laboratory notified about an abnormal result. Following the first audit, there were recommendations that were implemented in accordance with the BSPED and newborn screening program guidelines. We re-audited the following year after the recommendations to assess any improvement in our practice.

Method: The first audit was a retrospective case notes review for a period from 1 January 2005 to 31 December 2013. Data for when the notification was received form the screening laboratory in terms of day of life of the child, first clinical review, thyroid function test (TFT), radioisotope scan or US of thyroid, day of starting Thyroxine, starting dose of thyroxine, time for normalisation of TFT and out patient clinic follow up were noted. Whether maternal history and maternal TFT were done were also noted.

After the first audit a template was designed to clerk neonates referred for CH. After a year of using the recommended clerking template a re-audit was done to assess improvement or otherwise.

Re-audit period was from 1 January 2014 to 31 December 2014.

Results: Recommendation from the previous audit included designing a check list perform a with all the main domains of the standard guidelines. The re-audit showed that our service is improved in certain aspects. All patients started on treatment within 2 days of notification. 85% of patients seen in OPD within 2 days. All patients had maternal history documented, maternal thyroid status checked and outcome faxed to screening laboratory. OPD follow up improved as 71.4% of patient attended all the scheduled first year appointments.

Recommendation: Add scheduled out patient appointments to the CH proforma and give parents a copy. Phone message reminder system regarding clinic appointments. Contact the parents in advance to confirm the appointments.