Universal Decentralized Cord Blood TSH Screening Should Be Offered as Routine Delivery Care in Limited-Resource Settings

Abstract

Newborn screening (NBS) for congenital hypothyroidism (CH) facilitates early diagnosis and treatment and prevents permanent intellectual disability. Sadly, 50 years after the first introduction of NBS for CH, only 29.6% of newborns worldwide are screened. Africa and Asia, the continents with the highest birth rates, have very limited screening coverage. Most NBS programs measure TSH in a dried-blood spot taken from a heel-prick on a filter paper after 24 to 72 h of life. Implementing national NBS programs is logistically complex and expensive, requiring parental consent, specialized laboratories, and excellent infrastructure. In limited-resource settings, introducing such a complex program is often impossible. We propose universal decentralized cord blood TSH screening, offered as routine delivery care for all newborns in limited-resource settings. TSH measurement may be performed by local laboratories using widely available, inexpensive radioimmunoassay kits, with the report available within a few hours. Since the TSH report would be available before discharge, suitable clinical decision making would be possible, with a minimal need for recall, thus minimizing the parental, medical, and financial burden and improving developmental outcomes. The most important requirement is to change to a grassroots approach, with the education of obstetricians and pediatricians worldwide to perform routine cord blood TSH and make sure the TSH result is available before the baby is discharged.

Keywords: TSH; congenital hypothyroidism; cord blood; newborn screening.

Figure 1

Coverage rates for neonatal screening worldwide in 2024. Colors indicate coverage rates (green indicates coverage rates ≥ 90%, light blue indicates coverage rates between 75 and 90%, yellow indicates coverage rates between 50 and 75%, orange indicates coverage rates between 25 and 50, and red indicates coverage rates < 25%). Countries marked in gray either have no NBS program or no data (the exception is Greenland, which is screened under the Danish NBS program with >99% coverage). Figure originally published in reference [12].