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Developmental Screening of Children with Congenital Hypothyroidism Using Ages and Stages Questionnaires Test
Zahra Razavi1, Setila Dalili2, Mohammad Kazem Sabzehei3
1Department of Pediatric Endocrinology, Hamadan University of Medical Sciences, Hamadan, Iran.
Insights
Early diagnosis and treatment of congenital hypothyroidism (CH) are crucial for child development. Higher initial levothyroxine doses positively impact developmental outcomes, as measured by Ages & Stages Questionnaires (ASQ).
Area of Science:
- Pediatric Endocrinology
- Developmental Pediatrics
- Neonatal Screening
Background:
- Congenital hypothyroidism (CH) is a leading cause of preventable intellectual disability in children.
- Early identification and management of CH are critical for optimal neurodevelopmental outcomes.
- The Ages & Stages Questionnaires (ASQ) is a validated tool for assessing developmental status in young children.
Purpose of the Study:
- To evaluate the neurodevelopmental status of children with congenital hypothyroidism (CH) using the Ages & Stages Questionnaires (ASQ).
- To identify key factors influencing developmental outcomes in infants and children diagnosed with CH.
- To correlate ASQ scores with diagnostic and treatment parameters in CH patients.
Main Methods:
- A retrospective study analyzed data from 78 children diagnosed with CH.
- Neurodevelopmental status was assessed using the Ages & Stages Questionnaires (ASQ).
- Medical records were reviewed for demographic, clinical, and treatment-related data; statistical analysis was performed using SPSS.
Main Results:
- 41% of children with CH exhibited developmental disorders, including global motor delay and impaired problem-solving skills.
- Early diagnosis and treatment initiation (average 17.99 days) were associated with better developmental outcomes compared to later intervention (average 25.65 days).
- ASQ scores significantly correlated with the initial levothyroxine dose, age at diagnosis, and age at treatment initiation.
Conclusions:
- Early diagnosis and timely treatment initiation are paramount for improving developmental trajectories in children with CH.
- The initial dosage of levothyroxine is a significant determinant of developmental outcomes in CH patients.
- Higher initial levothyroxine doses may be required to optimize neurodevelopmental outcomes in infants with congenital hypothyroidism.
Objectives:
Congenital hypothyroidism (CH) is one of the most common causes of mental retardation in children. We investigated the developmental status of children with CH screened by Ages & Stages Questionnaires (ASQ) measurement scores.
Materials & Methods:
In this retrospective study, neurodevelopmental status of 78 children diagnosed with CH followed up at the Outpatient Pediatric Endocrinology Clinic of Besat Hospital, Hamadan, Iran from May 2006 to Mar 2013, was evaluated by ASQ method. Data on age, sex, birth weight, birth length, head circumference, residency location, parental education level, primary venous TSH and T4 levels, age at diagnosis, treatment start age and initial levothyroxine dosage were extracted from medical records. Data were analyzed using statistical software SPSS. P-value less than 0.05 was considered statistically significant.
Results:
Of the 78 patients, 34 (43.6%) were female, 32 (41%) had developmental disorder, and 56 (71.8%) were living in urban areas. Types of developmental impairments included: global motor delay in 13 (40.6%) patients, problem-solving in 11 (34.3%), impaired communication skills in 5 (15.6%), impaired fine motor skills in 2 (6.2%), and impairment of personal social skills in 1 (3.1%). The average ages for diagnosis and treatment were 25.65 days in patients with developmental impairment and 17.99 days in those without developmental delay. ASQ results showed significant statistical correlation with initial dose of levothyroxine (P=0.017), age of hypothyroidism diagnosis (P=0.002) and age of treatment initiation (P=0.018).
Conclusion:
Early diagnosis and treatment along with initial levothyroxine dose were most important factors of ASQ scores of children with CH. Higher dose of the levothyroxine is required at onset.
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