"A Simple Newborn Screening for a Very Serious Problem": Reviewing of Basic and non to be Forgotten Clinical Examination Features

Context: The main cause of preventable mental retardation is congenital hypothyroidism, most of neonatal screening programms are concern about its evaluation but only consider the management with hormone values considerably higher than those internationationally recommended with negative consequences for optimal neurodevelopment. Moreover minimal clinical signs as open posterior fontanelle are consider only with the coincidentially presence of other major signs for mental retardation.

Aim: Correlate the presence of an open and palpable posterior fontanelle in healthy newborns with the level of serum thyroid and thyroid stimulating hormones in the first seven days of life in order to establish the risk of thyroideal disfunction among a phenotipically andean population from the southern area of Quito, Ecuador.

Method: 128 neonates who showed a posterior fontanelle of 0,5cm or more in diameter, were evaluated for serum T4 and TSH by mass spectrophotometry at their seventh day of life. Clinical histories about birth conditions and events in neonatology wards were reviewed as well. From August 2017 to August 2019.

Outcome: It has been obtained 64% of cases with under normal values according to international references in babies without other hypothyroideal alteration or symptomatic evidence.

Conclusions: A minimal clinical evaluation for findings as a wide open posterior fontanelle must be considered as a simple screening method, that has a very high correlation with some degree of thyroid deficiency, being this transient or for a undetermined period that perhaps leads to limited neurodevelopment of unpredictable outcome. This could be considered as a first step with a high certainty index for carrying on comprobatory tests. It is a very important tool of basic knowledge in primary health conditions, where coincides lack of technological resources and crippled budgets.