From the Guidelines
For a newborn with a history of forceps delivery, large for gestational age (LGA), and maternal Hashimoto's thyroiditis with elevated Thyroid-Stimulating Hormone (TSH) levels during pregnancy, the following tests and screenings are recommended:
Recommended Tests and Screenings
- Standard newborn screening panel (includes thyroid function tests)
- Complete blood count (CBC)
- Blood glucose monitoring
- Bilirubin levels
- Physical examination for birth injuries
- Cranial ultrasound (if forceps or vacuum-assisted delivery)
- Thyroid function tests (TSH and free T4) These tests should be performed within the first 24-48 hours of life. The standard newborn screening is crucial for detecting various metabolic and genetic disorders, as noted in the context of maternal thyroid disease management 1. CBC helps assess for polycythemia, which is more common in large-for-gestational-age (LGA) infants.
Rationale for Each Test
- Blood glucose monitoring is important due to the risk of hypoglycemia in LGA babies, a concern highlighted by recent studies on neonatal hypoglycemia screening 1.
- Given the forceps delivery, a thorough physical exam and potentially a cranial ultrasound are necessary to rule out any birth injuries.
- Bilirubin levels should be checked to monitor for jaundice, which is more common in LGA infants.
- Due to the mother's history of Hashimoto's and elevated TSH during pregnancy, special attention should be given to the newborn's thyroid function. While thyroid tests are part of the standard screening, additional testing of TSH and free T4 may be warranted to ensure proper thyroid function in the newborn, as suggested by guidelines on thyroid disease in pregnancy 1. These tests will help identify any immediate health concerns and allow for prompt intervention if needed, ensuring the best possible start for the newborn.
From the Research
Recommended Tests and Screenings for Newborns
The following tests and screenings are recommended for a newborn with a history of forceps delivery, large for gestational age (LGA), and maternal Hashimoto's thyroiditis with elevated Thyroid-Stimulating Hormone (TSH) levels during pregnancy:
- Congenital hypothyroidism screening in the first days of life 2
- Thyroid function tests, including TSH and free thyroxine (FT4) levels, to assess for potential thyroid dysfunction 3, 2
- Screening for transient thyroid hormone disorders, which can occur in newborns born to mothers with thyroid dysfunction 3, 2
- Monitoring of thyroid function and development in newborns with suspected thyroid dysfunction or hypothyroidism 2
Considerations for Maternal Hashimoto's Thyroiditis
- TSH receptor antibody testing should be considered in pregnant women with a history of autoimmune thyroid disease and symptoms of fetal hyperthyroidism 4
- Maternal TSHR Ab can cross the placenta and cause fetal and transient neonatal hyper- or hypothyroidism 3
- Anti-thyroid drugs taken for autoimmune hyperthyroidism can cross the placenta and cause fetal and transient neonatal hypothyroidism 3
Additional Considerations
- Large for gestational age (LGA) newborns may be at increased risk for hypoglycemia and other metabolic disorders, and should be monitored accordingly
- Forceps delivery may increase the risk of birth trauma and other complications, and should be taken into consideration when evaluating the newborn's overall health and development.