ABSTRACT
Endocrine diseases are rare and can present very subtly in the neonatal period. Most are diagnosed using newborn screening in the United States; however, some infants may present with false negatives or more subtle findings. Endocrine etiologies should be considered during the management of critically ill infants. This article will give an overview of endocrine emergencies encountered in the neonatal period, including disorders of glucose metabolism, thyroid disorders, adrenal disorders, and pituitary disorders.
Subject(s)
Adrenal Insufficiency , Endocrine System Diseases , Thyroid Diseases , Infant, Newborn , Infant , Humans , Adrenal Insufficiency/diagnosis , Endocrine System Diseases/complications , Endocrine System Diseases/diagnosis , Endocrine System Diseases/therapy , Thyroid Diseases/diagnosisABSTRACT
BACKGROUND: There is significant variability in Child Protective Services (CPS) utilization of medical-forensic experts. In 2016, Missouri legislation (HB 1877) mandated that CPS investigators submit screening forms to a Child Abuse Pediatrician (CAP) to review children < 4 years investigated for abuse. Compliance with this mandate is unknown. OBJECTIVE: To measure compliance with HB 1877, hypothesizing that urban counties would have better compliance than rural counties. PARTICIPANTS AND SETTING: This retrospective study included evaluation of screening forms completed by Missouri CPS and submitted to Missouri CAPs during February, July and September of 2017. METHODS: Compliance was measured in three ways. Compliance Measure 1 (CM1) was the number of screening forms versus the number of eligible CPS investigations. Compliance Measure 2 (CM2) was the average number of days from an abuse report until form submission, and Compliance Measure 3 (CM3) was the percentage of forms with complete information. Urban and rural counties were classified by 2010 census data. t-Tests were used to compare compliance measures between urban and rural counties. RESULTS: Overall compliance with CM1 was 69% with 1496 screening forms submitted and 2170 child maltreatment investigations for children less than 4 years of age. For CM2, mean days from abuse report to form submission was 30 days. For CM3, 60.5% of statewide forms were complete. There was no significant difference between rural and urban county compliance. CONCLUSIONS: Limited compliance with HB 1877 demonstrates the necessity of continued monitoring and improvement for optimal efficacy of legal mandates.
