1026
bit, which is associated with delayed growth and embryo
mor-
These results suggest that intrafollicular overripeness of the ovum can be the source, not only of reproductive wastage in man,’ but also of a trouble in the programming of fetal growth.
tality in blastocysts or post-implantation.
I.N.S.E.R.M. Unit for Statistical 94800 Villejuif, France
Research,
E. PAPIERNIK A. SPIRA O. BOMSEL-HELMRICH S. LEBEL
CONGENITAL HYPOTHYROIDISM
SiR,-Your editorial of Sept. 29 (p. 678) describes clearly persuasive arguments in favour of neonatal screening for congenital hypothyroidism; if serious impairment of develop-
the
is to be avoided treatment should be started before the age of 3 months, but diagnosis is difficult in young babies and in all published series many patients remain unrecognised until
ment
0.2
0.4
0.6
Total
0.8
Doctor
10
1.2
1.4
16
delay (years)
later.
comparison with the development of children recognised screening, we are carrying out a retrospective by regional study of the development of children with hypothy-
Delays in diagnosis.
For
neonatal
roidism. The first part has involved 30 children under the age of 10 years with severe congenital hypothyroidism, having clinical, biochemical, and radiological evidence of onset before the age of 3 months. The mean of the intelligence quotient (Griffiths or WISC) of the group was one standard deviation below that of a normal population. However, of children whose treatment was started before the age of 3 months 75% had IQ scores greater than 95; of those treated between 3 months and 1 year 50% had IQs greater than 95; while only 23% in the group treated after 1 year had IQs greater than 95. Scores of all subtests were significantly better when a child was treated early, though like McFaul et a1.1 we found that neurological abnormalities were less directly related to age of diagnosis, abnormal signs being found commonly even in patients who had been diagnosed
there are significant doctor delays, frequent and important maternal delays also occur. These are unlikely ever to be prevented by medical education. One-third of the children had been admitted to a special-care baby unit during the newborn period and even amongst this group half were not diagnosed until after the age of 3 months. These findings confirm the difficulties in making an early diagnosis and support the plea for neonatal screening. G. J. FROST Department of Child Health, J. M. PARKIN University of Newcastle upon Tyne, D. ROWLEY Newcastle upon Tyne NE1 4LP
TEACHING ABOUT SEXUALLY TRANSMITTED DISEASES
early. As the home environment has an important influence upon the development of young children we attempted to make allowance for this by comparing the patient’s IQ with that of a sibling. The findings in 10 sibling pairs are shown in the table. These results confirm the importance of treatment being started before the age of 3 months. The median age of diagnosis of the patients in this study was 6 months, the range being from 10 days to 3tyears; only 30% were diagnosed before the age of 3 months. We were interested in the reasons for the delay in the diagnosis. In the figure, the age at which each child was taken to the doctor (maternal delay) is plotted against the time from presentation to the doctor to diagnosis (doctor delay). Although in many patients
Hertig AT. The overall problem in man. In: Benirschke K, ed. Comparative aspects of reproductive failure. Berlin: Springer-Verlag, 1967: 11-41. 1. MacFaul R, Dorner S, Brett EM, Grant DB. Neurological abnormalities in patients treated for hypothyroidism in early life. Arch Dis Childh 1978;
4.
53:611-19.
IQ
SIR,-We read with interest
Dr Robertson’s letter (Oct. 20, 856). The teaching on sexually transmissible diseases (STD) in England shows much variation and this is being studied by the British Co-operative Clinical Group. Leeds is perhaps fortunate in that undergraduates are taught in small groups of 20-30 throughout the year, each student receiving 5 hours of p.
lectures/tutorials and 8-12 hours of clinical instruction, 2 or 3 students sitting in on a consultation. This continuity places great demands on a specialty where there are few teachers. No doubt the proposed expansion of the medical school from 160 will exacerbate this continued demand on teachers. We agree with Robertson that if doctors are to become more aware about the proper management of STD undergraduates must be taught well. The extent of STD is such that the workload in Leeds, in number of patients seen per annum, exceeds that of any other specialty, and this is probably true of most other provincial cities. We agree that only good teaching will attract high calibre individuals into this often neglected shortage specialty. Some of our best supporters are our patients,
OF PATIENTS WITH CONGENITAL HYPOTHYROIDISM COMPARED WITH
IQ OF SIBLINGS