Even in the era of expanded newborn screening, utility of cord blood thyroid stimulating hormone (cTSH) for diagnosis of congenital hypothyroidism (CH) cannot be marginalised. This study was to assess the diagnostic utility of cTSH [ 20 lIU/L for screening CH. Generation of new cTSH value was the main outcome measure, to increase specificity. Designed as a cross-sectional analytic study in the neonatal unit of teaching hospital, 1200 term neonates with birth weight C2500 g, with no perinatal complications were included. Newborn cTSH assay was done by chemiluminescence. All screen positive were followed up on day five, 14 and 28 of life, to rule in or out CH (true or false positive). Positive predictive value and specificity were calculated. Receiver operating characteristic (ROC) was done to assess diagnostic accuracy of cTSH [ 20 lIU/L and to ascertain new cutoff to reduce false positivity. Of 1200 newborns screened, 69 (5.8%) were screen positive and followed up. In five, CH was confirmed (true positive); one in 240 newborns required thyroxine therapy. False positivity was noted in 59. Recall and dropouts were 6.25 and 7.2% respectively. Median cTSH of screen, true and false positives were 28.8, 43.5 and 27.2 lIU/L respectively. Comparison of median values of cord blood (U = 59; p = 0.017) and day five serum TSH (U = 0.0; p \ 0.001) among true and false positive subjects were statistically significant. Specificity calculated was 94.6% and positive predictive value 7.25%. ROC generated new permissible cTSH cutoff value of 30 lIU/L. In conclusion, an extended cTSH cutoff value of 30 lIU/L improves specificity.

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Renal tubular acidosis (RTA) is associated with normal or near normal glomerular filtration rate. Proximal RTA is associated with impaired bicarbonate reabsorption. This is manifested as bicarbonate wastage in the urine, and this reflects the defect in proximal tubular transport. Osteopenia or full-blown rickets may develop. Type 2 RTA is rare and occurs in association with conditions such as Fanconi syndrome. This is manifested as glycosuria, aminoaciduria, phosphate wasting and mild proteinuria. The basis of therapy is the continuous administration of appropriate amounts of alkali in the form of either bicarbonate or citrate, as well as the treatment of the cause.

Ovarian torsion in children is a rare cause of acute abdominal pain and is a true surgical emergency. The clinical presentation closely resembles other pathologies such as urinary tract infections, gastroenteritis and more common surgical emergencies such as appendicitis. We present a case of previously healthy 6 year old female child who presented with abdominal pain, intermittent fever and vomiting. Ultrasonography of the abdomen and pelvis revealed features suggestive of ovarian torsion for which Subacute Laparoscopic Oophorectomy was performed. The authors would like to sensitize readers to the possibility of ovarian torsion in the paediatric populace and reiterate that timely diagnosis and management can prevent catastrophic sequelae.