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Validity of Newborn Clinical Assessment to Determine Gestational Age in Bangladesh.

Abstract：

BACKGROUND:Gestational age (GA) is frequently unknown or inaccurate in pregnancies in low-income countries. Early identification of preterm infants may help link them to potentially life-saving interventions. METHODS:We conducted a validation study in a community-based birth cohort in rural Bangladesh. GA was determined by pregnancy ultrasound (<20 weeks). Community health workers conducted home visits (<72 hours) to assess physical/neuromuscular signs and measure anthropometrics. The distribution, agreement, and diagnostic accuracy of different clinical methods of GA assessment were determined compared with early ultrasound dating. RESULTS:In the live-born cohort (n = 1066), the mean ultrasound GA was 39.1 weeks (SD 2.0) and prevalence of preterm birth (<37 weeks) was 11.4%. Among assessed newborns (n = 710), the mean ultrasound GA was 39.3 weeks (SD 1.6) (8.3% preterm) and by Ballard scoring the mean GA was 38.9 weeks (SD 1.7) (12.9% preterm). The average bias of the Ballard was -0.4 weeks; however, 95% limits of agreement were wide (-4.7 to 4.0 weeks) and the accuracy for identifying preterm infants was low (sensitivity 16%, specificity 87%). Simplified methods for GA assessment had poor diagnostic accuracy for identifying preterm births (community health worker prematurity scorecard [sensitivity/specificity: 70%/27%]; Capurro [5%/96%]; Eregie [75%/58%]; Bhagwat [18%/87%], foot length <75 mm [64%/35%]; birth weight <2500 g [54%/82%]). Neonatal anthropometrics had poor to fair performance for classifying preterm infants (areas under the receiver operating curve 0.52-0.80). CONCLUSIONS:Newborn clinical assessment of GA is challenging at the community level in low-resource settings. Anthropometrics are also inaccurate surrogate markers for GA in settings with high rates of fetal growth restriction.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Lee AC,Mullany LC,Ladhani K,Uddin J,Mitra D,Ahmed P,Christian P,Labrique A,DasGupta SK,Lokken RP,Quaiyum M,Baqui AH,Projahnmo Study Group.

doi

10.1542/peds.2015-3303

subject

Has Abstract

pub_date

2016-07-01 00:00:00

issue

eissn

0031-4005

issn

1098-4275

pii

peds.2015-3303

journal_volume

138

pub_type

杂志文章

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Validity of Newborn Clinical Assessment to Determine Gestational Age in Bangladesh.