Postnatal Foot Length to Determine Gestational Age: A Pilot Study

Feasibility and diagnostic accuracy of neonatal anthropometric measurements in identifying low birthweight and preterm infants in Africa: a systematic review and meta-analysis

BACKGROUND

Complications of prematurity are the leading cause of under-5 mortality globally and 80% of newborn deaths are of low birth weight (LBW) babies. Early identification of LBW and preterm infants is crucial to initiate timely interventions.

OBJECTIVE

To evaluate the feasibility and diagnostic accuracy of alternative neonatal anthropometric measurements in identifying LBW and preterm infants in Africa.

METHODS

In this systematic review and meta-analysis, we evaluated the diagnostic performance of infant foot length, mid-upper arm circumference (MUAC), head and chest circumferences against birth weight and gestational age. Pooled correlation between the index and the reference methods was estimated. Multiple anthropometric thresholds were considered in estimating the pooled sensitivity, specificity and area under receiver operating characteristic curve (AUC).

RESULTS

21 studies from 8 African countries met the inclusion criteria. Correlation coefficients with birth weight were 0.79 (95% CI 0.70 to 0.85) for chest circumference, 0.71 (95% CI 0.62 to 0.78) for MUAC and 0.66 (95% CI 0.59 to 0.73) for foot length. Foot length measured by rigid ruler showed a higher correlation than tape measurement. Chest circumference with 28.8 cm cut-off detects LBW babies with AUC value of 0.92 (95% CI 0.71 to 0.97). Foot length identified preterm infants, with 82% sensitivity, 89% specificity and AUC of 0.91 (95% CI 0.69 to 0.98) at a 7.2 cm optimal cut-off point. MUAC had an AUC of 0.83 (95% CI 0.47 to 0.95) for preterm detection. In identifying LBW babies, foot length and MUAC have AUC values of 0.89 (95% CI 0.70 to 0.96) and 0.91 (95% CI 0.73 to 0.97) at 7.3 cm and 9.8 cm optimal cut-off points, respectively. Foot length and MUAC are relatively simple and minimise the risk of exposing infants to cold.

CONCLUSION

Newborn foot length, MUAC, head and chest circumferences have comparable diagnostic accuracy in identifying LBW and preterm babies. Using foot length and MUAC in low-resource settings are the most feasible proxy measures for screening where weighing scales are not available.

PROSPERO REGISTRATION NUMBER

CRD42023454497.

Assessing the diagnostic accuracy of postnatal clinical scoring methods and foot length measurement for estimating gestational age and birthweight of newborns in low- and middle-income countries: a systematic review and meta-analysis

BACKGROUND

This study aimed to update systematic reviews and meta-analyses on the diagnostic accuracy of postnatal clinical scoring (PCS) methods and foot length (FL) measurement for assessing gestational age (GA) and birth weight in low-income and middle-income countries (LMICs). In addition, the quality of reference standards, including antenatal ultrasound (A-US), last menstrual period (LMP), PCS and newborn weighing scales, was also evaluated.

METHODS

Studies from LMICs published between January 2000 and February 2024 were searched, using databases such as PubMed, Web of Science, Cochrane Library, CINAHL and Scopus. Studies that compared PCS and/or FL with LMP and/or A-US to estimate GA or used calibrated newborn weighing scales for birthweight estimation were included. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-II tool and evaluated the quality of the reference standards. When sufficient data were available, pooled estimates were calculated using random-effects models.

RESULTS

A total of 50 studies were included. A-US was a reasonable tool for GA assessment if conducted by physicians using fetal biometry and the Hadlock method for GA estimation. LMP was reasonable when women had regular cycles, knew their LMP, were not using contraceptives and LMP data were collected by healthcare providers. When A-US was used as the reference standard, PCS methods estimated GA with a precision of ±2.8 to ±3.2 weeks. FL measurement <7.5 cm showed a pooled sensitivity of 76.2% and specificity of 36.6% for identifying preterm birth. FL measurement ≤7.6 cm had a pooled sensitivity of 78.6% and specificity of 65.7% for identifying low birth weight (LBW). High heterogeneity across studies was observed.

CONCLUSION

This systematic review and meta-analysis highlights significant variability and methodological inconsistencies in using PCS methods and FL measurement for estimating GA and LBW in LMICs. The observed high heterogeneity across studies suggests a cautious interpretation of the results.

PROSPERO REGISTRATION NUMBER

CRD42020209455.

Diagnostic accuracy of foot length measurement for identification of preterm newborn in rural Sindh, Pakistan

INTRODUCTION

Assessing gestational age accurately is crucial for saving preterm newborns. In low and middle-income countries, such as Pakistan, where access to antenatal ultrasonography (A-USG) is limited, alternative methods are needed. This study evaluated the diagnostic accuracy of foot length (FL) measurement for identifying preterm newborns in rural Pakistan using A-USG as the reference standard.

METHODS

A test validation study was conducted between January and June 2023 in rural Sindh, Pakistan, within the catchment area of the Global Network for Maternal Newborn Health Registry, Thatta. Singleton newborns whose mothers had an A-USG before 20 weeks of gestation were enrolled. A research assistant measured FL three times using a rigid transparent plastic ruler within 48 hours of birth and the average FL was reported. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) and likelihood ratios were calculated. The optimal FL cut-off for the identification of preterm newborns was determined using the Youden Index.

RESULTS

A total of 336 newborns were included in the final analysis, of whom 75 (22.3%) were born before 37 weeks of gestation. The median gestational age of the newborns was 38.2 weeks, and the median FL was 7.9 cm. The area under the curve was 97.6%. The optimal FL cut-off for identifying preterm newborns was considered as ≤7.6 cm with a sensitivity of 90.8%, specificity of 96.0%, PPV of 86.7% and NPV of 97.3%. A lower cut-off of ≤7.5 cm had a sensitivity of 95.4%, specificity of 84.0%, PPV of 63.1% and NPV of 98.5%.

CONCLUSION

In conclusion, this study highlights the utility of FL measurement for identifying preterm newborns in rural settings where A-USG is unavailable before 20 weeks of gestation. Optimal cut-offs of ≤7.6 and ≤7.5 cm provide a simple, cost-effective and reliable tool for clinicians and frontline healthcare providers in rural areas, respectively.

TRIAL REGISTRATION NUMBER

NCT05515211.

Estimating gestational age using the anthropometric measurements of newborns in North Shewa Zone public hospitals, Oromia, Ethiopia

Background

The accurate estimation of gestational age is crucial in identifying prematurity and other health problems in newborns and in providing appropriate perinatal care. Although there are numerous methods for measuring gestational age, they are not always applicable. During these situations, it becomes challenging to ascertain whether a baby has been born prematurely or not. Therefore, this study aims to estimate gestational age by utilizing newborn anthropometric parameters.

Purpose

The objective of this study is to estimate the gestational age of newborns in public hospitals located in the North Shewa Zone of the Oromia Region in Ethiopia, by using anthropometric parameters.

Methods

A cross-sectional study was conducted at a facility from February 2022 to April 2022, using an interview-based questionnaire and anthropometric measurements. The anthropometric parameters that were measured include foot length (FL), mid-upper arm circumference (MUAC), and chest and head circumference (CHC). The study's sample size had a total of 420 participants. The data were cleaned, edited, manually checked for completeness, and entered into Epi-data version 3.1. Subsequently, the data were transferred into SPSS for analysis. The data were analyzed using descriptive analysis, simple linear regression, and multiple linear regressions. Finally, the data were presented using statements and tables.

Results

There is a significant and positive correlation between anthropometric parameters, including head circumference (r: 0.483), MUAC (r: 0.481), foot length (r: 0.457), and chest circumference (r: 0.482) with gestational age. All anthropometric parameters demonstrated positive and significant estimates of gestational age. The combination of the four measurements yielded the strongest estimate of gestational age. Gestational age can be calculated by the formula: Gestational age (Weeks) = 9.78 + 0.209*CHC + 0.607*MUAC + 0.727*FL + 0.322*HC.

Conclusion

Gestational age can be measured using head circumference, mid-upper arm circumference, foot length, and chest circumference. Utilizing the four anthropometric parameters in combination exhibits greater efficacy in estimating gestational age than using them individually. Therefore, it is recommended to use these alternative approaches when standard methods are not applicable.

Postnatal foot length in the estimation of gestational age in relation to intrauterine growth pattern among Nigerian neonates

Objectives

To determine the relationship between postnatal foot lengths and estimated gestational age (EGA) in relation to intrauterine growth patterns determined at birth among Nigerian neonates.

Design

Hospital-based, cross-sectional.

Setting

Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria.

Participants

260 neonates with EGA 30- 42 weeks within 48 hours of life.

Interventions

Postnatal foot lengths (FL) were measured with Vernier digital calliper in millimetres. The intra-uterine growth pattern was determined using the Lubchenco chart. Pearson correlation and regression analysis tests were performed.

Main outcome measures

Postnatal foot length in relation to Intra-Uterine Growth Pattern.

Results

The mean postnatal FL had a strong positive correlation with the EGA from 30 through 42 weeks (r = 0.855, p < 0.001). The overall mean foot length for preterm neonates was 65.44 (6.92) mm, while that of term neonates was 77.92 (4.24) mm. The linear regression equation was generated as: EGA = 9.43 + (0.37 × FL), p < 0.001. The EGA as measured by FL had the highest positive correlation with Small for Gestational Age (SGA) intra-uterine-growth pattern, followed by Appropriate for Gestational Age (AGA) and least by Large for Gestational Age (LGA) respectively (r = 0.936> 0.861 > 0.666).

Conclusion

The postnatal foot length correlated well with estimated gestational age, and the correlation was best among SGA infants.

Funding

None declared.

Estimated Gestational Age From Infant's Foot Length in Japanese

Aim In developed countries including Japan, gestational age (GA) is predicted by the last menstrual period (LMP) and/or fetal ultrasound. In some developing countries, GA is predicted by infant's foot length (FL). Pregnant women who did not have pregnancy check-up is not infrequent in Japan, therefore there are sometimes opportunities to estimate the GA from infants after the delivery. The aim of this study is to determine the estimated GA formula from infant's FL in Japanese. Methods This study was a prospective cohort study. Infants between May 2021 and August 2021 at Iizuka Hospital and Tagawa Hospital or transferred from other hospitals within 24 hours of birth were collected. GA was determined using LMP and/or fetal ultrasound. The infant's FL was measured with a digital caliper within 24 hours of birth. The relationship between FL and GA was analyzed by simple regression analysis to determine the coefficient of determination (R²). The infant's FL of males and females, infant's FL of preterm and term, and infant's FL of low birth weight and appropriate weight infants were performed by the t-test as independent samples. A statistically significant difference was p < 0.05. Statistical analysis was performed using JMP Pro 16 (SAS Institute Japan Co., Ltd., Minato-ku, Tokyo). Results Ninety of the 135 infants were enrolled. The average GA was 38.2 ± 1.8 weeks, the average infant's FL was 7.230 ± 0.411 centimeter (cm), and the range of the infant's FL was 5.385 to 8.089 cm. The estimated GA formula, GA = 18.49 + 0.27 x infant's FL (R² = 0.39), was determined. Conclusions We determined the estimated GA formula from the infant's FL. There are some limitations and care should be taken in the use.

Estimation of Kidney Size From Foot Length in Newborns: A Cross-Sectional Study

Background

Kidney size determination and sonographic follow-up are important in clinical diagnosis and treatment in children. Various anthropometric measurements are correlated with gestational age and birth weight and are used to identify high-risk babies in need of early interventions. Although foot length has emerged as a simple and reliable anthropometric measurement, it is not correlated with kidney size, except in the fetal period. This study was undertaken to find a correlation between foot length and kidney dimensions and estimate kidney size by finding regression equations in newborns.

Methods

We conducted a cross-sectional study and 216 newborns were enrolled at a tertiary care hospital. Foot length was measured by digital Vernier calipers and kidney dimensions were measured by ultrasonography. The Pearson correlation coefficient and simple linear regression tests were used to determine the relationship between foot length and kidney dimensions.

Results

Foot lengths and kidney dimensions were comparable in males and females as well as on the right and left sides, except for kidney length, which was found to be longer in males. Both right and left foot lengths showed highly significant (p<0.001) but small, positive correlations with corresponding side kidney length, breadth, and area, with R-values ranging from 0.2874 to 0.3668. However, the correlation between birth weight and foot length was significant, positive, and moderate (r=0.6962 and 0.6923 for right and left foot lengths, respectively). The regression equation for estimation of kidney size from foot length was obtained but the variance explained was small (e.g. R²=0.1325 for right kidney length). Out of 216 babies in our study, 10 babies had a renal anomaly.

Conclusions

We found a significant but small, positive correlation between foot length and kidney dimensions. Only 13.25% of the variance in kidney length was associated with foot length. Birth weight also had a significant and positive but small correlation with kidney dimensions. However, the correlation of birth weight with foot length was moderate, and a 57.14% variance in foot length was associated with birth weight. Multivariate regression analysis with more anthropometric parameters and gestational age may help in finding a better estimation of kidney size.

Morbidity and mortality in small for gestational age very preterm infants in a middle-income country

OBJECTIVE

To evaluate the impact of small for gestational age (SGA) on outcomes of very preterm infants at Groote Schuur Hospital (GSH), Cape Town, South Africa.

STUDY DESIGN

Data were obtained from the Vermont Oxford Network (VON) GSH database from 2012 to 2018. The study is a secondary analysis of prospectively collected observational data. Fenton growth charts were used to define SGA as birth weight < 10th centile for gestational age.

RESULTS

Mortality [28.9% vs. 18.5%, adjusted risk ratio (aRR) 2.1, 95% confidence interval (CI) 1.6-2.7], bronchopulmonary dysplasia (BPD; 14% vs. 4.5%, aRR 3.7, 95% CI 2.3-6.1), and late-onset sepsis (LOS; 16.7% vs. 9.6%, aRR 2.3, 95% CI 1.6-3.3) were higher in the SGA than in the non-SGA group.

CONCLUSION

Small for gestational age infants have a higher risk of mortality and morbidity among very preterm infants at GSH. This may be useful for counseling and perinatal management.

Evaluation of the correlation of the new Ballard scoring with the ultrasonographic optical nerve sheath diameter and brain volume of preterm infants

BACKGROUND

Optic nerve sheath diameter (ONSD) measurements with magnetic resonance imaging and ultrasonography in preterm infants are similar.

AIM

We measured ultrasonographic ONSD and calculated the brain volumes of preterm infants using two-dimensional cranial ultrasonography and explored the relationships thereof with gestational age, birth weight, head circumference, and new Ballard score.

METHOD

This prospective study included preterm infants admitted to the neonatal intensive care unit without intracranial pathology. Two images per eye were obtained from a linear array ultrasound transducer placed on the patient's superior eyelid. The ONSD was measured 3 mm behind the globe. The brain was considered an ellipsoid, and estimated absolute brain volumes were calculated by subtracting the volumes of the two lateral ventricles from the total brain volumes.

RESULTS

A total of 143 preterm infants (male 74, female 69) included in the study. The mean gestational age of the study population was 29.7 weeks (23-36), and the mean birth weight was 1390 g (500-2850). There was a significant difference in ONSD between the male and female gender. A significant, strong, and positive correlation was found between ONSD measurements and gestational age (r 0.901, p < 0.001), new Ballard score (r 0.946, p < 0.001), birth weight, head circumference, and brain volumes.

CONCLUSION

Our results suggested that ONSD measurements are highly correlated with anthropometry, and it could be a promising bedside, non-invasive objective tool for the determination of exact gestational age postnatally along with the new Ballard score.

Foot Length for Gestational Age Assessment and Identification of High-Risk Infants: A Hospital-Based Cross-Sectional Study

The knowledge of the gestational age of the newborn is essential for management. In the absence of a dating scan, the postnatal assessment scores have drawbacks of being difficult to learn and administer in the community. The measurement of the foot length is easy, reproducible and offers an objective assessment. The objective of this study was to determine the correlation of postnatal (<48 h) foot length measurement (with calipers) with gestational age as determined by antenatal dating ultrasound, create a predictive model for the same and propose foot length measurement cutoffs for <37 and <34 weeks of gestation. Secondary objectives were to assess the correlation between foot length as measured with calipers and that measured with a ruler and a paper footprint. This was a hospital-based cross-sectional study. Among the 520 babies assessed, the correlation of foot length with gestational age was 0.89. Operational cutoffs for the categories of <37 and <34 weeks at a sensitivity of 95% were <70 and <65 mm, respectively. The Pearson's correlation between foot length as measured by caliper and ruler was 0.95 and between caliper and paper footprint was 0.87. This study correlating foot length and gestational age has the potential to help neonatal care providers make informed management decisions, particularly in resource-limited settings.

A Comparison of the Accuracy of Various Methods of Postnatal Gestational Age Estimation; Including Ballard Score, Foot Length, Vascularity of the Anterior Lens, Last Menstrual Period and Also a Clinician's Non-Structured Assessment

INTRODUCTION

Gestational age is a strong determinant of neonatal mortality and morbidity. Early obstetric ultrasound is the clinical reference standard, but is not widely available in many developing countries.

METHODS

A prospectively designed diagnostic accuracy study in a tertiary referral hospital in a developing country. Early ultrasound (<20 weeks) was the clinical reference standard. Methods evaluated included anthropometric measurements (including foot length), vascularity of the anterior lens, the New Ballard Score and last menstrual period. Clinicians' non-structured global impression 'End of Bed' Assessment was also evaluated.

RESULTS

106 babies were included in the study. Median age at birth was 34 weeks (interquartile range 29-36). Ballard Score and 'End of Bed' Assessment had a mean bias of -0.14 and 0.06 weeks respectively but wide 95% limits of agreement. The physical component of the Ballard score, the total Ballard score and Foot length's ability to discriminate between term and preterm infants gave an area under the receiver operating characteristics curve of 0.97, 0.96 and 0.95, respectively.

DISCUSSION

Although 'End of Bed' Assessment and Ballard score had small mean biases, the wide confidence intervals render the methods irrelevant in clinical practice. Foot length was particularly poor in Small for Gestational Age infants. None of the methods studied were superior to a non-structured clinician's informal 'End of Bed' Assessment.

CONCLUSION

None of the methods studied met the a priori definition of clinical usefulness. Improving access to early ultrasound remains a priority. Instead of focusing on chronological accuracy, future research should compare the ability of early ultrasound and Ballard score to predict morbidity and mortality. Lay summary.

BACKGROUND

Gestational age describes the time interval between conception and the delivery of the baby. Babies born before 37 weeks of gestation (preterm) or after 42 weeks of gestation (post-dates) have an increased risk of death and specific illnesses. The best way to estimate the gestational age is to perform an ultrasound scan on the mother before 20 weeks. However, this is not widely available in many developing countries. Methods to estimate gestational age after birth include calculating the time from the last period, various measurements of the child (such as weight, foot length or head circumference) physical and neurological markers of maturity and examination of the blood vessels on the lens in the eye.

METHODS

In this study, we assessed how accurate these methods were when compared with the best available method; early ultrasound. We also analyzed the clinicians own personal feeling of what the most likely gestation was, based on an informal 'end of bed' assessment. If a method was to be deemed clinically useful it was agreed that it would have to confidently identify the gestation to within 1 week of the true gestation.

RESULTS

None of the methods studied could confidently predict the gestational age of individual babies within 1 week. Ballard scoring and the clinician's informal 'End of Bed' Assessment were the most accurate and also had the smallest inter-operator variability when the results of two separate researchers were compared. Foot length performed particularly badly with babies who were small for their gestational age.

CONCLUSION

None of the methods studied confidently predicted gestational age within a week, so have little use in clinical practice. Access to early ultrasound should be improved. Further research into the relationship between maturity markers such as the Ballard score and the rates of death and specific premature related illnesses is warranted.

Measuring newborn foot length to estimate gestational age in a high risk Northwest Ethiopian population

Introduction

Preterm birth is defined as all births before 37 completed weeks of gestation. Globally, the prevalence rate of preterm birth ranges from 47.5 to 137 per 1000 live births. In Ethiopia, the prevalence of preterm birth is 10.1%. Several anthropometric parameters, particularly, head circumference and foot length(FL) have been used as a proxy measure for gestational age(GA).

Objective

To assess the use of newborn foot length as a screening tool to identify preterm newborns and correlation factors at the University of Gondar Comprehensive Specialized Hospital (UOG CSH), Northwest Ethiopia.

Methods

Institutional based cross-sectional study design was conducted on 205 newborns admitted to a neonatal intensive care unit, UOG CSH. Systematic sampling technique was employed. Optimal cutoff newborn foot length and area under the curve (AUC) was calculated by the receiver operating characteristic curve analysis to assess the power of foot length measurement to diagnosis prematurity.

Results

The mean foot length was 7.41±0.67 cm with a range of 5.4–8.6 cm. Gestational age had a significant strong positive correlation with foot length(r = 0.865). The regression equation derived was GA = 4.5*FL + 3.61. Foot length had strong power (AUC = 0.99) to differentiate preterm from term newborns. A threshold newborn foot length of ≤7.35 cm had a sensitivity and specificity of 98.5% and 96.3%, respectively to predict prematurity.

Conclusion

Foot length had a high sensitivity and specificity in identifying preterm newborns, making it a reliable tool to identify preterm birth in a rural setting.

A Simulator for Breech Extraction of the Second Twin

BACKGROUND

Breech extraction of a second twin is a skill useful for any health care provider planning on undertaking vaginal delivery of twins. However, training opportunities in this skill may be limited.

METHOD

Using readily available supplies, a reusable model neoprene uterus can be constructed, as can a balloon model to simulate a fetus in the amniotic cavity.

EXPERIENCE

The model allowed demonstration of skills expected of trainees and is easy to construct. A simulated vagina addition increased extraction difficulty and increased the probability of balloon (amniotic sac) rupture during simulation. A hysterotomy addition enhanced model applicability for use at simulated cesarean delivery of the breech fetus.

CONCLUSION

This educational device for simulation of breech extraction realistically simulates a fetus suspended in an amniotic cavity and challenges learners to use tactile cues for prompt and proper identification, grasping, and delivery of the fetal foot or feet.

Updating fetal foot length to gestational age references: a chart review of abortion cases from 2012 to 2014

OBJECTIVES

We sought to develop an updated fetal foot length-to-gestational week reference range from patient-reported last menstrual period (LMP), ultrasound, and best-estimate for gestational age based on American College of Obstetricians and Gynecologists' (ACOG) pregnancy dating guidelines. Subsequently, we aimed to determine the impact, if any, of race/ethnicity on our findings and compare our measurements to commonly referenced ranges.

METHODS

We performed a chart review of 610 dilation and evacuation records with gestational ages 14 weeks 0 days to 21 weeks 6 days from October 2012 to December 2014 in Honolulu, Hawaii. We analyzed records containing pathology-measured fetal foot length and three gestational age estimation methods using ANOVA tests, determined if race/ethnicity affected fetal foot length, and compared our measurements to previously published studies.

RESULTS

Linear regression analysis demonstrated that ultrasound-derived gestational age dating provided the best-fit regression formula with an R-squared and adjusted R-squared value of 0.92. Patient body mass index (p=.15), parity (p=.15), and race (p=.99) did not affect the equation. Mean fetal foot length per gestational age differed from historically referenced ranges by 0.36-3.92 mm in either direction.

CONCLUSIONS

Our population's fetal foot length per gestational age differed from ranges typically referenced by pathologists following abortion at all gestational ages, using all three methods of fetal gestational age estimation. As gestational age increased, the variability of fetal foot length measurements per gestational week increased. If post-abortion fetal foot length measurements are obtained, it is important to use an updated reference range.

IMPLICATIONS

Reference ranges frequently used by pathologists to assess fetal foot length following abortion may be outdated, limiting their utility. If facilities routinely obtain these measurements to estimate gestational age, it is important to use an updated reference range.

The significance of foot length at the initiation of the Ponseti method: a prospective study

OBJECTIVES

We sought to evaluate foot length (FL) and forefoot circumference (FC) and their impact on the severity of idiopathic clubfoot (CF) and results of treatment. We hypothesized that a smaller foot size at birth that represents a lesser than term newborn may affect the response of the CF to the treatment.

METHODS

We conducted a prospective study documenting FL and FC of all neonates presented with idiopathic CF. Additional demographic information was collected. Outcome measures were number of casts needed for correction, need for recasting, additional surgery and functional score.

RESULTS

In all, 52 children with 73 CF with a minimum mean follow-up of two years (2.0 to 5.6; sd 1.08) were evaluated. Mean gestational age was 38.63 weeks and mean birth weight (BW) was 3184 g. The mean FL at presentation was 74 mm (5.70 to 9.00), initial Pirani score was 5.5 (2.5 to 6.0) while number of casts was 6.9 (4.0 to 11.0). The FL was significantly correlated both to initial Pirani score (r = -0.35; p < 0.01) and number of casts (r = -0.33; p < 0.05). Positive correlation was found between the number of casts to Pirani score and number of additional procedures (r = 0.39; r = 0.36; p < 0.01, respectively). A foot size of up to 8 cm, needed 7.3 casts (4 to 7) compared with a FL of 8 cm or longer who needed 4.7 casts (4 to 6; t = 7.11; p < 0.001).

CONCLUSION

FL is a simple approach to identify preterm babies. It can be used as part of the initial evaluation of CF and help in predicting the course of treatment. We recommend adding FL to the existing classification.

LEVEL OF EVIDENCE

I - Prognostic study.

Investigation into abandoned neonates admitted to Salt River Forensic Pathology Mortuary, Cape Town

The high rates of abandoned neonatal remains admitted to Salt River Mortuary (SRM), Cape Town, and the dearth of literature published in South Africa prompted a retrospective assessment of these cases to describe the profile and assess the scope of the post-mortem investigation of abandoned neonates, as well as determine the prosecution rate of abandoned live births. Demographic details, scene information and post-mortem findings were obtained from medico-legal case files concerning non-viable fetuses, stillbirths and concealment of birth cases admitted to SRM between 1 January 2012 and 31 December 2016 (n=249). Despite the majority of the cases being natural deaths, the cause of death frequently remained 'undetermined' in these cases, often due to the presence of decomposition. Histological analyses were only performed in a small fraction of undetermined cases. Furthermore, the hypothesis that the prosecution rate of abandoned live births is extremely low was supported by this study, with only one case prosecuted in the 5-year period. For the remainder of the cases, the court status was given as either 'under investigation' (47.8%) or 'case closed' (47.8%). In the majority of the instances, the case was closed due to the unknown identity of the biological mother; however, DNA analyses were not performed in all of these cases. Overall, the data highlighted the need for the development and implementation of standard protocols, and recommendations were made for conducting the medico-legal investigation of abandoned neonates in a South African setting.

In a Genomic Era, Placental Pathology Still Holds the Key in the Nondysmorphic Stillbirth

Objective To explore the relative utility of genetic testing in contrast to placental pathology in explaining causation of death in the structurally normal stillborn population. Methods A retrospective review of a structurally normal stillborn infant cohort in South East Scotland between 2011 and 2015, defined by death at or after 24 weeks of gestation. We reviewed pathology reports and collected demographic data on cases. This information was collated with genetic test results (quantitative fluorescent polymerase chain reaction and microarray analysis) and placental pathology to create a database for analysis. Primary Results Within the structurally normal population (n = 131), there were 125 genetic tests performed and 11 abnormal results. Sixty-six microarray analyses were performed, and 2 (3%) of the results were thought likely to reflect cause of stillbirth (1 case of incomplete trisomy 4 and 1 case of deletion of chromosome Xp in a female). Analysis was significantly limited in 2 cases as parental samples were not available. The placental pathology was available in a total of 129 cases; significant findings were identified in 100 cases; 79 (61%) showed changes that were considered to have caused death (including cord "accidents"), and a further 21 (16%) showed findings likely to influence the management of subsequent pregnancies. Conclusions We reaffirm the utility of placental examination in the investigation of stillbirth. In cases of nondysmorphic stillbirth where placental pathology does not explain the cause of stillbirth, microarray analysis of fetal DNA can add further diagnostic information in 3% of cases but can add further diagnostic confusion, and it is important that parental bloods are taken to minimize this risk.

Fetal foot length at delivery as a tool for determining gestation length in non-macerated stillbirths

OBJECTIVE

To assess whether fetal foot length at autopsy could reliably indicate gestation duration at stillbirth and the effects of maceration on this method.

METHODS

The present cross-sectional secondary analysis was part of the Safe Passage Study; all Safe Passage Study participants who experienced a stillbirth at Tygerberg Academic Hospital, Cape Town, South Africa, between August 1, 2007, and January 31, 2015, were eligible to participate. After providing written informed consent for autopsy, the duration of gestation calculated using early ultrasonography and fetal foot length were compared.

RESULTS

There were 69 fetal autopsies included in the present study; placental histology was available for 65. Generally, the gestation length calculated from the first ultrasonography scan correlated well with that calculated from the fetal foot length (Spearman correlation=0.85). However, significant differences were found in the gestation lengths calculated when the fetus was macerated (P<0.001), or when umbilical cord pathology (P<0.001) or maternal vascular malperfusion (P<0.001) was the cause of fetal death.

CONCLUSION

Foot length at stillbirth was a good indicator of gestation length; however, it was a weaker indicator if fetal maceration had occurred.

Foot length measurements of newborns of high and low risk pregnancies

OBJECTIVE

Comparing foot length measurements of newborns in high and low risk pregnancies at a public hospital in Goiânia, GO, Brazil.

METHOD

A cross-sectional study carried out between April, 2013 and May, 2015, with a sample consisting of 180 newborns; 106 infants of women from high-risk pregnancies and 74 of women from low-risk pregnancies. Data were descriptively analyzed. Foot length measurement was performed using a stiff transparent plastic ruler, graduated in millimeters. The length of both feet was measured from the tip of the hallux (big toe) to the end of the heel.

RESULTS

A statistically significant relationship was found between the foot length and newborn's weight, between the cephalic and thoracic perimeters in the high-risk group and between the cephalic perimeter in the control group.

CONCLUSION

There is a need for creating cut-off points to identify newborns with intrauterine growth disorders using foot length.

OBJETIVO

Comparar as medidas do comprimento hálux-calcâneo de recém-nascidos em gestações de alto e baixo risco em um hospital público de Goiânia, GO.

MÉTODO

Estudo transversal, realizado no período de abril de 2013 a maio de 2015, cuja amostra constituiu-se de 180 recém-nascidos, 106 filhos de mulheres com gestação de alto risco e 74 de mulheres com gestação de baixo risco. Os dados foram analisados descritivamente. A medida do comprimento hálux-calcâneo foi realizada utilizando-se de régua plástica transparente rígida, graduada em milímetros. Foram medidos ambos os pés, aferindo-se o comprimento da ponta do hálux até a extremidade do calcâneo.

RESULTADOS

Foi encontrada relação estatisticamente significante entre o comprimento hálux-calcâneo e o peso do recém-nascido, entre os perímetros cefálico e torácico no grupo de alto risco e entre o perímetro cefálico no grupo controle.

CONCLUSÃO

Existe necessidade da criação de pontos de corte para identificar recém-nascidos com desvios de crescimento intrauterino utilizando-se do comprimento hálux-calcâneo.

OBJETIVO

Comparar las mediciones de la longitud hallux-calcáneo de los recién nacidos en embarazos de alto y bajo riesgo en un hospital público de Goiânia, GO.MÉTODOSEstudio transversal realizado de abril 2013 a mayo 2015, cuya muestra estuvo constituida por 180 recién nacidos, 106 de mujeres con embarazos de alto riesgo y 74 de mujeres con embarazos de bajo riesgo. Los datos se analizaron de manera descriptiva. La medida de la longitud hallux-calcáneo se realizó mediante regla de plástico rígido transparente, graduada en milímetros. Se midieron en ambos pies, las longitudes de la punta del hallux hasta el final del calcáneo.

RESULTADOS

Se encontró una relación estadísticamente significativa entre la longitud hallux-calcáneo y el peso del recién nacido, entre las circunferencias cefálica y torácica en el grupo de alto riesgo y entre la circunferencia cefálica en el grupo control.

CONCLUSIÓN

Existe la necesidad de crear puntos de corte para identificar los recién nacidos con desviaciones de crecimiento intrauterino utilizando la longitud desde el hallux hasta el calcáneo.