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

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.

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.

How Can Nutrition Research Better Reflect the Relationship Between Wasting and Stunting in Children? Learnings from the Wasting and Stunting Project

Childhood wasting and stunting affect large numbers of children globally. Both are important risk factors for illness and death yet, despite the fact that these conditions can share common risk factors and are often seen in the same child, they are commonly portrayed as relatively distinct manifestations of undernutrition. In 2014, the Wasting and Stunting project was launched by the Emergency Nutrition Network. Its aim was to better understand the complex relationship and associations between wasting and stunting and examine whether current separations that were apparent in approaches to policy, financing, and programs were justified or useful. Based on the project's work, this article aims to bring a wasting and stunting lens to how research is designed and financed in order for the nutrition community to better understand, prevent, and treat child undernutrition. Discussion of lessons learnt focuses on the synergy and temporal relationships between children's weight loss and linear growth faltering, the proximal and distal factors that drive diverse forms of undernutrition, and identifying and targeting people most at risk. Supporting progress in all these areas requires research collaborations across interest groups that highlight the value of research that moves beyond a focus on single forms of undernutrition, and ensures that there is equal attention given to wasting as to other forms of malnutrition, wherever it is present.

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.

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.