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Validation of the foot length measure as an alternative tool to identify low birth weight and preterm babies in a low-resource setting like Nepal: a cross-sectional study.

Kc A, Nelin V, Vitrakoti R, Aryal S, Målqvist M - BMC Pediatr (2015)

Bottom Line: An operational cutoff of 7.2 cm was identified to screen for infants weighing <2000 grams at birth (sensitivity: 75.9%, specificity: 90.3%), and 7.8 cm was determined as the operational cutoff to identify preterm infants (sensitivity: 76.9%, specificity: 53.9%).In Nepal, at least in community settings, foot length measurement with a hard ruler may be a valid proxy to identify at-risk infants when birth weight or gestational age is unavailable.Further studies and piloting should be conducted to identify exact cutoffs that can be used within community settings.

View Article: PubMed Central - PubMed

Affiliation: International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, University Hospital, Uppsala, SE-751 85, Sweden. aaashis7@yahoo.com.

ABSTRACT

Background: The majority of infants who die in the neonatal period are born with a low birth weight (LBW, <2500 grams), or prematurely (before 37 weeks). Most deaths among these infants could be prevented with simple, low-cost interventions like kangaroo mother care (KMC) or prevention and early identification of infection. It is difficult, however, to determine birth weight and gestational age in community settings, and therefore necessary to find an appropriate alternative screening tool that can identify LBW and preterm infants.

Methods: This cross-sectional study was conducted at a tertiary hospital in Nepal to compare the validity of using three different foot length measurement methods (plastic ruler, measuring tape, and paper footprint) as screening tools for identifying babies with birth weights <2000 grams or infants born preterm (<37 weeks). LBW was defined as less than 2000 grams because of the implication for use of KMC for these infants. Non-parametric receiver operating characteristics (ROC) analysis was completed to determine which measurement method best predicted LBW and preterm birth. For the method that was the best predictor for each outcome (i.e. highest area under the curve), further analyses were completed to determine sensitivity, specificity, likelihood ratios and predictive values of an operational screening cutoff to predict LBW or preterm birth in this setting.

Results: Of the 811 infants included in this study, 30 infants had LBW and 54 were born preterm. The plastic ruler was the measurement method with the highest area under the curve, and thus predictive score for estimating both outcomes, so operational cutoffs were identified based on this method. An operational cutoff of 7.2 cm was identified to screen for infants weighing <2000 grams at birth (sensitivity: 75.9%, specificity: 90.3%), and 7.8 cm was determined as the operational cutoff to identify preterm infants (sensitivity: 76.9%, specificity: 53.9%).

Conclusions: In Nepal, at least in community settings, foot length measurement with a hard ruler may be a valid proxy to identify at-risk infants when birth weight or gestational age is unavailable. Further studies and piloting should be conducted to identify exact cutoffs that can be used within community settings.

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Related in: MedlinePlus

Flow chart of study participants.
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Fig1: Flow chart of study participants.

Mentions: During the study period, there were a total of 4,490 women who delivered at the hospital. Twenty percent of this population was randomly selected to be included in the study for foot length measurement, a total of 898 infants. Eighteen (2.0%) infants in the referent population were stillborn and thus excluded from the study population. Further, 55 (6.3%) of the remaining infants were excluded because of exclusion criteria given in the methods section. Fourteen (2.0%) of these infants were also excluded in the final analysis due to missing data, thus the final study population with foot length and outcome measurements included 811 infants (90% of the randomly selected population) (Figure 1).Figure 1


Validation of the foot length measure as an alternative tool to identify low birth weight and preterm babies in a low-resource setting like Nepal: a cross-sectional study.

Kc A, Nelin V, Vitrakoti R, Aryal S, Målqvist M - BMC Pediatr (2015)

Flow chart of study participants.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4403672&req=5

Fig1: Flow chart of study participants.
Mentions: During the study period, there were a total of 4,490 women who delivered at the hospital. Twenty percent of this population was randomly selected to be included in the study for foot length measurement, a total of 898 infants. Eighteen (2.0%) infants in the referent population were stillborn and thus excluded from the study population. Further, 55 (6.3%) of the remaining infants were excluded because of exclusion criteria given in the methods section. Fourteen (2.0%) of these infants were also excluded in the final analysis due to missing data, thus the final study population with foot length and outcome measurements included 811 infants (90% of the randomly selected population) (Figure 1).Figure 1

Bottom Line: An operational cutoff of 7.2 cm was identified to screen for infants weighing <2000 grams at birth (sensitivity: 75.9%, specificity: 90.3%), and 7.8 cm was determined as the operational cutoff to identify preterm infants (sensitivity: 76.9%, specificity: 53.9%).In Nepal, at least in community settings, foot length measurement with a hard ruler may be a valid proxy to identify at-risk infants when birth weight or gestational age is unavailable.Further studies and piloting should be conducted to identify exact cutoffs that can be used within community settings.

View Article: PubMed Central - PubMed

Affiliation: International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, University Hospital, Uppsala, SE-751 85, Sweden. aaashis7@yahoo.com.

ABSTRACT

Background: The majority of infants who die in the neonatal period are born with a low birth weight (LBW, <2500 grams), or prematurely (before 37 weeks). Most deaths among these infants could be prevented with simple, low-cost interventions like kangaroo mother care (KMC) or prevention and early identification of infection. It is difficult, however, to determine birth weight and gestational age in community settings, and therefore necessary to find an appropriate alternative screening tool that can identify LBW and preterm infants.

Methods: This cross-sectional study was conducted at a tertiary hospital in Nepal to compare the validity of using three different foot length measurement methods (plastic ruler, measuring tape, and paper footprint) as screening tools for identifying babies with birth weights <2000 grams or infants born preterm (<37 weeks). LBW was defined as less than 2000 grams because of the implication for use of KMC for these infants. Non-parametric receiver operating characteristics (ROC) analysis was completed to determine which measurement method best predicted LBW and preterm birth. For the method that was the best predictor for each outcome (i.e. highest area under the curve), further analyses were completed to determine sensitivity, specificity, likelihood ratios and predictive values of an operational screening cutoff to predict LBW or preterm birth in this setting.

Results: Of the 811 infants included in this study, 30 infants had LBW and 54 were born preterm. The plastic ruler was the measurement method with the highest area under the curve, and thus predictive score for estimating both outcomes, so operational cutoffs were identified based on this method. An operational cutoff of 7.2 cm was identified to screen for infants weighing <2000 grams at birth (sensitivity: 75.9%, specificity: 90.3%), and 7.8 cm was determined as the operational cutoff to identify preterm infants (sensitivity: 76.9%, specificity: 53.9%).

Conclusions: In Nepal, at least in community settings, foot length measurement with a hard ruler may be a valid proxy to identify at-risk infants when birth weight or gestational age is unavailable. Further studies and piloting should be conducted to identify exact cutoffs that can be used within community settings.

Show MeSH
Related in: MedlinePlus