Accuracy of foot length measurement for gestational age assessment in neonates: a prospective observational study in Central India

Authors

  • Asmita Singhal Department of Neonatology, Super-Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
  • Avyact Agrawal Department of Pediatrics, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
  • Rashmi Parihar Department of Neonatology, Super-Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
  • Nency Sahu Department of Pediatrics, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
  • Jaya Upadhyay Department of Neonatology, Super-Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India https://orcid.org/0000-0003-3192-4962

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20240930

Keywords:

GA, Prematurity, ENBS, FL

Abstract

Background: Gestational age (GA) is a critical-factors in the decision making and predicting mortality and morbidities of neonates. In low resource settings where affordability and availability of first trimester scan is limited, assessment is often done by postnatal methods like expanded new Ballard score (ENBS) which are often clinical skill dependent and complex. Hence, there is a need of a simple and cost-effective method which can be readily adopted by frontline health care workers at periphery. One such method is assessment of foot length (FL).

Methods: This prospective cross-sectional study was conducted in the level 3 NICU of Central India over a period of 18 months. Included neonates were assessed for GA by measuring FL by vernier calliper within 48 hours of birth and its validity was tested against ENBS as reference standard. Other anthropometric measurements like birth weight, head circumference and length were obtained within 48 hours of birth.

Results: Total 700 neonates were included in the study. For, determining preterm newborn, the potential cut-off of FL of ≤6.86 cm, with a sensitivity of 94.6% and specificity of 73.8%. The area under ROC (receiver operating characteristic) curve is 0.92.

Conclusions: FL measurement is a cost-effective and time-saving simple intervention that can facilitate early identification of preterm newborns as well as help in initiating timely interventions and hence improving neonatal outcomes in resource-poor settings.

References

Ahmed I, Ali SM, Amenga-Etego S. Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in South Asia and sub-Saharan Africa: a multi-country prospective cohort study. Lancet Glob Health. 2018;6:e1297-308.

Lawn JE, Ohuma EO, Bradley E. Small babies, big risks: global estimates of prevalence and mortality for vulnerable newborns to accelerate change and improve counting. Lancet. 2023;401:1707-19.

Jana A. Correlates of low birth weight and preterm birth in India. PLoS One. 2023;18(8):e0287919.

Liu L, Chu Y, Oza S, Dan H, Jamie P, Diego GB, et al. National, regional, and state-level all cause and cause-specific Under-5 mortality in India in 2000-15: a systematic analysis with implications for the sustainable development goals. Lancet Glob Health. 2019;7(6):e721-34.

Survive and thrive: transforming care for every small and sick newborn. Geneva: World Health Organization. 2019. Available at: https://www.who. int/publications/i/item/9789241515887. Accessed on 2 January 2024.

Behrman RE, Butler AS. Preterm birth: causes, consequences, and prevention. Washington DC: National Academies Press (US). 2007.

Global goals for health and well being cannot be achieved without reduction in preterm birth and child deaths. press release online. UNICEF. 2017. Available at: https://www.unicef.org/pakistan/press-releases/global-goals-health-and-well-being-cannot-be-achieved-without-reduction-preterm. Accessed on 2 January 2024.

Scott K, Gupta S, Williams E, Arthur M, Somayajulu U, Noguchi L. I can guess the month but beyond that, I can’t tell” an exploratory qualitative study of health care provider perspectives on gestational age estimation in Rajasthan, India. BMC Pregnancy Childbirth. 2020;20(1):529.

Stuart C, WS L, David L, Cooper DJ. Routine ultrasound screening for the prediction of gestational age. Obstet Gynecol. 1985;65:613-20.

Karunasekere KAW, Sirisena J, Jayasinghe JACT, Perera GUI. How accurate is Postnatal Estimation of Gestational Age. J Trop Pediatr. 2002;48:270-2.

Sasidharan K, Dutta S, Narang A. Validity of New Ballard Score until 7th day of postnatal life in moderately preterm neonates. Arch Dis Child Fetal Neonatal Ed. 2009;94(1):F39-44.

Born Too Soon: The global action report on preterm birth. Geneva: World Health Organization. 2012. Available at: https://apps.who.int/iris/handle/ 10665/44864. Accessed on 12 February, 2024.

Stevenson A, Joolay Y, Levetan C, Price C, Tooke L. 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 nonstructured assessment. J Trop Pediatr. 2021;67:fmaa113:1-12.

Kuponiyi O, Ogunlesi T, Adekanmbi A, Akodu O, Olowonyo M. Tape Rule Measurement of Foot Length as Proxy for Vernier Digital Calliper in Estimating Gestational Age among Nigerian Neonates. West Afr J Med. 2023;40(3):345-50.

Thi HN, Khanh DK, Thu Hle T, Thomas EG, Lee KJ, Russell FM. Foot Length, Chest Circumference, and Mid Upper Arm Circumference Are Good Predictors of Low Birth Weight and Prematurity in Ethnic Minority Newborns in Vietnam: A Hospital-Based Observational Study. PLoS One. 2015;10(11):156-63.

Rakkappan I, Kuppusamy N. Newborn foot length measurement to identify high-risk neonates. Int J Sci Stud. 2016;4(1):13-9.

Lee AC, Mullany LC, Ladhani K, Jamal U, Dipak M, Parvez A, et al. Validity of newborn clinical assessment to determine gestational age in Bangladesh. Pediatrics. 2016;138(1):e20153303.

Wyk LV, Smith J. Postnatal foot length to determine gestational age: a pilot study. J Trop Pediatr 2016;62:144-51.

Tikmani SS, Brown N, Inayat A, Andreas M, Sarah S, Thomas M. Diagnostic accuracy of foot length measurement for identification of preterm newborn in rural Sindh, Pakistan. BMJ Paediatr Open. 2024;8(2):e002316.

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Published

2024-04-06

How to Cite

Singhal, A., Agrawal, A., Parihar, R., Sahu, N., & Upadhyay, J. (2024). Accuracy of foot length measurement for gestational age assessment in neonates: a prospective observational study in Central India. International Journal Of Community Medicine And Public Health, 11(5), 1828–1832. https://doi.org/10.18203/2394-6040.ijcmph20240930

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Original Research Articles