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Anthropometric measurements can identify small for gestational age newborns: a cohort study in rural Tanzania

BACKGROUND: Small-for-gestational-age (SGA) is associated with increased neonatal mortality and morbidity. In low and middle income countries an accurate gestational age is often not known, making the identification of SGA newborns difficult. Measuring foot length, chest circumference and mid upper...

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Autores principales: Paulsen, Cecilie Bøge, Nielsen, Birgitte Bruun, Msemo, Omari Abdul, Møller, Sofie Lykke, Ekmann, Josephine Roth, Theander, Thor Grundtvig, Bygbjerg, Ib Christian, Lusingu, John Peter Andrea, Minja, Daniel Thomas Remias, Schmiegelow, Christentze
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477730/
https://www.ncbi.nlm.nih.gov/pubmed/31014291
http://dx.doi.org/10.1186/s12887-019-1500-0
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author Paulsen, Cecilie Bøge
Nielsen, Birgitte Bruun
Msemo, Omari Abdul
Møller, Sofie Lykke
Ekmann, Josephine Roth
Theander, Thor Grundtvig
Bygbjerg, Ib Christian
Lusingu, John Peter Andrea
Minja, Daniel Thomas Remias
Schmiegelow, Christentze
author_facet Paulsen, Cecilie Bøge
Nielsen, Birgitte Bruun
Msemo, Omari Abdul
Møller, Sofie Lykke
Ekmann, Josephine Roth
Theander, Thor Grundtvig
Bygbjerg, Ib Christian
Lusingu, John Peter Andrea
Minja, Daniel Thomas Remias
Schmiegelow, Christentze
author_sort Paulsen, Cecilie Bøge
collection PubMed
description BACKGROUND: Small-for-gestational-age (SGA) is associated with increased neonatal mortality and morbidity. In low and middle income countries an accurate gestational age is often not known, making the identification of SGA newborns difficult. Measuring foot length, chest circumference and mid upper arm circumference (MUAC) of the newborn have previously been shown to be reasonable methods for detecting low birth weight (< 2500 g) and prematurity (gestational age <  37 weeks). The aim of this study was to investigate if the three anthropometric measurements could also correctly identify SGA newborns. METHODS: In the current study from a rural area of northeastern Tanzania, 376 live newborns had foot length, chest circumference, and MUAC measured within 24 h of birth. Gestational age was estimated by transabdominal ultrasound in early pregnancy and SGA was diagnosed using a sex-specific weight reference chart previously developed in the study area. Receiver operating characteristic curves were generated for each of the anthropometric measurements and the area under the curve (AUC) compared. Operational cutoffs for foot length, chest circumference, and MUAC were defined while balancing as high as possible sensitivity and specificity for identifying SGA. Positive and negative predictive values (PPV and NPV) were then calculated. RESULTS: Of the 376 newborns, 68 (18.4%) were SGA. The AUC for detecting SGA was 0.78 for foot length, 0.88 for chest circumference, and 0.85 for MUAC. Operational cut-offs to detect SGA newborns were defined as ≤7.7 cm for foot length, ≤31.6 cm for chest circumference and ≤ 10.1 cm for MUAC. Foot length had 74% sensitivity, 69% specificity, PPV of 0.35 and NPV of 0.92 for identifying SGA. Chest circumference had 79% sensitivity, 81% specificity, PPV of 0.49 and NPV of 0.95 for identifying SGA. Finally, MUAC had 76% sensitivity, 77% specificity, PPV of 0.43 and NPV of 0.94 for identifying SGA. CONCLUSION: In a setting with limited availability of an accurate gestational age, all three methods had a high NPV and could be used to rule out the newborn as being SGA. Overall, chest circumference was the best method to identify SGA newborns, whereas foot length and MUAC had lower detection ability. TRIAL REGISTRATION: Clinicaltrials.gov (NCT02191683). Registered 2 July 2014. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12887-019-1500-0) contains supplementary material, which is available to authorized users.
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spelling pubmed-64777302019-05-01 Anthropometric measurements can identify small for gestational age newborns: a cohort study in rural Tanzania Paulsen, Cecilie Bøge Nielsen, Birgitte Bruun Msemo, Omari Abdul Møller, Sofie Lykke Ekmann, Josephine Roth Theander, Thor Grundtvig Bygbjerg, Ib Christian Lusingu, John Peter Andrea Minja, Daniel Thomas Remias Schmiegelow, Christentze BMC Pediatr Research Article BACKGROUND: Small-for-gestational-age (SGA) is associated with increased neonatal mortality and morbidity. In low and middle income countries an accurate gestational age is often not known, making the identification of SGA newborns difficult. Measuring foot length, chest circumference and mid upper arm circumference (MUAC) of the newborn have previously been shown to be reasonable methods for detecting low birth weight (< 2500 g) and prematurity (gestational age <  37 weeks). The aim of this study was to investigate if the three anthropometric measurements could also correctly identify SGA newborns. METHODS: In the current study from a rural area of northeastern Tanzania, 376 live newborns had foot length, chest circumference, and MUAC measured within 24 h of birth. Gestational age was estimated by transabdominal ultrasound in early pregnancy and SGA was diagnosed using a sex-specific weight reference chart previously developed in the study area. Receiver operating characteristic curves were generated for each of the anthropometric measurements and the area under the curve (AUC) compared. Operational cutoffs for foot length, chest circumference, and MUAC were defined while balancing as high as possible sensitivity and specificity for identifying SGA. Positive and negative predictive values (PPV and NPV) were then calculated. RESULTS: Of the 376 newborns, 68 (18.4%) were SGA. The AUC for detecting SGA was 0.78 for foot length, 0.88 for chest circumference, and 0.85 for MUAC. Operational cut-offs to detect SGA newborns were defined as ≤7.7 cm for foot length, ≤31.6 cm for chest circumference and ≤ 10.1 cm for MUAC. Foot length had 74% sensitivity, 69% specificity, PPV of 0.35 and NPV of 0.92 for identifying SGA. Chest circumference had 79% sensitivity, 81% specificity, PPV of 0.49 and NPV of 0.95 for identifying SGA. Finally, MUAC had 76% sensitivity, 77% specificity, PPV of 0.43 and NPV of 0.94 for identifying SGA. CONCLUSION: In a setting with limited availability of an accurate gestational age, all three methods had a high NPV and could be used to rule out the newborn as being SGA. Overall, chest circumference was the best method to identify SGA newborns, whereas foot length and MUAC had lower detection ability. TRIAL REGISTRATION: Clinicaltrials.gov (NCT02191683). Registered 2 July 2014. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12887-019-1500-0) contains supplementary material, which is available to authorized users. BioMed Central 2019-04-23 /pmc/articles/PMC6477730/ /pubmed/31014291 http://dx.doi.org/10.1186/s12887-019-1500-0 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Paulsen, Cecilie Bøge
Nielsen, Birgitte Bruun
Msemo, Omari Abdul
Møller, Sofie Lykke
Ekmann, Josephine Roth
Theander, Thor Grundtvig
Bygbjerg, Ib Christian
Lusingu, John Peter Andrea
Minja, Daniel Thomas Remias
Schmiegelow, Christentze
Anthropometric measurements can identify small for gestational age newborns: a cohort study in rural Tanzania
title Anthropometric measurements can identify small for gestational age newborns: a cohort study in rural Tanzania
title_full Anthropometric measurements can identify small for gestational age newborns: a cohort study in rural Tanzania
title_fullStr Anthropometric measurements can identify small for gestational age newborns: a cohort study in rural Tanzania
title_full_unstemmed Anthropometric measurements can identify small for gestational age newborns: a cohort study in rural Tanzania
title_short Anthropometric measurements can identify small for gestational age newborns: a cohort study in rural Tanzania
title_sort anthropometric measurements can identify small for gestational age newborns: a cohort study in rural tanzania
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477730/
https://www.ncbi.nlm.nih.gov/pubmed/31014291
http://dx.doi.org/10.1186/s12887-019-1500-0
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