title: The measurement of knee-heel length in newborn infants using a simple vernier calipers.
abstract: OBJECTIVE
  To assess the usefulness of a simple vernier calipers for measuring knee-heel length in neonates.
  
  
  METHODS
  Using a simple vernier calipers, knee-heel length was measured five times by 2 observers in 50 babies (29M, 21F; mean birthweight 1597 g; median gestational age at birth 29 weeks) at a median postnatal age of 11 days. A subgroup of 20 babies had knee-heel length measured similarly at weekly intervals for 3 weeks. Corrected gestational age and weight were simultaneously recorded. One observer was experienced in using the vernier calipers. The precision of the calipers was established using 4 steel gauge blocks of varying length (7.62-10.17 cm).
  
  
  RESULTS
  The calipers were very precise when measuring steel gauge blocks. In babies, there was a downward trend across the first 2 measurements for both observers, the measurements stabilizing over the last three. Using the final three measurements per baby (n = 50), the experienced observer had a mean standard deviation of 0.023 cm and mean coefficient of variation 0.23% when measuring an average knee-heel length of 9.99 cm. The inexperienced observer had a mean standard deviation of 0.057 cm and a mean coefficient of variation of 0.56%, when measuring an average knee-heel length of 10.14 cm. The inter-observer reliability, measured by the intra-class correlation coefficient, was 0.99. The agreement between observers was such that one observer measured knee-heel length consistently less (0.15 cm, SD 0.18 cm) than the other. The reliability for knee-heel length velocity was lower (R = 0.85), but agreement between observers was high with an average difference of 0.016 cm/week. Knee-heel length was significantly correlated (p < 0.001) with corrected gestational age (r = 0.85) and with weight (r = 0.96). There was a weaker but significant correlation (r = 0.47, p < 0.001) between knee-heel length velocity and rate of weight gain (g/day), indicating that weight gain may not always be accompanied by an increase in linear growth.
  
  
  CONCLUSIONS
  The measurement of knee-heel length by a simple vernier calipers is an accurate, reproducible and non-invasive method of assessing short-term linear growth in neonates. However, it is recommended that measurements of knee-heel length in a individual baby should be made by a single experienced observer.
authors.affiliation: Division of Endocrinology, British Columbia's Children's Hospital, Vancouver, Canada.
authors.forename: A M
authors.initials: AM
authors.lastname: Skinner
authors.forename: Z
authors.initials: Z
authors.lastname: Cieslak
authors.forename: L
authors.initials: L
authors.lastname: MacWilliam
authors.forename: A
authors.initials: A
authors.lastname: Solimano
authors.forename: H F
authors.initials: HF
authors.lastname: Kitson
mesh_terms: D000367:Age Factors; D000886:Anthropometry / Q000295:instrumentation*; D001724:Birth Weight; D001827:Body Height; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn / Q000254:growth & development*; D007866:Leg / Q000033:anatomy & histology*; D015588:Observer Variation; D015203:Reproducibility of Results