Validity of Newborn Clinical Assessment to Determine Gestational Age in Bangladesh.
Gestational age (GA) is frequently unknown or inaccurate in pregnancies in low-income countries. Early identification of preterm infants may help link them to potentially life-saving interventions.



We conducted a validation study in a community-based birth cohort in rural Bangladesh. GA was determined by pregnancy ultrasound (<20 weeks). Community health workers conducted home visits (<72 hours) to assess physical/neuromuscular signs and measure anthropometrics. The distribution, agreement, and diagnostic accuracy of different clinical methods of GA assessment were determined compared with early ultrasound dating.



In the live-born cohort (n = 1066), the mean ultrasound GA was 39.1 weeks (SD 2.0) and prevalence of preterm birth (<37 weeks) was 11.4%. Among assessed newborns (n = 710), the mean ultrasound GA was 39.3 weeks (SD 1.6) (8.3% preterm) and by Ballard scoring the mean GA was 38.9 weeks (SD 1.7) (12.9% preterm). The average bias of the Ballard was -0.4 weeks; however, 95% limits of agreement were wide (-4.7 to 4.0 weeks) and the accuracy for identifying preterm infants was low (sensitivity 16%, specificity 87%). Simplified methods for GA assessment had poor diagnostic accuracy for identifying preterm births (community health worker prematurity scorecard [sensitivity/specificity: 70%/27%]; Capurro [5%/96%]; Eregie [75%/58%]; Bhagwat [18%/87%], foot length <75 mm [64%/35%]; birth weight <2500 g [54%/82%]). Neonatal anthropometrics had poor to fair performance for classifying preterm infants (areas under the receiver operating curve 0.52-0.80).



Newborn clinical assessment of GA is challenging at the community level in low-resource settings. Anthropometrics are also inaccurate surrogate markers for GA in settings with high rates of fetal growth restriction.
Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; alee6@partners.org.
Anne Cc
AC
Lee
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
Luke C
LC
Mullany
Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Global Health & Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts;
Karima
K
Ladhani
Child Health Research Foundation, Shishu Hospital, Dhaka, Bangladesh;
Jamal
J
Uddin
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
Dipak
D
Mitra
International Centre for Diarrheal Disease Research, Dhaka, Bangladesh; and.
Parvez
P
Ahmed
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
Parul
P
Christian
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
Alain
A
Labrique
International Centre for Diarrheal Disease Research, Dhaka, Bangladesh; and.
Sushil K
SK
DasGupta
Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois.
R Peter
RP
Lokken
International Centre for Diarrheal Disease Research, Dhaka, Bangladesh; and.
Mohammed
M
Quaiyum
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
Abdullah H
AH
Baqui
D001459:Bangladesh; D001724:Birth Weight; D003906:Developing Countries; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D008297:Male; D015997:Neonatal Screening; D011247:Pregnancy; D047928:Premature Birth / Q000175:diagnosis*; D019035:Rural Health Services; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal