title: Postnatal Prediction of Gestational Age Using Newborn Fetal Hemoglobin Levels.
abstract: BACKGROUND
  In many parts of the developing world procurement of antenatal gestational age estimates is not possible, challenging provision of appropriate perinatal care. This study aimed to develop a model for postnatal gestational age estimation utilizing measures of the newborn hemoglobin levels and other metabolic analyte data derived from newborn blood spot samples.
  
  
  METHODS
  We conducted a retrospective cohort analysis of 159,215 infants born January 2012-December 2014 in Ontario, Canada. Multivariable linear and logistic regression analyses were used to evaluate the precision of developed models.
  
  
  RESULTS
  Models derived from a combination of hemoglobin ratios and birthweight were more precise at predicting gestational age (RMSE1·23weeks) than models limited to birthweight (RMSE1·34). Models including birthweight, hemoglobin, TSH and 17-OHP levels were able to accurately estimate gestational age to ±2weeks in 95·3% of the cohort and discriminate ≤34 versus >34 (c-statistic, 0·98). This model also performed well in small for gestational age infants (c-statistic, 0·998).
  
  
  CONCLUSIONS
  The development of a point-of-care mechanism to allow widespread implementation of postnatal gestational age prediction tools that make use of hemoglobin or non-mass spectromietry-derived metabolites could serve areas where antenatal gestational age dating is not routinely available.
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Institute of Clinical Evaluative Sciences, uOttawa Site, Ottawa, Ontario, Canada.
authors.forename: Kumanan
authors.initials: K
authors.lastname: Wilson
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Institute of Clinical Evaluative Sciences, uOttawa Site, Ottawa, Ontario, Canada; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Steven
authors.initials: S
authors.lastname: Hawken
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Malia S Q
authors.initials: MSQ
authors.lastname: Murphy
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Atkinson
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Beth K
authors.initials: BK
authors.lastname: Potter
authors.affiliation: Better Outcomes Registry & Network, Ottawa, Ontario, Canada.
authors.forename: Ann
authors.initials: A
authors.lastname: Sprague
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Better Outcomes Registry & Network, Ottawa, Ontario, Canada; Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Walker
authors.affiliation: Better Outcomes Registry & Network, Ottawa, Ontario, Canada; Newborn Screening Ontario, Ottawa, Ontario, Canada; Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Pranesh
authors.initials: P
authors.lastname: Chakraborty
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Julian
authors.initials: J
authors.lastname: Little
mesh_terms: D001724:Birth Weight; D005260:Female; D005319:Fetal Hemoglobin; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D015233:Models, Statistical; D015997:Neonatal Screening; D009864:Ontario; D019095:Point-of-Care Systems; D011159:Population Surveillance; D011247:Pregnancy; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D005319:Fetal Hemoglobin
keywords: Gestational age; Metabolomics; Newborn screening; Prediction modelling; Preterm birth