Abstract
The validity of three methods (last menstrual period [LPM], Ballard and Dubowitz scores) for assessment of gestational age for premature infants in a low-resource setting was assessed, using antenatal ultrasound as the gold standard. It was hypothesized that LMP and other methods would perform similarly in determining postnatal gestational age. Concordance analysis was applied to data on 355 neonates of <33 weeks gestational age enrolled in a topical skin-therapy trial in a tertiary-care children's hospital in Bangladesh. The concordance coefficient for LMP, Ballard, and Dubowitz was 0.878, 0.914, and 0.886 respectively. LMP and Ballard underestimated gestational age by one day (+/-11) and 2.9 days (+/-7.8) respectively while Dubowitz overestimated gestational age by 3.9 days (+/-7.1) compared to ultrasound finding. LMP in a low-resource setting was a more reliable measure of gestational age than previously thought for estimation of postnatal gestational age of preterm infants. Ballard and Dubowitz scores are slightly more reliable but require more technical skills to perform. Additional prospective trials are warranted to examine LMP against antenatal ultrasound for primary assessment of neonatal gestational age in other low-resource settings.
Highlights
Accurate determination of neonatal gestational age is important for guiding both individual infant management and care-seeking and for epidemiologic purposes
Half of the mothers were primiparous with a mean age of 24.0 years [standard deviation (SD) 5.1], and 45% of the mothers had received at least a secondary school education
last menstrual period (LMP) was predominantly reported as an integer rounded to the nearest week; only nine of 355 raw data fell to either side of a week category (Fig. 1)
Summary
Accurate determination of neonatal gestational age is important for guiding both individual infant management and care-seeking and for epidemiologic purposes. In low-resource settings such as Bangladesh where limited information or technical knowledge is routinely available, healthcare workers often determine gestational age of newborns by relying on LMP and/or neonatal birthweight and on available obstetric clinical estimates, such as measurement of fundal height and timing of first quickening [4,5,6]. Relying on Dubowitz and Ballard scores, instead of LMP, and/or clinical estimates of gestational age requires technical skills and may not work as well among malnourished populations, due to intrauterine stress and potential premature neurological maturation, a comparison of score performance in Cameroon showed the Dubowitz and Ballard to be rather accurate [10,11]. Some researchers have attempted to refine or simplify existing neonatal gestational age-estimation systems, such as the Dubowitz and Ballard scores; the addition of birthweight to the scores in Zimbabwe showed promise but has not been externally validated [8,9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
