What Matters Most for the Survival of Small Newborns in Resource-Limited Settings?

Abstract

In 1963, Lubchenco proposed a system to characterize intrauterine growth by gestational age, which highlighted the differences between preterm and growth-restricted term infants.1 More than 50 years later, there is limited capacity to distinguish preterm from small but mature infants in low- and middle-income countries where these conditions, together with asphyxia and infection, are leading causes of neonatal death. Lee et al sought to determine if community health workers could use physical/neuromuscular signs and anthropometrics to estimate the maturity of infants born in rural communities in Bangladesh with the ultimate goal of facilitating early identification and referral of preterm infants.2 The study used community surveillance for early diagnosis of pregnancy and successfully accomplished ultrasound dating of pregnancy before 20 weeks. Twenty-five physical, neuromuscular, and anthropometric observations were assessed and then analyzed individually and in combination for their diagnostic accuracy. All fell short of acceptable utility for estimation of gestational age in this population with a high prevalence of intrauterine growth restriction. So what broader significance do such negative findings hold? They reaffirm the realities of improving survival … Susan Niermeyer, MD, MPH, Section of Neonatology, Children’s Hospital Colorado, 13121 East 17th Ave, Mail Stop 8402, Aurora, CO 80045. E-mail: susan.niermeyer{at}ucdenver.edu