Aim: To assess the degree of discomfort caused by length measurement in neonates, performed with one or both lower limbs extended, on the first and second day after birth, with either one or both lower limbs extended. Methods: Healthy full-term neonates were systematically sampled during the months of February and March 2004. Crown Áheel length was measured, using a 1-mm precision neonatometer, at approximately 8 h and 32 h after birth, with one and both lower limbs extended. The Neonatal Facial Coding System was used to assess discomfort during measurements. Data were analysed by parametric and non-parametric tests as appropriate. Results: Whatever the measurement technique, discomfort scores are significantly higher during the length measurement than at baseline. Whenever length measurements are performed, discomfort scores are significantly higher when extending both lower limbs rather than one lower limb (p B/0.006). The measured length is greater with one lower limb extended; however, the difference decreases over time, being 0.19 cm (95% CI 0.1 Á0.3; p B/0.001) at approximately 32 h of age. No significant differences in length were found between measurements at approximately 8 or 32 h, regardless of the technique used. The best correlation between length measurements with one or both lower limbs extended was observed at approximately 32 h after birth (r 0/0.98). Conclusion:Measuring crown Áheel length is a distressful procedure for the neonate. Measurements with one lower limb extended result in less discomfort than when both lower limbs are extended, without decreasing the accuracy.

Aim: To assess the degree of discomfort caused by length measurement in neonates, performed with one or both lower limbs extended, on the first and second day after birth, with either one or both lower limbs extended. Methods: Healthy full-term neonates were systematically sampled during the months of February and March 2004. Crown Áheel length was measured, using a 1-mm precision neonatometer, at approximately 8 h and 32 h after birth, with one and both lower limbs extended. The Neonatal Facial Coding System was used to assess discomfort during measurements. Data were analysed by parametric and non-parametric tests as appropriate. Results: Whatever the measurement technique, discomfort scores are significantly higher during the length measurement than at baseline. Whenever length measurements are performed, discomfort scores are significantly higher when extending both lower limbs rather than one lower limb (p B/0.006). The measured length is greater with one lower limb extended; however, the difference decreases over time, being 0.19 cm (95% CI 0.1 Á0.3; p B/0.001) at approximately 32 h of age. No significant differences in length were found between measurements at approximately 8 or 32 h, regardless of the technique used. The best correlation between length measurements with one or both lower limbs extended was observed at approximately 32 h after birth (r 0/0.98). Conclusion:Measuring crown Áheel length is a distressful procedure for the neonate. Measurements with one lower limb extended result in less discomfort than when both lower limbs are extended, without decreasing the accuracy.

Background: Accuracy of neonatal length measurement may be influenced by the reluctance of the measurer to forcefully extend both lower limbs against the normal flexor posture. On the other hand, during the first days after birth the measured length may increase because of the gradual decrease of the intrauterine state of flexion. Objective: To assess potential differences in discomfort during length measurement with one or both lower limbs extended and any variation in measured length within the first two days after birth. Methods: Seventy healthy full-term neonates born at Hospital Dona Estefânia were systematically sampled. Crown-heel length was measured using a 1 mm precision neonatometer, at circa 8 hours and 32 hours after birth, with one and both lower limbs completely extended. The Neonatal Facial Coding System was used to assess discomfort during measurements. Data were analyzed by parametric and nonparametric tests as appropriate. Results: Discomfort scores are significantly higher during length measurement than at baseline, whatever the measurement method. Whenever length measurements are performed, discomfort scores are significantly higher extending two rather than one lower limb (pϽ0.006). Measured length is higher with one lower limb extended, the difference decreases in time: at circa 32 hours of age 0.19 cm (95% CI: 0.1-0.3; pϭ0.000). No significant differences on length were found between measurements at circa 8 or 32 hours after birth, for both one and two lower limbs extended. The best correlation between measurements with one or two extended lower limbs was observed at circa 32 hours after birth (rϭ0.98). Conclusion: The best balance between the comfort of the neonate and the accuracy of crown-heel length measurement is achieved at circa 32 hours after birth extending one lower limb.