Measuring newborn foot length to identify small babies in need of extra care: a cross sectional hospital based study with community follow-up in Tanzania

Abstract

BackgroundNeonatal mortality because of low birth weight or prematurity remains high in many developing country settings. This research aimed to estimate the sensitivity and specificity, and the positive and negative predictive values of newborn foot length to identify babies who are low birth weight or premature and in need of extra care in a rural African setting.MethodsA cross-sectional study of newborn babies in hospital, with community follow-up on the fifth day of life, was carried out between 13 July and 16 October 2009 in southern Tanzania. Foot length, birth weight and gestational age were estimated on the first day and foot length remeasured on the fifth day of life.ResultsIn hospital 529 babies were recruited and measured within 24 hours of birth, 183 of whom were also followed-up at home on the fifth day. Day one foot length <7 cm at birth was 75% sensitive (95%CI 36-100) and 99% specific (95%CI 97-99) to identify very small babies (birth weight <1500 grams); foot length <8 cm had sensitivity and specificity of 87% (95%CI 79-94) and 60% (95%CI 55-64) to identify those with low birth weight (<2500 grams), and 93% (95%CI 82-99) and 58% (95%CI 53-62) to identify those born premature (<37 weeks). Mean foot length on the first day was 7.8 cm (standard deviation 0.47); the mean difference between first and fifth day foot lengths was 0.1 cm (standard deviation 0.3): foot length measured on or before the fifth day of life identified more than three-quarters of babies who were born low birth weight.ConclusionMeasurement of newborn foot length for home births in resource poor settings has the potential to be used by birth attendants, community volunteers or parents as a screening tool to identify low birth weight or premature newborns in order that they can receive targeted interventions for improved survival

Detection of low birth weights in newborns by Foot length as proxy measure

“…In newborns <2.0 kg group Sarlahi et al had cut off Foot length <6.9 cm, whereas in our study it was 7.4 cm. In newborns <2.5 kg group Mathur et al 12 had cut off Foot length <7.2cm, Hirve et al 10 had <7.6 cm(wt 1.5-2.5 kg) , Mukherjee et al 11 7.9 cm ,whereas in our case it was 8.2 cm.Sensitivity & specificity of foot length for birth wt < 1.5 kg , was 100% & 95.2% in Hirve et al 10 ,75% & 99 % in Marchant et al 9 , 100% and 95% in Mukherjee et al 11 and in our study it was 92% and 87% respectively. In our study Foot length had highest correlation with birth weight ( r=0.96), followed by head circumference (r=0.88),chest circumference(r=0.82), calf circumference(r=0.76) and length (r=0.65), Elizabeth et al 8 had also highest correlation of Foot length with birth weight (r=0.97) like us and head circumference (r=0.88), however Foot length had higher correlation with chest circumference in their study (r= 0.93) whereas in our study it was lower (r=0.82).…”

Validity of Newborn Clinical Assessment to Determine Gestational Age in Bangladesh

“…The following devices were used: KL-218 digital weighing scale (precision 10g; Dongguan Manufacturing, Hong Kong, China), JiVitA infant length board (JiVitA, Gaibandha, Bangladesh), 25,26 and JiVitA measuring tape (JiVtA). 26 Foot length was measured from base of the heel to tip of the hallux with a clear plastic metric ruler (locally purchased, Sylhet, Bangladesh) using methods described by Marchant et al 12 A total of 24 CHWs were trained and standardized in the newborn assessment (detailed in the text of the Supplemental Information). Refresher training was conducted after 6 months.…”

“…Simplified methods to identify premature infants that rely on fewer characteristics, 7 external signs only, 8,9 or individual physical anthropometrics [10][11][12] have been described and developed for lower resource settings. The Eregie, Capurro, and Parkin scores (Supplemental Table 5) have been reported to estimate GA in high correlation with the Dubowitz score.…”

Foot length measurements of newborns of high and low risk pregnancies

“…In Brazil, the percentage of infant births with low birth weight has increased slightly from 7.7% in 2000 to 8.5% in 2011 (16) . In a hospital-based recruitment conducted in Tanzania, a 15% prevalence of LBW infants was identified (17) . On the other hand, a study developed in Uganda showed a slightly lower percentage of LBW, being 12% (7) .…”

“…The ideal maximum period to perform HCL measurement is still controversial. Some authors state that HCL maintains a strong correlation with weight from birth up to the fifth day after birth, being a good predictor for the evaluation of low birth weight (16)(17)(18) . However, a study revealed that newborn's feet significantly increase in length/size during the first five days of life, suggesting that further research needs to be developed to determine the maximum period for this measure (7) .…”