Lee Anne Cc, Panchal Pratik, Folger Lian, Whelan Hilary, Whelan Rachel, Rosner Bernard, Blencowe Hannah, Lawn Joy E
Department of Pediatric Newborn Medicine, and
Harvard Medical School, Harvard University, Boston, Massachusetts.
Pediatrics. 2017 Dec;140(6). doi: 10.1542/peds.2017-1423. Epub 2017 Nov 17.
An estimated 15 million neonates are born preterm annually. However, in low- and middle-income countries, the dating of pregnancy is frequently unreliable or unknown.
To conduct a systematic literature review and meta-analysis to determine the diagnostic accuracy of neonatal assessments to estimate gestational age (GA).
PubMed, Embase, Cochrane, Web of Science, POPLINE, and World Health Organization library databases.
Studies of live-born infants in which researchers compared neonatal signs or assessments for GA estimation with a reference standard.
Two independent reviewers extracted data on study population, design, bias, reference standard, test methods, accuracy, agreement, validity, correlation, and interrater reliability.
Four thousand nine hundred and fifty-six studies were screened and 78 included. We identified 18 newborn assessments for GA estimation (ranging 4 to 23 signs). Compared with ultrasound, the Dubowitz score dated 95% of pregnancies within ±2.6 weeks ( = 7 studies), while the Ballard score overestimated GA (0.4 weeks) and dated pregnancies within ±3.8 weeks ( = 9). Compared with last menstrual period, the Dubowitz score dated 95% of pregnancies within ± 2.9 weeks ( = 6 studies) and the Ballard score, ±4.2 weeks ( = 5). Assessments with fewer signs tended to be less accurate. A few studies showed a tendency for newborn assessments to overestimate GA in preterm infants and underestimate GA in growth-restricted infants.
Poor study quality and few studies with early ultrasound-based reference.
Efforts in low- and middle-income countries should focus on improving dating in pregnancy through ultrasound and improving validity in growth-restricted populations. Where ultrasound is not possible, increased efforts are needed to develop simpler yet specific approaches for newborn assessment through new combinations of existing parameters, new signs, or technology.
据估计，每年有1500万新生儿早产。然而，在低收入和中等收入国家，孕周的确定往往不可靠或未知。
进行系统的文献综述和荟萃分析，以确定新生儿评估估计胎龄（GA）的诊断准确性。
PubMed、Embase、Cochrane、科学网、POPLINE和世界卫生组织图书馆数据库。
对活产婴儿的研究，其中研究人员将用于GA估计的新生儿体征或评估与参考标准进行比较。
两名独立的评审员提取了关于研究人群、设计、偏倚、参考标准、测试方法、准确性、一致性、有效性、相关性和评分者间信度的数据。
筛选了4956项研究，纳入了78项。我们确定了18种用于GA估计的新生儿评估方法（体征数量从4到23个不等）。与超声检查相比，Dubowitz评分在±2.6周内确定了95%的孕周（n = 7项研究），而Ballard评分高估了GA（0.4周），并在±3.8周内确定了孕周（n = 9项研究）。与末次月经相比，Dubowitz评分在±2.9周内确定了95%的孕周（n = 6项研究），Ballard评分为±4.2周（n = 5项研究）。体征较少的评估往往准确性较低。一些研究表明，新生儿评估有高估早产儿GA和低估生长受限婴儿GA的趋势。
研究质量较差，以早期超声为参考的研究较少。
低收入和中等收入国家应致力于通过超声改善孕周确定，并提高生长受限人群中的有效性。在无法进行超声检查的地方，需要加大力度，通过现有参数、新体征或技术的新组合，开发更简单但更具特异性的新生儿评估方法。
