评估产后临床评分方法和足底长测量法在估计中低收入国家新生儿胎龄和出生体重的诊断准确性：系统评价和荟萃分析。

Assessing the diagnostic accuracy of postnatal clinical scoring methods and foot length measurement for estimating gestational age and birthweight of newborns in low- and middle-income countries: a systematic review and meta-analysis.

机构信息

Global health and migration unit, Department of Women's & Children's Health, Uppsala University, Uppsala, Sweden

Population and Reproductive Health Section, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.

出版信息

BMJ Paediatr Open. 2024 Aug 30;8(1):e002717. doi: 10.1136/bmjpo-2024-002717.

DOI:10.1136/bmjpo-2024-002717

PMID:39214548

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11367336/

Abstract

BACKGROUND

This study aimed to update systematic reviews and meta-analyses on the diagnostic accuracy of postnatal clinical scoring (PCS) methods and foot length (FL) measurement for assessing gestational age (GA) and birth weight in low-income and middle-income countries (LMICs). In addition, the quality of reference standards, including antenatal ultrasound (A-US), last menstrual period (LMP), PCS and newborn weighing scales, was also evaluated.

METHODS

Studies from LMICs published between January 2000 and February 2024 were searched, using databases such as PubMed, Web of Science, Cochrane Library, CINAHL and Scopus. Studies that compared PCS and/or FL with LMP and/or A-US to estimate GA or used calibrated newborn weighing scales for birthweight estimation were included. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-II tool and evaluated the quality of the reference standards. When sufficient data were available, pooled estimates were calculated using random-effects models.

RESULTS

A total of 50 studies were included. A-US was a reasonable tool for GA assessment if conducted by physicians using fetal biometry and the Hadlock method for GA estimation. LMP was reasonable when women had regular cycles, knew their LMP, were not using contraceptives and LMP data were collected by healthcare providers. When A-US was used as the reference standard, PCS methods estimated GA with a precision of ±2.8 to ±3.2 weeks. FL measurement <7.5 cm showed a pooled sensitivity of 76.2% and specificity of 36.6% for identifying preterm birth. FL measurement ≤7.6 cm had a pooled sensitivity of 78.6% and specificity of 65.7% for identifying low birth weight (LBW). High heterogeneity across studies was observed.

CONCLUSION

This systematic review and meta-analysis highlights significant variability and methodological inconsistencies in using PCS methods and FL measurement for estimating GA and LBW in LMICs. The observed high heterogeneity across studies suggests a cautious interpretation of the results.

PROSPERO REGISTRATION NUMBER

CRD42020209455.

摘要

背景

本研究旨在更新关于在中低收入国家（LMICs）中评估胎龄（GA）和出生体重的产后临床评分（PCS）方法和足部长度（FL）测量的系统评价和荟萃分析。此外，还评估了参考标准的质量，包括产前超声（A-US）、末次月经（LMP）、PCS 和新生儿称重秤。

方法

检索了 2000 年 1 月至 2024 年 2 月期间在 LMICs 发表的研究，使用了 PubMed、Web of Science、Cochrane 图书馆、CINAHL 和 Scopus 等数据库。纳入了比较 PCS 和/或 FL 与 LMP 和/或 A-US 来估计 GA 或使用校准的新生儿称重秤来估计出生体重的研究。使用诊断准确性研究质量评估工具 II 评估了偏倚风险，并评估了参考标准的质量。当有足够的数据时，使用随机效应模型计算合并估计值。

结果

共纳入 50 项研究。如果由医生使用胎儿生物测量和 Hadlock 方法进行 GA 估计，A-US 是一种合理的 GA 评估工具。如果女性月经规律、知道自己的 LMP、未使用避孕药且 LMP 数据由医疗保健提供者收集，则 LMP 是合理的。当 A-US 用作参考标准时，PCS 方法估计 GA 的精度为±2.8 至±3.2 周。FL 测量值<7.5cm 时，识别早产的敏感度为 76.2%，特异度为 36.6%。FL 测量值≤7.6cm 时，识别低出生体重（LBW）的敏感度为 78.6%，特异度为 65.7%。研究之间存在显著的异质性。