非洲新生儿人体测量指标在识别低出生体重和早产儿中的可行性和诊断准确性：系统评价和荟萃分析。

Feasibility and diagnostic accuracy of neonatal anthropometric measurements in identifying low birthweight and preterm infants in Africa: a systematic review and meta-analysis.

机构信息

Department of Pediatrics and Child Health, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia

Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia.

出版信息

BMJ Paediatr Open. 2024 Oct 1;8(1):e002741. doi: 10.1136/bmjpo-2024-002741.

DOI:10.1136/bmjpo-2024-002741

PMID:39353710

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11448207/

Abstract

BACKGROUND

Complications of prematurity are the leading cause of under-5 mortality globally and 80% of newborn deaths are of low birth weight (LBW) babies. Early identification of LBW and preterm infants is crucial to initiate timely interventions.

OBJECTIVE

To evaluate the feasibility and diagnostic accuracy of alternative neonatal anthropometric measurements in identifying LBW and preterm infants in Africa.

METHODS

In this systematic review and meta-analysis, we evaluated the diagnostic performance of infant foot length, mid-upper arm circumference (MUAC), head and chest circumferences against birth weight and gestational age. Pooled correlation between the index and the reference methods was estimated. Multiple anthropometric thresholds were considered in estimating the pooled sensitivity, specificity and area under receiver operating characteristic curve (AUC).

RESULTS

21 studies from 8 African countries met the inclusion criteria. Correlation coefficients with birth weight were 0.79 (95% CI 0.70 to 0.85) for chest circumference, 0.71 (95% CI 0.62 to 0.78) for MUAC and 0.66 (95% CI 0.59 to 0.73) for foot length. Foot length measured by rigid ruler showed a higher correlation than tape measurement. Chest circumference with 28.8 cm cut-off detects LBW babies with AUC value of 0.92 (95% CI 0.71 to 0.97). Foot length identified preterm infants, with 82% sensitivity, 89% specificity and AUC of 0.91 (95% CI 0.69 to 0.98) at a 7.2 cm optimal cut-off point. MUAC had an AUC of 0.83 (95% CI 0.47 to 0.95) for preterm detection. In identifying LBW babies, foot length and MUAC have AUC values of 0.89 (95% CI 0.70 to 0.96) and 0.91 (95% CI 0.73 to 0.97) at 7.3 cm and 9.8 cm optimal cut-off points, respectively. Foot length and MUAC are relatively simple and minimise the risk of exposing infants to cold.

CONCLUSION

Newborn foot length, MUAC, head and chest circumferences have comparable diagnostic accuracy in identifying LBW and preterm babies. Using foot length and MUAC in low-resource settings are the most feasible proxy measures for screening where weighing scales are not available.

PROSPERO REGISTRATION NUMBER

CRD42023454497.

摘要

背景

早产并发症是全球导致 5 岁以下儿童死亡的主要原因，80%的新生儿死亡是低出生体重（LBW）婴儿。早期识别 LBW 和早产儿对于及时干预至关重要。

目的

评估替代新生儿人体测量学指标在识别非洲 LBW 和早产儿中的可行性和诊断准确性。

方法

在这项系统评价和荟萃分析中，我们评估了婴儿足长、中上臂围（MUAC）、头围和胸围与出生体重和胎龄的诊断性能。估计了指标与参考方法之间的汇总相关性。考虑了多种人体测量学阈值来估计汇总敏感性、特异性和受试者工作特征曲线下面积（AUC）。

结果

来自 8 个非洲国家的 21 项研究符合纳入标准。与出生体重的相关系数分别为 0.79（95%CI 0.70 至 0.85）的胸围、0.71（95%CI 0.62 至 0.78）的 MUAC 和 0.66（95%CI 0.59 至 0.73）的足长。使用硬尺测量的足长显示出更高的相关性。28.8cm 截断值的胸围检测 LBW 婴儿的 AUC 值为 0.92（95%CI 0.71 至 0.97）。足长可识别早产儿，其 7.2cm 最佳截断点的敏感性为 82%，特异性为 89%，AUC 为 0.91（95%CI 0.69 至 0.98）。MUAC 对早产的 AUC 值为 0.83（95%CI 0.47 至 0.95）。在识别 LBW 婴儿时，足长和 MUAC 的 AUC 值分别为 0.89（95%CI 0.70 至 0.96）和 0.91（95%CI 0.73 至 0.97），最佳截断点分别为 7.3cm 和 9.8cm。新生儿足长、MUAC、头围和胸围在识别 LBW 和早产儿方面具有相当的诊断准确性。在资源匮乏的环境中，使用足长和 MUAC 作为筛查体重秤不可用时最可行的替代指标。