在巴基斯坦信德省农村地区，将产后足长测量作为一线卫生工作者识别低出生体重儿的替代方法：一项诊断准确性研究。

Postnatal foot length measurement as a proxy to identify low birth weight for frontline health workers in rural Sindh Province, Pakistan: a diagnostic accuracy study.

作者信息

Tikmani Shiyam Sunder, Brown Nick, Inayat Ali Alijaan, Martensson Andreas, Saleem Sarah, Martensson Thomas

机构信息

Global Health and Migration Unit, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden

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

出版信息

BMJ Open. 2024 Dec 26;14(12):e089153. doi: 10.1136/bmjopen-2024-089153.

DOI:10.1136/bmjopen-2024-089153

PMID:39730154

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11683970/

Abstract

OBJECTIVE

To assess the diagnostic accuracy of postnatal foot length (FL) measurements as a proxy to identify low birth weight (LBW) for frontline healthcare workers in rural Sindh Province, Pakistan.

DESIGN

A community-based cross-sectional study.

SETTING

This study was conducted in the catchment area of Global Network's Maternal and Newborn Health Registry, Thatta, Sindh Province, Pakistan, from January to June 2023.

PARTICIPANTS

Singleton live births irrespective of gestational age at birth.

REFERENCE STANDARD

Birth weight was measured using calibrated digital weighing scales in grams based on the average of three readings with minimal clothing.

INDEX TEST

FL was measured within 48 hours of birth using a rigid transparent plastic ruler in centimetres based on the average of three measurements.

PRIMARY OUTCOME

Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), receiver operating characteristics curve and area under the curve with 95% CI were calculated. Euclidean distance was used to identify the cutoff of FL to identify LBW. A simple linear equation was created to predict the birth weight.

RESULTS

Out of 336 analysed newborns, 179 (53.3%) were male and 157 (46.7%) were female. The median birth weight was 2801 g (IQR: 2465-3057), of whom 88 (26.2%) were LBW. The median foot length was 7.9 cm (IQR: 7.6-8.1). For identifying LBW, the foot length cutoff was ≤7.6 cm with 90.3% sensitivity, 81.8% specificity, 63.8% PPV and 96.0% NPV. A FL of 7.6 cm predicted birth weight of 2459.4 g.

CONCLUSION

Postnatal FL cutoff of ≤7.6 cm has adequate predictive value served as a simple, low-cost and reliable method to identify LBW for frontline healthcare providers in the rural settings of Thatta without calibrated weighing scales to triage LBW newborns in need of higher-level care.

TRIAL REGISTRATION NUMBER

NCT05515211.

摘要

目的

评估产后足长（FL）测量作为一种替代指标，用于为巴基斯坦信德省农村地区的一线医护人员识别低出生体重（LBW）的诊断准确性。

设计

一项基于社区的横断面研究。

背景

本研究于2023年1月至6月在巴基斯坦信德省塔塔市全球网络孕产妇和新生儿健康登记处的集水区进行。

参与者

单胎活产，无论出生时的孕周如何。

参考标准

使用校准后的数字秤以克为单位测量出生体重，测量时穿着最少衣物，取三次读数的平均值。

指标测试

在出生后48小时内，使用硬质透明塑料尺以厘米为单位测量足长，取三次测量的平均值。

主要结果

计算敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、受试者工作特征曲线以及曲线下面积（95%CI）。使用欧几里得距离确定足长的截断值以识别低出生体重。创建一个简单的线性方程来预测出生体重。

结果

在336例分析的新生儿中，179例（53.3%）为男性，157例（46.7%）为女性。出生体重中位数为2801克（IQR：2465 - 3057），其中88例（26.2%）为低出生体重。足长中位数为7.9厘米（IQR：7.6 - 8.1）。对于识别低出生体重，足长截断值≤7.6厘米时，敏感性为90.3%，特异性为81.8%，PPV为63.8%，NPV为96.0%。足长7.6厘米预测出生体重为2459.4克。