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CC BY-NC-ND 4.0 · Am J Perinatol
DOI: 10.1055/a-1905-5334
Original Article

Development and Validation of a Neonatal Physical Maturity Score for Low- and Middle-Income Countries

Vaisakh Krishnan
1   Department of Brain Sciences, Centre of Perinatal Neuroscience, Imperial College London, London, United Kingdom
,
Vijay Kumar
1   Department of Brain Sciences, Centre of Perinatal Neuroscience, Imperial College London, London, United Kingdom
,
Hemadri Vegda
1   Department of Brain Sciences, Centre of Perinatal Neuroscience, Imperial College London, London, United Kingdom
,
Vidya Ujjanappa
1   Department of Brain Sciences, Centre of Perinatal Neuroscience, Imperial College London, London, United Kingdom
,
Anju Manari
2   International Perinatal Epidemiology Unit, Bengaluru, Karnataka, India
,
Ajithkumar V. Thamunni
3   Department of Paediatrics Institute of Maternal and Child Health, Government Medical College, Kozhikode, Kerala, India
,
Ashraf T. P.
3   Department of Paediatrics Institute of Maternal and Child Health, Government Medical College, Kozhikode, Kerala, India
,
Sahana Devadas
4   Department of Paediatrics Bangalore Medical College, Bengaluru, Karnataka, India
,
Sudindrashayana Fattepur
5   Department of Paediatrics Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India
,
Paul Basett
6   Stasconsultancy, London, United Kingdom
,
Sudhin Thayyil
1   Department of Brain Sciences, Centre of Perinatal Neuroscience, Imperial College London, London, United Kingdom
› Author Affiliations Funding The study was funded by a program grant from the National Institute of Health Research (NIHR), United Kingdom, and was supported by the NIHR Biomedical Research Centre based at Imperial College London. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health.
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Abstract

Objective Currently available gestational age scoring systems are complex and inaccurate for wider use in low- and middle-income countries (LMIC), particularly in infants with neonatal encephalopathy. Here, we aimed to develop a scoring system based on physical characteristics for identifying late preterm infants from term infants.

Study Design This was a prospective observational study conducted in 2 phases- the discovery phase and validation phase. In the first phase, we examined the accuracy of 10 objective physical characteristics in a prospective cohort of 1,006 infants recruited from three hospitals in South India. A weighted scoring system and a photo card were then developed based on the six best performing characteristics which were validated in another prospective cohort of 1,004 infants.

Results The final score had a sensitivity of 66.0% (95% confidence intervals [CIs], 58.4–73.8%), specificity of 80.0% (95% CI, 77.2–82.7%), and a negative predictive value of 93.0% (95% CI, 90.5–94.5%).

Conclusion This scoring system may have wider applications in LMIC, particularly in community settings and in infants with neonatal encephalopathy.

Key Points

  • This is an easily administered scoring system using physical characters to identify late preterm infants.

  • The scoring is not affected by neurological injury and can be used in encephalopathic infants.

  • Overall accuracy is better than previous scores encompassing the physical criteria alone.

Keywords

newborn - gestational assessment - preterm infants - low- and middle-income countries

Authors' Contributions

V.K. conceived the idea, designed the study, developed the study protocol, trained the research nurses in collecting the data, analyzed and interpreted the data, and wrote the first draft of the manuscript. V.K., H.V., V.U., and A.M. recruited and examined the infants, and A.V.T., A.T.P., S.D., and S.F. supervised the study at each of the trial sites. P.B. analyzed the data. S.T. supervised the entire project, including protocol development, interpretation of the data and preparation of the manuscript, and is the guarantor for the study. All authors have participated in development of the manuscript and have approved the final version for submission. V.K. and S.T. have full access to the data.


Supplementary Material



Publication History

Received: 02 March 2022

Accepted: 06 July 2022

Accepted Manuscript online:
20 July 2022

Article published online:
12 September 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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