Use of physical and neurologic observations in assessment of gestational age in low birth weight infants

doi:10.1016/S0022-3476(87)80416-X

The Journal of Pediatrics

Volume 110, Issue 6, June 1987, Pages 921-928

https://doi.org/10.1016/S0022-3476(87)80416-X Get rights and content

The relative validities of three clinical assessment methods for estimatinggestational age in newborn low birth weight infants were evaluated with reference to estimates based on the date of the mother's last menstrual period. For 1246 infants in eight diverse institutions, estimates based on physical criteria correlated more strongly with dates estimates, ylelded estimates more similar on average to dates estimates, and yielded higher proportions of correct classifications of prematurity and small for gestational age than did estimates based on neurologic criteria or neurologic and physical criteria combined. These results support the use of physical criteria rather than neurologic or combined criteria for the clinical assessment of gestational age in low birth weight infants. In a subsample of 511 black and white infants, there were no ethnic differences in mean error of estimate for any of the three methods.

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The Infant Health and Development Program (IHDP) was a randomized clinical trial of early intervention services for low birth weight, premature infants. Mothers and infants received services for 3 years beginning at neonatal discharge. At the intervention's conclusion, mothers in the intervention group who had lighter (< 2001 g) birth weight infants had been employed longer than mothers in the comparison group. Intervention group mothers also reported less emotional distress, scored higher on the home environment measure and used harsh discipline less frequently with sons. Among measures of mothers' employment, mental health and home environment at 2-, 5-and 15-years post-intervention, employment was the only domain showing a treatment effect over time; this effect depended on child birth weight. Results suggest that early intervention services may have more success altering a mother's life course than her mental health or parenting style. Further research is needed to investigate the factors influencing the decisions made by low birth weight infants' mothers regarding whether and when to work outside the home.
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Citation Excerpt :
All infants were examined with serial cranial ultrasonography beginning at the sixth postnatal hour and continuing through the expected obstetric due date; the grading systems for intraventricular hemorrhage, periventricular leukomalacia, and ventriculomegaly are described elsewhere [16]. Prenatal, perinatal, and postnatal data were obtained prospectively by maternal interviews and from chart review, and all infants underwent gestation age assessment on the first postnatal day [17]. Cognitive assessments were performed by research staff blinded to the child's study group and medical status.
Preterm birth is frequently associated with both neuropathologic and cognitive sequelae. This study examined cortical lobe, subcortical, and lateral ventricle development in association with perinatal variables and cognitive outcome. High-resolution volumetric magnetic resonance imaging scans were acquired and quantified using advanced image processing techniques. Seventy-three preterm and 33 term control children ages 7.3-11.4 years were included in the study. Results indicated disproportionately enlarged parietal and frontal gray matter, occipital horn, and ventricular body, as well as reduced temporal and subcortical gray volumes in preterm children compared with control subjects. Birth weight was negatively correlated with parietal and frontal gray, as well as occipital horn volumes. Intraventricular hemorrhage was associated with reduced subcortical gray matter. Ventricular cerebrospinal fluid was negatively correlated with subcortical gray matter volumes but not with white matter volumes. Maternal education was the strongest predictor of cognitive function in the preterm group. Preterm birth appears to be associated with disorganized cortical development, possibly involving disrupted synaptic pruning and neural migration. Lower birth weight and the presence of intraventricular hemorrhage may increase the risk for neuroanatomic abnormality.
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The establishment of the National Institute of Health and Human Development Neonatal Research Network in 1986 was an acknowledgement by the medical community of the need to rigorously perform patient-oriented research in neonates. The limit of viability was being pushed below 26 weeks’ gestation by physicians willing to try almost anything to save their extremely low gestational age patients and/or by parents who were willing to accept survival at almost any cost. Too often new treatments or procedures had become standard therapies before efficacy and/or safety had been evaluated. During its first 15 years, the Network has conducted randomized, controlled trials and prospective observational studies focused on such major neonatal issues as brain injury, neuroprotection, late-onset infection, bronchopulmonary dysplasia, severe hypoxic respiratory failure, postnatal growth and nutrition, and long-term neurodevelopmental outcome. This paper reviews the Network’s investigative activities during that time, highlights some of the lessons learned in its attempts to identify clinically relevant outcomes that would change clinical practice, and addresses future challenges.
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2002, International Journal of Gynecology and Obstetrics
Objectives: To evaluate the performance and the utility of using birthweight-adjusted scores of Dubowitz and Ballard methods of estimating gestational age in a Zimbabwean population. Method: The Dubowitz and the Ballard methods of estimating gestational age were administered to 364 African newborn infants with a known last menstrual period (LMP) at Harare Maternity Hospital. Results: Both methods were good predictors of gestational age useful in differentiating term from pre-term infants. Our regression line was Y_{(LMP gestational age)}=23.814+0.301*score for the Dubowitz and Y_{(LMP gestational age)}=24.493+0.420*score for the Ballard method. Addition of birthweight to the regression models improved prediction of gestational age; Y_{(LMP gestational age)}=23.512+0.219*score+0.0015*grams for Dubowitz and Y_{(LMP gestational age)}=24.002+0.292*score+0.0016*grams for Ballard method. Conclusions: We recommend the use of our birthweight-adjusted maturity scales; the Dubowitz for studies of prematurity, and the Ballard for routine clinical practice.
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^*: Supported by the Robert Wood Johnson Foundation, and by theDivision of Maternal and Child Health, U.S. Public Health Service, the National Institute of Child Health and Human Development, and the Pew Trusts.

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Use of physical and neurologic observations in assessment of gestational age in low birth weight infants*

J Pediatr

Am J Obstet Gynecol

Am J Obstet Gynecol

Lancet

Ear Hum Dev

J Pediatr

Rapid assessment of gestational age at birth

Arch Dis Child

Intrauterine growth as estimated from liveborn birthweight data at 24–42 weeks of gestation

Pediatrics

Neurological evaluation of the maturity of newborn infants

Arch Dis Child

The determination of maturity

La maturation neurologique du premature

Etudes Neonat