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A comparison of the accuracy of various methods of postnatal gestational age estimation; including Ballard score, foot length, vascularity of the anterior lens, last menstrual period and also a clinician's non-structured assessment
Rationale Gestational age is a strong determinant of neonatal mortality and morbidity. Early obstetric ultrasound is the clinical reference standard, but is not widely available in many developing countries. There is a well recognised need to identify reliable and simple methods of postnatal gestati...
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| Format: | Thesis |
| Language: | English |
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Department of Paediatrics and Child Health
2021
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| _version_ | 1867613148246179840 |
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| access_status_str | Open Access |
| author | Stevenson, Alexander Graham |
| author2 | Tooke, Lloyd |
| author_browse | Stevenson, Alexander Graham Tooke, Lloyd |
| author_facet | Tooke, Lloyd Stevenson, Alexander Graham |
| author_sort | Stevenson, Alexander Graham |
| collection | Thesis |
| description | Rationale Gestational age is a strong determinant of neonatal mortality and morbidity. Early obstetric ultrasound is the clinical reference standard, but is not widely available in many developing countries. There is a well recognised need to identify reliable and simple methods of postnatal gestational age estimation. Methods A prospectively designed methods comparison study in a tertiary referral hospital in a developing country. Early ultrasound (<20 weeks) was the clinical reference standard. Methods evaluated included anthropometric measurements (including foot-length), vascularity of the anterior lens, the New Ballard Score and Last Menstrual Period. Clinicians' non-structured global impression “End of Bed” Assessment was also evaluated. Results 106 babies were included in the study. Median age at birth was 34 weeks (IQR 29-36). Ballard Score and “End of Bed” Assessment had a mean bias of -0.14 and 0.06 weeks respectively but wide 95% limits of agreement. The physical component of the Ballard score, the total Ballard score and Foot-length's ability to discriminate between term and preterm infants gave an AUROC of 0.97, 0.96 and 0.95 respectively. Discussion Although “End of Bed” Assessment and Ballard score had small mean biases, the wide confidence intervals render the methods irrelevant in clinical practice. Foot-length was particularly poor in Small for Gestational Age infants. None of the methods studied were superior to a non-structured clinician's informal “End of Bed” Assessment. Conclusion None of the methods studied met the a priori definition of clinical usefulness. Improving access to early ultrasound remains a priority. Instead of focusing on chronological accuracy, future research should compare the ability of early ultrasound and Ballard score to predict morbidity and mortality. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/33997 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:31:31.816Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2021 |
| publishDateRange | 2021 |
| publishDateSort | 2021 |
| publisher | Department of Paediatrics and Child Health |
| publisherStr | Department of Paediatrics and Child Health |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/33997 A comparison of the accuracy of various methods of postnatal gestational age estimation; including Ballard score, foot length, vascularity of the anterior lens, last menstrual period and also a clinician's non-structured assessment Stevenson, Alexander Graham Tooke, Lloyd Joolay, Yaseen Child Health Rationale Gestational age is a strong determinant of neonatal mortality and morbidity. Early obstetric ultrasound is the clinical reference standard, but is not widely available in many developing countries. There is a well recognised need to identify reliable and simple methods of postnatal gestational age estimation. Methods A prospectively designed methods comparison study in a tertiary referral hospital in a developing country. Early ultrasound (<20 weeks) was the clinical reference standard. Methods evaluated included anthropometric measurements (including foot-length), vascularity of the anterior lens, the New Ballard Score and Last Menstrual Period. Clinicians' non-structured global impression “End of Bed” Assessment was also evaluated. Results 106 babies were included in the study. Median age at birth was 34 weeks (IQR 29-36). Ballard Score and “End of Bed” Assessment had a mean bias of -0.14 and 0.06 weeks respectively but wide 95% limits of agreement. The physical component of the Ballard score, the total Ballard score and Foot-length's ability to discriminate between term and preterm infants gave an AUROC of 0.97, 0.96 and 0.95 respectively. Discussion Although “End of Bed” Assessment and Ballard score had small mean biases, the wide confidence intervals render the methods irrelevant in clinical practice. Foot-length was particularly poor in Small for Gestational Age infants. None of the methods studied were superior to a non-structured clinician's informal “End of Bed” Assessment. Conclusion None of the methods studied met the a priori definition of clinical usefulness. Improving access to early ultrasound remains a priority. Instead of focusing on chronological accuracy, future research should compare the ability of early ultrasound and Ballard score to predict morbidity and mortality. 2021-09-22T14:46:42Z 2021-09-22T14:46:42Z 2020 2021-09-22T14:46:00Z Master Thesis Masters MPhil http://hdl.handle.net/11427/33997 eng application/pdf Department of Paediatrics and Child Health Faculty of Health Sciences |
| spellingShingle | Child Health Stevenson, Alexander Graham A comparison of the accuracy of various methods of postnatal gestational age estimation; including Ballard score, foot length, vascularity of the anterior lens, last menstrual period and also a clinician's non-structured assessment |
| thesis_degree_str | Master's |
| title | A comparison of the accuracy of various methods of postnatal gestational age estimation; including Ballard score, foot length, vascularity of the anterior lens, last menstrual period and also a clinician's non-structured assessment |
| title_full | A comparison of the accuracy of various methods of postnatal gestational age estimation; including Ballard score, foot length, vascularity of the anterior lens, last menstrual period and also a clinician's non-structured assessment |
| title_fullStr | A comparison of the accuracy of various methods of postnatal gestational age estimation; including Ballard score, foot length, vascularity of the anterior lens, last menstrual period and also a clinician's non-structured assessment |
| title_full_unstemmed | A comparison of the accuracy of various methods of postnatal gestational age estimation; including Ballard score, foot length, vascularity of the anterior lens, last menstrual period and also a clinician's non-structured assessment |
| title_short | A comparison of the accuracy of various methods of postnatal gestational age estimation; including Ballard score, foot length, vascularity of the anterior lens, last menstrual period and also a clinician's non-structured assessment |
| title_sort | comparison of the accuracy of various methods of postnatal gestational age estimation including ballard score foot length vascularity of the anterior lens last menstrual period and also a clinician s non structured assessment |
| topic | Child Health |
| url | http://hdl.handle.net/11427/33997 |
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