Anne C C Lee|Pratik Panchal|Lian V. Folger|Hilary Whelan|Rachel Whelan|Bernard Rosner|Hannah Blencowe|Joy E Lawn
Diagnostic Accuracy of Neonatal Assessment for Gestational Age Determination: A Systematic Review
Harvard University|Harvard Global Health Institute|OpenBiome|University of Rochester Medical Center|Community Partners|Harvard University|Brigham and Women's Hospital|London School of Hygiene & Tropical Medicine|London School of Hygiene & Tropical Medicine
estimated 15 million neonates born preterm annually however low middleincome countries dating pregnancy frequently unreliable unknownto conduct systematic literature review metaanalysis determine diagnostic accuracy neonatal assessments estimate gestational age gapubmed embase cochrane web science popline world health organization library databasesstudies liveborn infants researchers compared neonatal signs assessments ga estimation reference standardtwo independent reviewers extracted data study population design bias reference standard test methods accuracy agreement validity correlation interrater reliabilityfour thousand nine hundred fiftysix studies screened 78 included identified 18 newborn assessments ga estimation ranging 4 23 signs compared ultrasound dubowitz score dated 95 pregnancies within 26 weeks n 7 studies ballard score overestimated ga 04 weeks dated pregnancies within 38 weeks n 9 compared last menstrual period dubowitz score dated 95 pregnancies within 29 weeks n 6 studies ballard score 42 weeks n 5 assessments fewer signs tended less accurate studies showed tendency newborn assessments overestimate ga preterm infants underestimate ga growthrestricted infantspoor study quality studies early ultrasoundbased referenceefforts low middleincome countries focus improving dating pregnancy ultrasound improving validity growthrestricted populations ultrasound possible increased efforts needed develop simpler yet specific approaches newborn assessment new combinations existing parameters new signs technology