Tape Rule Measurement of Foot Length as Proxy for Vernier Digital Calliper in Estimating Gestational Age among Nigerian Neonates.

BACKGROUND: Estimating gestational age at birth could be challenging, particularly in settings where the expertise to use conventional methods is lacking. The use of the postnatal foot length has been proposed for this purpose. The ideal tool for measuring foot length, the Vernier Digital Calliper, is not readily available in resource-poor settings. OBJECTIVE: To determine the degree of correlation between postnatal foot length measurement using a Vernier Digital Calliper and a tape measure in the estimation of gestational age among Nigerian neonates. METHODS: Neonates aged 0 to 48 hours without lower limb deformities were studied. The Gestational age was determined using the New Ballard Scoring method. The Foot length was measured as the distance between the tip of the second toe and the heel using both the Vernier Digital Calliper (FLC) and a non-elastic, flexible tape measure (FLT). The measurements were subjected to statistical comparisons. RESULTS: A total of 260 newborn infants comprising 140 preterm and 120 term babies were studied. The foot length measurements using both the calliper and tape measure progressively increased with gestational age. FLT was consistently relatively higher than FLC across gestational ages. The relationship between the two tools was FLC = 3.05 + (0.9 x FLT) for preterm babies and FLC = 23.39 + (0.6 x FLT) for term babies. The Cronbach's Alpha correlation ranged from 0.775 to 0.958 across the gestational ages. The degree of agreement between the tools ranged from -2.03 to -1.34 with a mean difference of -1.68 (t = -9.67, p <0.001). CONCLUSION: There is a high level of intra-gestational age reliability between caliper measurements and tape measurements, the latter can be suitably used as a suitable proxy for the former in the measurement of postnatal foot length in the estimation of gestational age at birth.

CONTEXTE: L'estimation de l'âge gestationnel à la naissance peut s'avérer difficile, en particulier dans les contextes où l'expertise nécessaire à l'utilisation des méthodes conventionnelles fait défaut. La longueur du pied postnatal a été proposée à cette fin. L'outil idéal pour mesurer la longueur du pied, le pied à coulisse numérique de Vernier, n'est pas facilement disponible dans les régions à faibles ressources. OBJECTIF: Déterminer la corrélation entre deux méthodes de mesure de la longueur du pied postnatal dans l'estimation de l'âge gestationnel chez les nouveau-nés nigérians. MÉTHODES: Des nouveau-nés âgés de 0 à 48 heures sans déformation des membres inférieurs ont été étudiés. L'âge gestationnel a été déterminé à l'aide de la méthode New Ballard Scoring. La longueur du pied a été mesurée comme la distance entre l'extrémité du deuxième orteil et le talon à l'aide d'un pied à coulisse numérique de Vernier (FLC) et d'un mètre ruban souple non élastique (FLT). RÉSULTATS: Au total, 260 nouveau-nés, dont 140 prématurés et 120 nés à terme, ont été étudiés. Les mesures de la longueur du pied à l'aide du pied à coulisse et du mètre ruban augmentent progressivement avec l'âge gestationnel. La FLT était toujours relativement plus élevée que la FLC, quel que soit l'âge gestationnel. La relation entre les deux outils était la suivante : FLC = 3,05 + (0,9 x FLT) pour les prématurés et FLC = 23,39 + (0,6 x FLT) pour les enfants nés à terme. La corrélation alpha de Cronbach allait de 0,775 à 0,958 selon l'âge gestationnel. CONCLUSION: Le mètre ruban est un substitut adéquat au pied à coulisse pour la mesure de la longueur du pied postnatal. Mots clés: Âge gestationnel estimé; Pied à coulisse numérique; Longueur du pied; Prématurité.

The echocardiographic findings in kwashiorkor.

Echocardiography (ECHO), electrocardiography (ECG), and chest radiography (CXR) were performed in 44 children with kwashiorkor, and 44 age- and sex-matched controls. In patients with kwashiorkor, mean values obtained for end diastolic dimension (29.2 +/- 3.8 mm), end systolic dimension (20.9 +/- 2.8 mm), posterior ventricular wall thickness (5.42 +/- 0.57 mm), and shortening fraction (28.2 +/- 4.3%) were significantly smaller than the corresponding values obtained in the controls -38.0 +/- 5.8 mm (P < 0.001), 27.6 +/- 4.5 mm (P < 0.001), 7.07 +/- 0.71 mm (P < 0.001) and 31.4 +/- 4.5% (P < 0.05), respectively. Similarly, mean cardiothoracic ratio (48.6 +/- 3.4%) and QRS amplitude (13.20 +/- 4.85 mm) were significantly (P < 0.001) smaller in subjects than controls, corresponding values being 54 +/- 3.2 per cent and 20.18 +/- 5.12 mm, respectively. In the subjects, there was very good correlation between posterior ventricular wall thickness and cardiothoracic ratio (r = 0.93; P < 0.001) and also between the estimated left ventricular mass and S1 + R6 amplitude (r = 0.89; P < 0.001).

The electrocardiographic changes in kwashiorkor.

An electrocardiogram (ECG), serum electrolytes, serum albumin, haematocrit and cardiothoracic ratio were recorded in 90 Nigerian children with kwashiorkor and 90 age- and sex-matched controls. The ECG abnormalities observed among the study group included sinus tachycardia (91%), low QRS amplitude (100%) and prolonged QTc intervals (17%). Other ECG abnormalities noted were short QTc intervals (three children), prolonged PR intervals (four children) and right axis deviation (two children). The mean serum sodium, potassium, calcium, albumin, haematocrit and cardiothoracic ratio were significantly lower in children with kwashiorkor than in the controls (p < 0.001). The correlation between the QRS amplitude and serum potassium and calcium was poor (p > 0.05). Also, there was poor correlation between heart rate and haematocrit (p > 0.05) and between QTc intervals and serum calcium and potassium (p > 0.05). However, the correlation between the QRS amplitude and cardiothoracic ratio was good (r = 0.91, p < 0.001). These findings suggest that the ECG changes in kwashiorkor are due to myocardial atrophy.

The prognostic significance of the QRS amplitudes of electrocardiogram in kwashiorkor

Electrocardiograms (ECGs) were performed on 52 children with kwashiorkor and 52 age-and sex-matched controls. Heart rates were higher (p0.05) and QTc intervals longer (p0.05) in patients with kwashiorkor than in the controls. The QRS amplitude in all the leads in patients with kwashiorkor was smaller (p0.05) than those of the controls. The QRS amplitudes in the survivors were significantly wider (p0.05) controls. The QRS amplitudes in the survivors were significantly wider (p0.05) than in those of the patients who died. Average QRS amplitude of less than 5mm in the standard limb leads and less than 10mm in the chest leads indicated poor prognosis