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Zakaria Z, Van Rostenberghe H, Ramli N, Suhaimi MS, Hazlan SNH, Abdullah JM. The Key Aspects of Neonatal and Infant Neurological Examination: The Ballard Score, the Infant's Head with Hydrocephalus and Assessment in a Clinical Setting. Malays J Med Sci 2023; 30:193-206. [PMID: 37655147 PMCID: PMC10467588 DOI: 10.21315/mjms2023.30.4.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/12/2022] [Indexed: 09/02/2023] Open
Abstract
The physical examination of the newborn is essential in diagnosing neurological or neurosurgical conditions in the newborn. This article focuses on three clinical assessments of newborns and infants that are especially important if neurological problems are suspected: The Ballard score, the examination of the head in a baby with (suspected) hydrocephalus, and the neurological and developmental evaluation of an infant in an ambulatory setting. A textual description and a link to a video describe each assessment.
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Affiliation(s)
- Zaitun Zakaria
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Neurosciences, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
- Brain and Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Hans Van Rostenberghe
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Paediatrics, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Noraida Ramli
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Paediatrics, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Mohamad Syahrain Suhaimi
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Paediatrics, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Siti Nur Haidar Hazlan
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Paediatrics, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Jafri Malin Abdullah
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
- Department of Neurosciences, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kelantan, Malaysia
- Brain and Behaviour Cluster, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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Ceran B, Beşer E, Karaçağlar NB, Beyoğlu R, Şimşek GK, Canpolat FE, Kutman HGK. Evaluation of the correlation of the new Ballard scoring with the ultrasonographic optical nerve sheath diameter and brain volume of preterm infants. Early Hum Dev 2021; 163:105506. [PMID: 34773864 DOI: 10.1016/j.earlhumdev.2021.105506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Optic nerve sheath diameter (ONSD) measurements with magnetic resonance imaging and ultrasonography in preterm infants are similar. AIM We measured ultrasonographic ONSD and calculated the brain volumes of preterm infants using two-dimensional cranial ultrasonography and explored the relationships thereof with gestational age, birth weight, head circumference, and new Ballard score. METHOD This prospective study included preterm infants admitted to the neonatal intensive care unit without intracranial pathology. Two images per eye were obtained from a linear array ultrasound transducer placed on the patient's superior eyelid. The ONSD was measured 3 mm behind the globe. The brain was considered an ellipsoid, and estimated absolute brain volumes were calculated by subtracting the volumes of the two lateral ventricles from the total brain volumes. RESULTS A total of 143 preterm infants (male 74, female 69) included in the study. The mean gestational age of the study population was 29.7 weeks (23-36), and the mean birth weight was 1390 g (500-2850). There was a significant difference in ONSD between the male and female gender. A significant, strong, and positive correlation was found between ONSD measurements and gestational age (r 0.901, p < 0.001), new Ballard score (r 0.946, p < 0.001), birth weight, head circumference, and brain volumes. CONCLUSION Our results suggested that ONSD measurements are highly correlated with anthropometry, and it could be a promising bedside, non-invasive objective tool for the determination of exact gestational age postnatally along with the new Ballard score.
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Affiliation(s)
- Burak Ceran
- Department of Neonatology, NICU, Ankara City Hospital, University of Health Sciences, Bilkent, Çankaya, Ankara 06800, Turkey.
| | - Esra Beşer
- Department of Neonatology, NICU, Ankara City Hospital, University of Health Sciences, Bilkent, Çankaya, Ankara 06800, Turkey
| | - Nazmiye Bengü Karaçağlar
- Department of Neonatology, NICU, Ankara City Hospital, University of Health Sciences, Bilkent, Çankaya, Ankara 06800, Turkey
| | - Rana Beyoğlu
- Department of Pediatric Radiology, Ankara City Hospital, University of Health Sciences, Bilkent, Çankaya, Ankara 06800, Turkey
| | - Gülsüm Kadıoğlu Şimşek
- Department of Neonatology, NICU, Ankara City Hospital, University of Health Sciences, Bilkent, Çankaya, Ankara 06800, Turkey
| | - Fuat Emre Canpolat
- Department of Neonatology, NICU, Ankara City Hospital, University of Health Sciences, Bilkent, Çankaya, Ankara 06800, Turkey
| | - Hayriye Gözde Kanmaz Kutman
- Department of Neonatology, NICU, Ankara City Hospital, University of Health Sciences, Bilkent, Çankaya, Ankara 06800, Turkey
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Unger H, Thriemer K, Ley B, Tinto H, Traoré M, Valea I, Tagbor H, Antwi G, Gbekor P, Nambozi M, Kabuya JBB, Mulenga M, Mwapasa V, Chapotera G, Madanitsa M, Rulisa S, de Crop M, Claeys Y, Ravinetto R, D’Alessandro U. The assessment of gestational age: a comparison of different methods from a malaria pregnancy cohort in sub-Saharan Africa. BMC Pregnancy Childbirth 2019; 19:12. [PMID: 30621604 PMCID: PMC6323786 DOI: 10.1186/s12884-018-2128-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Determining gestational age in resource-poor settings is challenging because of limited availability of ultrasound technology and late first presentation to antenatal clinic. Last menstrual period (LMP), symphysio-pubis fundal height (SFH) and Ballard Score (BS) at delivery are therefore often used. We assessed the accuracy of LMP, SFH, and BS to estimate gestational age at delivery and preterm birth compared to ultrasound (US) using a large dataset derived from a randomized controlled trial in pregnant malaria patients in four African countries. METHODS Mean and median gestational age for US, LMP, SFH and BS were calculated for the entire study population and stratified by country. Correlation coefficients were calculated using Pearson's rho, and Bland Altman plots were used to calculate mean differences in findings with 95% limit of agreements. Sensitivity, specificity, positive predictive value and negative predictive value were calculated considering US as reference method to identify term and preterm babies. RESULTS A total of 1630 women with P. falciparum infection and a gestational age > 24 weeks determined by ultrasound at enrolment were included in the analysis. The mean gestational age at delivery using US was 38.7 weeks (95%CI: 38.6-38.8), by LMP, 38.4 weeks (95%CI: 38.0-38.9), by SFH, 38.3 weeks (95%CI: 38.2-38.5), and by BS 38.0 weeks (95%CI: 37.9-38.1) (p < 0.001). Correlation between US and any of the other three methods was poor to moderate. Sensitivity and specificity to determine prematurity were 0.63 (95%CI 0.50-0.75) and 0.72 (95%CI, 0.66-0.76) for LMP, 0.80 (95%CI 0.74-0.85) and 0.74 (95%CI 0.72-0.76) for SFH and 0.42 (95%CI 0.35-0.49) and 0.77 (95%CI 0.74-0.79) for BS. CONCLUSIONS In settings with limited access to ultrasound, and in women who had been treated with P. falciparum malaria, SFH may be the most useful antenatal tool to date a pregnancy when women present first in second and third trimester. The Ballard postnatal maturation assessment has a limited role and lacks precision. Improving ultrasound facilities and skills, and early attendance, together with the development of new technologies such as automated image analysis and new postnatal methods to assess gestational age, are essential for the study and management of preterm birth in low-income settings.
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Affiliation(s)
- Holger Unger
- Department of Obstetrics and Gynaecology, Simpson Centre for Reproductive Health, Edinburgh Royal Infirmary, Edinburgh, UK
- Department of Medicine at the Doherty Institute, The University of Melbourne, Melbourne, Australia
| | - Kamala Thriemer
- Institute of Tropical Medicine, Antwerp, Belgium
- Menzies School of Health Research, Darwin, Australia
| | - Benedikt Ley
- Institute of Tropical Medicine, Antwerp, Belgium
- Menzies School of Health Research, Darwin, Australia
| | - Halidou Tinto
- Institut de Recherche en Sciences de la Santé - Clinical Trial Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Maminata Traoré
- Institut de Recherche en Sciences de la Santé - Clinical Trial Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Innocent Valea
- Institut de Recherche en Sciences de la Santé - Clinical Trial Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Harry Tagbor
- School of Medicine, University of Health and Allied Sciences, Hohoe, Ghana
| | - Gifty Antwi
- School of Medicine, University of Health and Allied Sciences, Hohoe, Ghana
| | | | | | | | | | - Victor Mwapasa
- Department of Public Health, College of Medicine, Blantyre, Malawi
| | | | | | - Stephen Rulisa
- University of Rwanda, School of Medicine and Pharmacy, Kigali, Rwanda
| | | | - Yves Claeys
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Umberto D’Alessandro
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, London, UK
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