Using AMANHI-ACT cohorts for external validation of Iowa new-born metabolic profiles based models for postnatal gestational age estimation.

Autor:	Sazawal S; Center for Public Health Kinetics, Global Division, New Delhi, India.; Public Health Laboratory-IDC, Chake Chake, Pemba,Tanzania., Ryckman KK; University of Iowa, College of Public Health, Department of Epidemiology, Iowa City, Iowa, USA., Mittal H; Center for Public Health Kinetics, Global Division, New Delhi, India., Khanam R; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA., Nisar I; Aga Khan University, Department of Paediatrics and Child Health, Karachi, Sindh, Pakistan., Jasper E; University of Iowa, College of Public Health, Department of Epidemiology, Iowa City, Iowa, USA., Rahman S; Projahnmo Research Foundation, Dhaka, Bangladesh., Mehmood U; Aga Khan University, Department of Paediatrics and Child Health, Karachi, Sindh, Pakistan., Das S; Center for Public Health Kinetics, Global Division, New Delhi, India., Bedell B; University of Iowa, College of Public Health, Department of Epidemiology, Iowa City, Iowa, USA., Chowdhury NH; Projahnmo Research Foundation, Dhaka, Bangladesh., Barkat A; Aga Khan University, Department of Paediatrics and Child Health, Karachi, Sindh, Pakistan., Dutta A; Center for Public Health Kinetics, Global Division, New Delhi, India., Deb S; Center for Public Health Kinetics, Global Division, New Delhi, India.; Public Health Laboratory-IDC, Chake Chake, Pemba,Tanzania., Ahmed S; Projahnmo Research Foundation, Dhaka, Bangladesh., Khalid F; Aga Khan University, Department of Paediatrics and Child Health, Karachi, Sindh, Pakistan., Raqib R; International Center for Diarrheal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh., Ilyas M; Aga Khan University, Department of Paediatrics and Child Health, Karachi, Sindh, Pakistan., Nizar A; Aga Khan University, Department of Paediatrics and Child Health, Karachi, Sindh, Pakistan., Ali SM; Public Health Laboratory-IDC, Chake Chake, Pemba,Tanzania., Manu A; World Health Organization (MCA/MRD), Geneva, Switzerland., Yoshida S; World Health Organization (MCA/MRD), Geneva, Switzerland., Baqui AH; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA., Jehan F; Aga Khan University, Department of Paediatrics and Child Health, Karachi, Sindh, Pakistan., Dhingra U; Center for Public Health Kinetics, Global Division, New Delhi, India., Bahl R; World Health Organization (MCA/MRD), Geneva, Switzerland.
Jazyk:	angličtina
Zdroj:	Journal of global health [J Glob Health] 2021 Jul 17; Vol. 11, pp. 04044. Date of Electronic Publication: 2021 Jul 17 (Print Publication: 2021).
DOI:	10.7189/jogh.11.04044
Abstrakt:	Background: Globally, 15 million infants are born preterm and another 23.2 million infants are born small for gestational age (SGA). Determining burden of preterm and SGA births, is essential for effective planning, modification of health policies and targeting interventions for reducing these outcomes for which accurate estimation of gestational age (GA) is crucial. Early pregnancy ultrasound measurements, last menstrual period and post-natal neonatal examinations have proven to be not feasible or inaccurate. Proposed algorithms for GA estimation in western populations, based on routine new-born screening, though promising, lack validation in developing country settings. We evaluated the hypothesis that models developed in USA, also predicted GA in cohorts of South Asia (575) and Sub-Saharan Africa (736) with same precision. Methods: Dried heel prick blood spots collected 24-72 hours after birth from 1311 new-borns, were analysed for standard metabolic screen. Regression algorithm based, GA estimates were computed from metabolic data and compared to first trimester ultrasound validated, GA estimates (gold standard). Results: Overall Algorithm (metabolites + birthweight) estimated GA to within an average deviation of 1.5 weeks. The estimated GA was within the gold standard estimate by 1 and 2 weeks for 70.5% and 90.1% new-borns respectively. Inclusion of birthweight in the metabolites model improved discriminatory ability of this method, and showed promise in identifying preterm births. Receiver operating characteristic (ROC) curve analysis estimated an area under curve of 0.86 (conservative bootstrap 95% confidence interval (CI) = 0.83 to 0.89); P  < 0.001) and Youden Index of 0.58 (95% CI = 0.51 to 0.64) with a corresponding sensitivity of 80.7% and specificity of 77.6%. Conclusion: Metabolic gestational age dating offers a novel means for accurate population-level gestational age estimates in LMIC settings and help preterm birth surveillance initiatives. Further research should focus on use of machine learning and newer analytic methods broader than conventional metabolic screen analytes, enabling incorporation of region-specific analytes and cord blood metabolic profiles models predicting gestational age accurately. Competing Interests: Competing interests: The authors completed the ICMJE Unified Competing Interest form (available upon request from the corresponding author), and declare no conflicts of interest. (Copyright © 2021 by the Journal of Global Health. All rights reserved.)
Databáze:	MEDLINE
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