A simple, rapid assessment tool to identify and triage preterm infants
Preterm birth leads to more annual neonatal deaths (1 million) than any other single cause; these deaths primarily occur in low income settings where many infants are born at home and gestational age is rarely assessed. Innovative ways to identify preterm infants in the community are needed to facilitate rapid and appropriate targeting of interventions and referral. Newborn clinical assessment by medically trained personnel allows accurate estimation of gestational age, but methods are complex and simplified methods have not been developed and validated for use by community health workers (CHWs). We have developed a simple, color-coded pictorial scorecard intended for use by CHWs to identify early preterm (<34 weeks=red zone) and late preterm (34-37 weeks= yellow zone) infants. Five physical characteristics (skin texture, ear shape, breast form, foot skin creases, and lanugo) are assessed without any computational requirement. Infants may be triaged by their gestational age/risk categories: caretakers of late preterm infants (yellow zone) would receive additional training in skin to skin contact and breast-feeding support, while early preterm infants (red zone) would be referred to a hospital facility for further management. Nesting this activity within an ongoing study of genitourinary tract infections in pregnancy will allow us to compare gestational age of 800 newborns estimated through this tool with gold-standard first trimester ultrasound dating. Validation of this simple tool for use by CHWs may help reduce the large burden of newborn deaths related to prematurity.