Diagnostic value of newborn foot length to predict gestational age

Main Article Content

Mutia Farah Fawziah
Bambang Soebagyo
Dwi Hidayah


Background  Identification of gestational age, especially within 48 hours of birth, is crucial for newborns, as the earlier preterm status is detected, the earlier the child can receive optimal management. Newborn foot length is an anthropometric measurement which is easy to perform, inexpensive, and potentially efficient for predicting gestational age.

Objective  To analyze the diagnostic value of newborn foot length in predicting gestational age.

Methods  This diagnostic study was performed between October 2016 and February 2017 in the High Care Unit of Neonates at Dr. Moewardi General Hospital, Surakarta. A total of 152 newborns were consecutively selected and underwent right foot length measurements before 96 hours of age. The correlation between newborn foot length to classify as full term and gestational age was analyzed with Spearman’s correlation test because of non-normal data distribution. The cut-off point of newborn foot length was calculated by receiver operating characteristic (ROC) curve and diagnostic values of newborn foot length were analyzed by 2 x 2 table with SPSS 21.0 software.

Results There were no significant differences between male and female newborns in terms of gestational age, birth weight, choronological age, and newborn foot length (P>0.05). Newborn foot length and gestational age had a significant correlation (r=0.53; P=0.000). The optimal cut-off newborn foot length to predict full term status was 7.1 cm. Newborn foot length below 7.1 cm had sensitivity 75%, specificity 98%, positive predictive value 94.3%, negative predictive value 90.6%, positive likelihood ratio 40.5, negative likelihood ratio 0.25, and post-test probability 94.29%, to predict preterm status in newborns.

Conclusion  Newborn foot length can be used to predict gestational age, especially for the purpose of differentiating between preterm and full term newborns.

Article Details

How to Cite
Fawziah M, Soebagyo B, Hidayah D. Diagnostic value of newborn foot length to predict gestational age. PI [Internet]. 5Jan.2018 [cited 16Sep.2019];57(4):181-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/1376
Author Biography

Mutia Farah Fawziah, Department of Child Health, Sebelas Maret University Medical School/Dr. Moewardi General Hospital, Surakarta, Central Java

PPDS Ilmu Kesehatan Anak FK UNS/RSUD Dr.Moewardi Surakarta
Received 2017-05-04
Accepted 2017-07-27
Published 2018-01-05


1. Katz J, Lee AC, Kozuki N, Lawn JE, Cousens S, Blencowe H, et al. Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis. Lancet. 2013:382:417–25.
2. Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, Paul VK, et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost? Lancet. 2014:384:347–70.
3. Lawn JE, Kinney MV, Belizan JM, Mason EM, McDougall L, Larson J, et al. Born too soon: accelerating actions for prevention and care of 15 million newborns born too soon. Reprod Health. 2013:10:Suppl 1:S6.
4. Bahl R, Martines J, Bhandari N, Biloglav Z, Edmond K, Iyengar S, et al. Setting research priorities to reduce global mortality from preterm birth and low birth weight by 2015. J Glob Health. 2012:2:10403.
5. Lozano R, Wang H, Foreman KJ, Rajaratnam JK, Naghavi M, Marcus JR, et al. Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet. 2011:378:1139–65.
6. Marchant T, Jaribu J, Penfold S, Tanner M, Armstrong Schellenberg J. Measuring newborn foot length to identify small babies in need of extra care: a cross-sectional hospital based study with community follow up in Tanzania. BMC Public Health. 2010:10:624.
7. Marchant T, Penfold S, Mkumbo E, Shamba D, Jaribu J, Manzi F, et al. The reliability of a newborn foot length measurement tool used by community volunteers to identify low birth weight or premature babies born at home in southern Tanzania. BMC Public Health. 2014:14:859.
8. Mullany LC, Darmstadt GL, Khatry SK, Leclerq SC, Tielsch JM. Relationship between the surrogate anthropometric measures, foot length and chest circumference and birth weight among newborns of Sarlahi, Nepal. Eur J Clin Nutr. 2007:61:40–6.
9. Moraes CL, Reichenheim ME. Validity of Neonatal Clinical Assessment for Estimation of Gestational Age: Comparison of New Ballard Score With Date of Last Menstrual Period and Ultrasonography. Cad Saude Publica. 2000, vol.16, hlm.83-94.
10. Sasidharan K, Dutta S, Narang A. 2009. Validity of New Ballard Score until 7th Day of Postnatal Life in Moderately Preterm Neonates. Arch Dis Child Fetal Neonatal Ed, vol 94, no. 1, hlm. F39-44.
11. Sulistyo H, Ismail D, dan Wibowo T. 2011. Agreement Between Pediatrician and Trained Paramedic in The Assessment of Gestational Age Among Newborns using New Ballard Scored. J Med Sci, vol 43, no.2, hlm. 112-5.
12. Sreekumar K, D’Lima A, Nesargi S, Rao S dan Bhat S. 2012. Comparison of New Ballards Score and Parkins Score for Gestational Age Estimation. Indian Pediatrics, vol.50, hlm. 771-3.
13. Kc A, Nelin V, Viltrakoti R, Aryal S, Malqvist M. Validation of the foot length measure as an alternative tool to identify low birth weight and preterm babies in a low-resource setting like Nepal: a cross-sectional study. BMC Pediatr. 2015:15:43.
14. Mukherjee S, Roy P, Mitra S, Samanta M, Chatterjee S. Measuring new born foot length to identify small babies in need of extra care: a cross-sectional hospital based study. Iran J Pediatr. 2013:23:508–12.
15. Srivastata A, Sharma U, Kumar S. 2015. To study of foot length and gestational age of newborn by new Ballard score. International Journal of Research in Medical Sciences, vol.3(11), hlm. 3119-22.
16. Thi HN, Khanh DK, Thu Hie T, Thomas EG, Lee KJ, Russell FM. Foot length, chest circumference, and mid upper arm circumference are good predictors of low birth weight and prematurity in ethnic minority newborns in Vietnam: a hospital-based observational study. PloS One. 2015:10:e0142420.
17. Lee AC, Mullany LC, Ladhani K, Uddin J, Mitra D, Ahmed P, et al. Validity of newborn clinical assessment to determine gestational age in Bangladesh. Pediatrics. 2016:138:e20153303.
18. Gavhane S, Kale A, Golawankar A, Sangle A. Correlation of foot length and gestational maturity in neonates. Int J Contemp Pediatr. 2016:3:705-8.
19. Dahlan MS. Besar sampel dalam penelitian kedokteran dan kesehatan. Jakarta: PT Arkans; 2006. p.81-9
20. Dahlan MS. Uji Diagnostik. Jakarta: Salemba Medika; 2009. p.11-8.