Reducing discomfort while measuring crown–heel length in neonates

Abstract

Aim: To assess the degree of discomfort caused by length measurement in neonates, performed with one or both lower limbs extended, on the first and second day after birth, with either one or both lower limbs extended. Methods: Healthy full-term neonates were systematically sampled during the months of February and March 2004. Crown Áheel length was measured, using a 1-mm precision neonatometer, at approximately 8 h and 32 h after birth, with one and both lower limbs extended. The Neonatal Facial Coding System was used to assess discomfort during measurements. Data were analysed by parametric and non-parametric tests as appropriate. Results: Whatever the measurement technique, discomfort scores are significantly higher during the length measurement than at baseline. Whenever length measurements are performed, discomfort scores are significantly higher when extending both lower limbs rather than one lower limb (p B/0.006). The measured length is greater with one lower limb extended; however, the difference decreases over time, being 0.19 cm (95% CI 0.1 Á0.3; p B/0.001) at approximately 32 h of age. No significant differences in length were found between measurements at approximately 8 or 32 h, regardless of the technique used. The best correlation between length measurements with one or both lower limbs extended was observed at approximately 32 h after birth (r 0/0.98). Conclusion:Measuring crown Áheel length is a distressful procedure for the neonate. Measurements with one lower limb extended result in less discomfort than when both lower limbs are extended, without decreasing the accuracy.

Precision of recumbent crown-heel length when using an infantometer

“…This is consistent with the findings of other researchers who have previously reported a difference between the two techniques [18]. There was less variability in CHL measurements between different measurers when extending both legs rather than one, regardless of age group or subject cooperation.…”

“…When measuring CHL in neonates a great deal of care should be taken, bearing in mind their fragility [18]. However, neonates are largely unaffected by the presence of the measurers and can be easily soothed, whereas infants and children are more aware of their surroundings and can be wary in an unfamiliar environment and thus uncooperative.…”

A novel technique for infant length measurement based on stereoscopic vision

“…Measurement of infant's crown–heel length necessitates stretching the infants against the normal flexor posture. Reluctance of medical staff to forcefully extend the infant may lead to inaccuracy and unreliability of the measurements 9 19 20. Therefore, length measurements of infants tend to be negatively biased 11.…”

Is intrauterine growth appropriate to monitor postnatal growth of preterm neonates?

“…The small dimension of the samples providing birth length data in comparison with those providing birth weight data may be due to the methodological difficulty in obtaining accurate neonatal length measurements in large multicenter surveys. Measured neonatal length may be influenced by reluctance of the observer to provoke discomfort when extending the lower limbs against the normal flexor posture, especially in term infants [13]. Moreover, it seems that tape was used for measuring the length in the survey by Olsen et al [11], the greatest sample of preterm neonates with measured birth length.…”