Master of Science
Nurses at the Medical College of Virginia Hospitals (MCVH) in Richmond, Virginia, use the Newborn Maturity Rating and Classification Tool to identify high risk infants. An estimate of gestational age is made and using this estimate, weight, length, and head circumference measurements are plotted on graphs on the tool to determine if the infant achieves intrauterine growth smaller, larger or equal to gestational age.
The data used to generate the graphs on the Newborn Maturity Rating and Classification Tool were collected in Colorado during the 1950's. Two nurses at MCVH questioned the use of these graphs. They wanted to know if graphs produced from their population would be different from the graphs they now use because of population and time differences.
An initial pilot study was done to examine any problems with measurement reliability. There were no problems with interrater reliability for the length and head circumference measurements. Examination of the chest circumference measurements revealed that one rater had consistently larger measurements than the other.
Data from 98 infants were collected and graphs of weight, length, and head circumference produced. There were differences between the Richmond and Colorado graphs. The 10th percentile for weight for Richmond infants is higher than the 10th percentile for the Colorado infants for 35-42 weeks of gestation. At 40 and 41 weeks of gestation the 90th percentile for the Richmond infants is larger than the 90th percentile for the Colorado infants. These differences result in fewer Richmond infants being identified as small for gestational age and more Richmond infants being classified as large for gestational age than when the Colorado graphs are used.
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