What Matters Most for the Survival of Small Newborns in Resource-Limited Settings?

In 1963, Lubchenco proposed a system to characterize intrauterine growth by gestational age, which highlighted the differences between preterm and growth-restricted term infants.¹ More than 50 years later, there is limited capacity to distinguish preterm from small but mature infants in low- and middle-income countries where these conditions, together with asphyxia and infection, are leading causes of neonatal death. Lee et al sought to determine if community health workers could use physical/neuromuscular signs and anthropometrics to estimate the maturity of infants born in rural communities in Bangladesh with the ultimate goal of facilitating early identification and referral of preterm infants.² The study used community surveillance for early diagnosis of pregnancy and successfully accomplished ultrasound dating of pregnancy before 20 weeks. Twenty-five physical, neuromuscular, and anthropometric observations were assessed and then analyzed individually and in combination for their diagnostic accuracy. All fell short of acceptable utility for estimation of...