Background Globally, prematurity is the leading cause of under-five mortality. Differentiating premature infants from term-growth restricted infants can be challenging in low- and middle-income countries (LMICs). The Dubowitz exam uses 21 neuromuscular and physical signs to estimate gestational age. It is the most accurate neonatal assessment compared to ultrasound dating; however, the exam is relatively long and requires specialized training which may inhibit widespread use in LMICs. Objective To evaluate a protocol for teaching the Dubowitz exam by assessing the agreement of trainee-trainer scores and to explore implementation barriers to the Dubowitz exam in two LMIC settings. Design/Methods We taught the Dubowitz exam during two half-day workshops in Malawi and India. We used didactic presentations followed by small group skills training. We compared agreement of scoring between the trainer (neonatologist) and trainees by calculating the percent agreement for individual signs. We used Bland Altman analysis to compare the gestational age...

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