Validation of caregiver interviews to diagnose common causes of severe neonatal illness

The objective of this study was to validate retrospective caregiver intervi ews for diagnosing major causes of severe neonatal illness and death. A con venience sample of 149 infants aged < 28 days with one or more suspected di agnoses of interest (low birthweight/severe malnutrition, preterm birth, bi rth asphyxia, birth trauma, neonatal tetanus, pneumonia, meningitis, septic aemia, diarrhoea, congenital malformation or injury) was taken from patient s admitted to two hospitals in Dhaka, Bangladesh. Study paediatricians perf ormed a standardised history and physical examination and ordered laborator y and radiographic tests according to study criteria. With a median interva l of 64.5 days after death or hospital discharge, caregivers of 118 (79%) i nfants were interviewed about their child's illness. Using reference diagno ses based on predefined clinical and laboratory criteria, the sensitivity a nd specificity of particular combinations of signs (algorithms) reported by the caregivers were ascertained. Sufficient numbers of children with five reference standard diagnoses were studied to validate caregiver reports. Al gorithms with sensitivity and specificity > 80% were identified for neonata l tetanus, low birthweight/severe malnutrition and preterm delivery. Algori thms with specificities > 80% for birth asphyxia and pneumonia had sensitiv ities <70%, or alternatively had high sensitivity with lower specificity. I n settings with limited access to medical care, retrospective caregiver int erviews provide a valid means of diagnosing several of the most common caus es of severe neonatal illness and death.