The Capurro test it is a test used by neonatologists. It is used to calculate the gestational age of the newborn when there is doubt about the date of the last menstrual period. This test allows the newborn to be classified into three categories: preterm, full-term or post-term baby.
A preterm newborn is one born before the normal gestational time of 42 weeks. Specifically, it refers to children born less than 37 weeks. These newborns are also called premature babies..
They can be classified as mild premature (between 35 to 36 weeks), moderate (between 32 to 34 weeks) and extreme (< de 32 semanas). Los niños prematuros pueden tener dificultad respiratoria, entre otras deficiencias, debido a que muchos de sus órganos aún no están maduros. Ejemplo los pulmones.
While, a full-term baby is one that is born between 37 to 42 weeks of gestation, that is, it is a neonate that has been born at the time established as normal. In this period of time, the baby has completed its development and is ready to face the new environment..
Finally, a baby born post-term means that the gestation time has exceeded 42 weeks. In many countries it is popularly said: "The delivery is over".
The Capurro method takes into consideration the analysis of 4 physical and 2 neurological parameters (Capurro A) or only 5 physical parameters (Capurro B).
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The Capurro test is based on the calculation of gestational age through the analysis of certain parameters.
The parameters to be evaluated, according to the original method by Dubowitz et al, consisted of a number of physical and neuromuscular characteristics..
Later Ballard summarized them in 6 somatic and 6 neurological characteristics and, finally, Capurro summarized them in 4 physical and 2 neurological parameters (Capurro A) or only 5 physical parameters (Capurro B).
In any case, later other methods have emerged, such as the New Ballard Score test, who refined the parameters, managing to determine the gestational age in extremely premature infants..
According to Capurro, in those neonates who are not in conditions to be evaluated from the neurological point of view, this step is simply ignored and a physical parameter is attached to the 4 existing ones.
The parameters that are evaluated (Capurro A or B) provide the necessary information to estimate gestational age and allow the newborn to be classified as premature, full-term or post-term..
There are 2 types of Capurro test. The Capurro A test and the Capurro B test.
It is applied to newborn children who do not have any impediment to be examined and who do not show any neuromuscular damage due to trauma, anesthesia or infection.
It is applied in newborn children who have a condition that makes it impossible to be examined. For example, newborns who are critically ill and have a central line taken or have had to be intubated, or have neuromuscular problems.
For the test to be applicable, the newborn must weigh more than 1,500 grams.
Shape of the pinna, diameter of the mammary gland, skin texture and characteristics of the plantar folds.
The sign of the scarf and the fall of the head.
Neurological signs are ignored and only the aforementioned physical parameters are evaluated and the formation of the nipple is attached to these..
In this case, the neonatologist stands in front of the newborn and observes the upper part of the newborn's pinna. Specifically, you will see if it protrudes forming a kind of roof.
Later, you will move the child's head from side to side to visualize the accentuation of the curvatures. During the evaluation the pavilion should not be touched, only seen.
Observed characteristics are scored as follows:
-Flattened flag without bend: 0 points.
-Partially curved edge on top: 8 points.
-Top edge fully curved: 16 points.
-The entire pinna of the ear curved: 24 points.
The neonatologist will touch the mammary glands of the newborn, specifying very well how far the breast tissue reaches. The physician will need to identify the boundary with the subcutaneous tissue of the skin. Then he will carefully measure the diameter of the breast tissue, using a tape measure..
It is dotted as follows:
-Not palpable: 0 points.
-Diameter < 5 mm: 5 puntos.
-Diameter between 5 - 10 mm: 10 points.
-Diameter> 10 mm: 15 points.
In this parameter, the diameter of the nipple will be measured with the tape measure.
-Barely visible without areola: 0 points.
-Nipple smaller than 7.5 mm with smooth and flat areola: 5 points.
-Nipple> 7.5 mm with pointed areola and non-raised edge: 10 points.
-Nipple> 7.5 mm with pointed areola and raised edge: 15 points.
The specialist will examine the baby's skin, looking for signs of flaking or cracking. It will especially explore the skin of the forearms, legs, back of the hands and feet.
It is valued as follows:
-Very fine and jelly-like skin: 0 points.
-Smooth and fine skin: 5 points.
-Slightly thicker skin with little scaling: 10 points.
-Thick skin with certain superficial cracks and significant peeling, both hands and feet: 15 points.
-Thick skin and very deep cracks. Parchment Cracks: 20 points.
The grooves and folds they present should be observed on the soles of the feet. These are easily recognizable. Both feet of the baby are taken and the skin of the sole is spread as far as possible. The furrows disappear when the skin is extended, while the folds are marked.
According to the furrows observed, it is valued as follows:
-No pleats: 0 points.
-Bad definition of marks in the previous half: 5 points.
-Very well defined markings with grooves, both on the anterior half of the sole of the foot: 10 points.
-Grooves in the anterior half of the sole of the foot: 15 points.
-Grooves in more than the anterior half of the sole of the foot: 20 points.
Measures axial and scapular muscle tone. The newborn's hand is carefully taken and passed over the thorax, reaching up to the neck in the form of a scarf. The position of the elbow should be observed comparing it with the midline.
Punctuation:
-The elbow is located on the opposite axillary line: 0 points.
-The elbow is located between the axillary line of the opposite side and the midline: 6 points.
-The elbow is located in the middle line: 12 points.
-The elbow is located on the axillary line on the same side: 18 points.
Measures the tone of the cervical muscles, also assesses the neurological maturity of the newborn.
Assessment:
-Head drop completely back: 0 points (angle> 270 °).
-Head drop at an angle between 180 ° - 270 °: 4 points.
-Head drop at 180 ° angle: 8 points.
-Head drop at an angle < a 180°: 12 puntos.
As has already been seen, there is an evaluation system where the possibilities of responses to each parameter are reflected and each one has a score. This evaluation system is the product of numerous investigations.
At the end, the accumulated points are added according to the observed characteristics and the corresponding formula is applied, as the case may be..
Estimated gestational age = (200 + cumulative score) / 7 days of the week
Estimated gestational age = (208 + cumulative score) / 7 days of the week
Estimated gestational age = (204 + cumulative score) / 7 days of the week
In all cases the result is obtained in weeks.
Another way to calculate gestational age by the Capurro method is using the following graph.
In it, the score obtained in the 5-parameter test (Capurro B) is located and extrapolated to obtain the weeks of gestation, without using any formula.
The Capurro method, in general, is useful for newborns 29 weeks and older. In fact, this method has low sensitivity when evaluating gestational age in premature infants..
Keep in mind that although this method is widely used, it is not infallible, as some parameters are very subjective. Therefore, the method has a margin of error of approximately ± 8 to 9 days. The error can increase if the evaluator does not have much experience.
In this sense, Ventura believes that the Capurro method has a tendency to overestimate the gestational age of the newborn. He came to this conclusion after comparing Capurro's method against running ultrasounds from 10 + 0 to 14 + 2 weeks.
On the other hand, Salamea and Torres compared the modified Ballard and Capurro method against the date of the last menstruation (LMP) and determined that both methods had good correlation, 72% and 64% respectively..
They also determined that there are better correlation results with female newborns and with babies weighing 3,500 grams and above..
All this leads to the reflection that the gold standard to assess gestational age is the last date of menstruation or early ultrasound control.
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