Formula and scale for body surface area estimation in high-risk infants

Advances in medical technology and the health sciences have lead to a rapid increase in the prevalence and morbidity of high-risk infants with chronic or permanent sequels such as the birth of early preterm infants. A suitable formula is therefore needed for body surface area (BSA) estimation for high-risk infants to more accurately devise therapeutic regimes in clinical practice. A cohort study involving 5014 high-risk infants was conducted to develop a suitable formula for estimating BSA using four of the existing formulas in the literature. BSA of high-risk infants was calculated using the four BSA equations (Boyd-BSA, Dubois-BSA, Meban-BSA, Mosteller-BSA), from which a new calculation, Mean-BSA, was arithmetically derived as a reference BSA measure. Multiple-regression was performed using nonlinear least squares curve fitting corresponding to the trend line and the new equation, Neo-BSA, developed using Excel and SPSS 17.0. The Neo-BSA equation was constructed as follows: Neo-BSA = 5.520 x W(0.5526) x L(0.300). With the assumption of the least square root relation between weight and length, a BSA scale using only weight was fabricated specifically for clinical applications where weight is more available in high-risk infant populations than is length. The validity of Neo-BSA was evaluated against Meban-BSA, the best of the four equations for high-risk infants, as there is a similarity of subjects in the two studies. The other formulas revealed substantial variances in BSA compared to Neo-BSA. This study developed a new surface area equation, Neo-BSA, as the most suitable formula for BSA measurement of high-risk infants in modern-day societies, where an emerging population of newborns with shorten gestational ages are becoming more prevalent as a result of new advances in the health sciences and new development of reproductive technologies. In particular, a scale for 400-7000 g body weight babies derived from the Neo-BSA equation has the clinical advantage of using only weight as a measurement, since length is often not feasible as a measurement due to the newborn's body posture. Further studies are required to confirm our findings for the application of Neo-BSA and the BSA scale (based on weight) for various populations and ethnicities under different clinical conditions.