Elsevier

The Journal of Pediatrics

Volume 154, Issue 4, April 2009, Pages 521-526.e1
The Journal of Pediatrics

Original article
Infant Stool Form Scale: Development and Results

https://doi.org/10.1016/j.jpeds.2008.10.010Get rights and content

Objective

To develop an infant stool scale describing consistency, amount, and color and test its usefulness by assessing the differences between term and preterm infants, between breastfed and formula fed infants and examining interobserver and intraobserver variability.

Study design

Information about gestational age, postnatal age, and feeding type was collected in relation to each photograph taken. An infant stool form scale describing consistency (4-point scale), amount (4-point scale), and color (6 categories) was developed. All photographs were scored twice with the newly developed scale to assess interobserver and intraobserver variability. Consensus database describing stool characteristics was developed.

Results

A total of 555 photographs of infant stools were analyzed; 60 (11%) of the infants studied were term, and 495 (89%) were born prematurely. No differences were found between preterm and term infants. Breastfed infants had smaller amounts of stools compared with formula-fed infants (P < .001). The interobserver weighed κ value (95% CI) was good for consistency and amount; the simple κ value was good for color. For observers I and II intraobserver κ values were excellent.

Conclusion

This “Amsterdam” stool form scale is useful to assess defecation patterns in both premature and term born infants.

Section snippets

Scale Development

Daily digital photographs were taken from all stools of preterm and term infants during their hospital stay in an academic and nonacademic hospital in Amsterdam, the Netherlands, between August and October 2006. Stools of otherwise healthy infants without metabolic, congenital diseases or gastrointestinal disorders requiring surgery were photographed. Photographs were taken at daytime by 2 researchers with a digital camera (zoom lens, original magnification × 4 and × 7.2 megapixels) while

Baseline Characteristics

A total of 907 digital photographs of infant stools were taken of which 555 could be analyzed. The other photographs (n = 442) were duplicates or of poor quality and were therefore not useful for further analysis. Images of 555 stools of infants with a median GA of 31 weeks (range: 25-42) and with a median age of 15 days after birth (range: 1-120) were analyzed (Figure 3 and Figure 4; available at www.jpeds.com). Sixty of the participating infants (11%) were term born. Of the premature born

Discussion

On the basis of the analysis of more than 500 digital infant stool photographs, we were able to develop the stool form scale for premature and term-born infants aged up to 120 days after birth. Validity of this scale was supported by the good to excellent interobserver and intraobserver agreement scores. With this stool scale, no difference was found in stool characteristics between preterm and term-born infants. Significant differences in stool amount were found between BF and FF infants, but

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    We also asked if their under-five has had blood in their stool in the past 14 days and, if so, if and where they sought care [15]. Participants in the pictorial arm were shown the Amsterdam Stool Chart (Appendix 3) and asked to select all the pictures resembling the stools observed from their under-five over the past 14 days [22]. If loose or watery stools were reported, we asked how many times the child had this stool type on the worst day and how many days this stool type lasted.

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The authors declare no potential conflicts of interest, and there were no study sponsors involved in this project.

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