Background. Several factors, including gestational age (GA), gender, race and geographical/regional area, contribute to variations in the size of the anterior fontanelle (AF). While the impact of GA and gender are clearly established, the influences of region and ethnicity vary in the published literature. Objectives. To assess AF sizes in normal newborn Igbo babies in south-eastern Nigeria, establish baseline values for our population, and evaluate the relationship of our findings to some factors reported to affect AF size. Methods. AF size was measured in 269 healthy term newborn babies using the method proposed by Popich and Smith and modified by Faix. Measurements were taken 24 -48 hours after birth. Results. The mean AF size was 2.97 cm (± standard deviation (SD) 0.71, range 2.0 -4.8). Female babies had slightly larger anterior fontanelles than males (2.98±0.75 cm v. 2.97±0.67 cm, respectively), although this was not statistically significant (p>0.05). Size of the AF had no significant correlation with head circumference (Pearson correlation coefficient r=-0.01; p=0.89), birth weight (r=-0.05; p=0.39) or length (r=-0.00; p=0.99) of these term babies. Neither GA nor mode of delivery influenced AF size (p>0.05). The mean anteroposterior dimension of the AF (3.22±0.82 cm) was significantly longer than the mean transverse dimension (2.71±0.65 cm) (p<0.01). Conclusions. At term, AF size has no relationship to GA or such growth parameters as head circumference, birth weight and length. The mean AF size of 2.97±0.71 cm obtained in this study is recommended for use in assessing term Igbo newborns.
There is a trend toward earlier presentation and increased survival of babies with NIO in our setting. Improving the existing facilities and trained manpower, and establishing collaboration with centers that have excellent results may further encourage the trend.
BackgroundThe World Health Organisation has recommended the use of anthropometric measurements as birth weight surrogates. However, it has been found that cut-off points for these anthropometric measurements vary across nations and ethnic groups.ObjectivesTo determine the predictive values of chest circumference (CC), occipito-frontal circumference (OFC) and their combinations for low birth weight (LBW) detection in Igbo newborns.MethodsLive newborns of Igbo origin were recruited within 24 hours of delivery. Their CC, OFC and weight were measured. Cut off points for predicting low birth weight was determined using ROC analysis.ResultsA total of 511 live newborns were recruited. For birth weight <2500 g, cut-off values were: CC 30.9 cm; OFC 33.8 cm; summation of CC and OFC 64.9 cm; ratio of CC to OFC 0.92. For weight <2000 g, the cut-off values were: CC 29.6 cm; OFC 32.8 cm; summation of CC and OFC 63.7 cm; ratio of CC to OFC 0.91. CC correlated best with birth weight (r = 0.918).ConclusionCC is the best predictor for LBW.
43We aimed to compare plotting accuracy and interpretation of weight gain patterns in average 44 and small infants on Road-to-Health (RTH) and the new WHO growth charts in Enugu, 45Nigeria. Child health staff plotted standard weights on both formats. Twelve plotted charts 46 were created, permutating 3 different weight trajectories (fast, steady, slow) ending at two 47 attained weights (average, small), with each plotted on both chart formats. Respondents 48 were shown four of these charts and asked to describe the weight gain pattern shown and 49 what action this pattern would prompt. There were 222 respondents, of whom 78% were 50 hospital-based; 54% were nurses, 32% medical doctors, and 13% nutritionists. Plotting 51 accuracy was good on both the WHO and RTH charts, but rating of weight gain was 52 generally poor. On the RTH chart, slow weight gain was correctly recognised in only 19% 53 average and 35% small infants and responses were not significantly associated with the 54 pattern shown. On the WHO charts, slow weight gain was correctly recognised in 40% 55 average and 65% small infants (p=0.002 and <0.001), but they were also more likely to rate 56 small children with normal growth as slow weight gain. In a logistic regression model, final 57 weight predicted a slow weight gain rating more strongly (OR=2.4; 1.8 to 3.2) than an actual 58 slow weight gain pattern (OR 1.8; 1.1 to 1.6). Health staff seemed unable to recognize slow 59 weight gain and were influenced more by current weight than actual weight gain pattern, 60 though the new WHO format improved recognition. 61 62
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