Study of the prevalence of and high risk factors for fetal malnutrition in term newborns

Abstract

This observational study was done to discover the prevalence of fetal malnutrition (FM) in term newborns using clinical assessment of nutritional status (CANS score) and to identify associated risk factors. All term babies born in a referral teaching hospital during the 1-year study period were included in the sample. Gestational age and weight-for-gestational-age were assessed, and babies were classified as appropriate-for-gestational-age (AGA), small-for-gestational-age (SGA) or large-for-gestational-age (LGA). Maternal risk factors were recorded in each case. Fetal malnutrition was present in 19.6% of babies, of whom 40.7% had intrauterine growth retardation. Of the babies with FM, 59.9% were AGA and 1.9% were SGA even though they had no signs of FM. FM was evident in 84.2% of SGA babies, and 12.9% of AGA babies showed FM. The weights of babies with FM were significantly lower than of those without FM. Maternal risk factors for FM included adverse age, primiparity, low pre-pregnancy weight and height, a bad obstetric history and pregnancy-induced hypertension. Malnutrition in the newborn might be missed if intrauterine growth curves only are used for assessment. The CANS score is a simple and rapid clinical scoring system for diagnosing fetal malnutrition. Not all SGA babies are malnourished and those without FM have a better outcome and faster catch-up growth.

Relationship between Ponderal Index, Mid-Arm Circumference/ Head Circumference Ratio and Clinical Assessment of Nutritional Status Score (CANSCORE) in the Determination of Nutritional Status of Newborn at Birth in Nigeria

“…These three figures of 23.3%, 24.0%, and 28.0% are from developing countries where intrauterine growth restriction may contribute to the high burden of LBW in these countries. Like the present study, all these previous studies [4,17,18] used the CANSCORE method to assess the nutritional status of neonates delivered at term. In 1999, Jayant and Rajkumar [3] reported a prevalence of 19.6% in India but a decade later a prevalence of 28.0% was reported in the same country [17].…”

“…The CANSCORE ranges between 9 (lowest) and 36 (highest). Babies with CANSCORE of 25 and above were regarded as normal or having no FM [4]. Babies with CANSCORE below 25 were diagnosed as having FM.…”

“…This anticipatory management of such infants at birth may decrease morbidity and improve the survival of such infants. Perinatal problems and/or long term central nervous system sequelae are known to occur primarily in babies with fetal malnutrition (FM) whether appropriate for gestational age (AGA) or small for gestational age (SGA) but less so among those who are SGA but without fetal malnutrition [3,4]. There is thus a need for prompt identification of babies with features of malnutrition.…”

“…Others are mid-arm circumference to head circumference ratio (MAC/HC), the Rohrer's ponderal index (PI) [6], and may be recently the clinical assessment of nutritional status (CANS) and the score (CANSCORE) [1,3]. CANSCORE is occurring more frequently in literatures and reviews of recent studies as relatively more acceptable method of determining fetal wasting because it is a purely clinical assessment like Ballard or Dubowitz assessment of gestational age scores [1,3,4]. It identifies babies with wasting whether small, appropriate or large for gestational age (SGA, AGA or LGA).…”

Assessment of Fetal Malnutrition and its proportion among AGA and SGA using CAN Score

“…is much simpler to learn and easy to do, particularly with the aid of simple illustrations of the signs and scores on the paper as described by Metcoff 3 . Several studies 3,9,10 Including the present study indicate that CAN score is a simple and best clinical method for assessment of fetal malnutrition in newborn.…”