Determination of Fetal Malnutrition in Preterm Newborns

Abstract

Background: Fetal malnutrition has been associated with an increased risk of neonatal morbidities and mortalities and its proper documentation in a newborn is essential for optimal management of the child.Objective: To determine the nutritional status of preterm newborns at birth using CANSCORE and anthropometry and to compare the relative efficiency of CANSCORE and the anthropometric indices in detecting FM.Methods:The study was carried out on consecutive, singleton, live born babies of ≥28 completed weeks through 36 weeks gestation born at Lagos University Teaching Hospital, Lagos, Nigeria without any major congenital abnormalities or severe perinatal illness. Each infant was examined by the investigator within 48 hours of birth. Birth weights and lengths were recorded for each infant at birth. Using the Oloweintrauterine growth chart, birth weights for gestational age below the 3rd percentile and above the 97th percentile on the chart were taken as small for gestational age and large for gestational age respectively. PI was computed from the formula: PI = weight (g) / length3 (cm) X100. A PI <2.2 was considered as malnutrition.The MAC/HC ratio was calculated for each infant and value plotted on and compared with a standard curve. Clinical assessment of nutritional status score (CANSCORE) consisted of inspection and estimation of loss of subcutaneous tissues and muscles in the designated areas. A maximum score of 4 was awarded to each parameter with no evidence of malnutrition, and the lowest score of 1 was awarded to parameter with the worst evidence of malnutrition. Fetal malnutrition was defined as CANSCORE less than 25. Statistical analysis was done using the Epi info statistics software version 3.5.1.Results:One hundred and forty preterm newborns were assessed.One hundred and eight (77%) of them were of LBW. CANSCORE identified 34.3% of the babies as FM while PI, MAC/HC and birth weight identified 30.7%, 12.1 and 3.6% of the babies, respectively, as FM. The mean CANSCORE and anthropometry between males and females were not significantly different (p >0.05). Both CANSCORE and PI detected significantly large numbers of FM in the study sample compared with birth weight. All the anthropometric parameters showed low sensitivity in detection of FM (which is the visible wasting or loss of subcutaneous tissues and muscles) but they all had high specificity.Conclusion:FM is still prevalent in our environment even in preterm babies. CANSCORE identified moremalnourished subjects than anthropometry.