Head Circumference as An Indicator of Nutritional Status in Critically Ill Children under 2 Years of Age

Abstract

Many clinical, biochemical, and anthropometric factors have been used to determine the nutritional status of critically ill children. One of the most commonly used anthropometric measurements in children is the head circumference. It is used to assess their development, and in some instances, can be an indicator of chronic malnutrition. We aim to study the association between head circumference and the nutritional status of critically ill children under 2 years old. We retrospectively obtained the head circumference measurements of 142 patients between 30 days and 2 years of age in the pediatric intensive care unit (PICU), and calculated their head circumference percentile-for-age based on CDC growth charts. We compared the head circumference percentiles to their nutritional status as determined by the Subjective Global Nutritional Assessment (SGNA) tool using the Mann-Whitney test. The median head circumference percentile was 9.5 (IQR 1.1-33.5) in patients with malnutrition and 54 (IQR 29.7-81.7) in patients with normal nutritional status (P < 0.001). There was no significant association between nutritional status and other possible confounders such as prematurity, age at admission, sex, and race by multivariate analysis. We found that critically ill patients with chronic malnutrition had significantly smaller head circumference than those with a normal nutritional status. However, it would be necessary to conduct a larger study in order to confidently determine a cutoff point for head circumference percentile that can be used to detect malnutrition in the PICU.