The Nomogram of Clitoral Length and Width in Iranian Term and Preterm Neonates.

Mohammadreza Alaei,Roya Isa Tafreshi,Hamid Salehiniya,Nahid Hematian Boroujeni,Farzaneh Rohani,Elahe Norouzi,Fahimeh Soheilipour

doi:10.3389/fendo.2020.00297

Abstract

Background and Objectives: Clitoromegaly is an important parameter in the evaluation of ambiguous genitalia in neonates, but the normative data for clitoral size in newborns have racial/ethnic differences. The present study aimed to determine clitoral length (CL) and clitoral width (CW) values and establish cutoff measurement to define clitoromegaly in both term and preterm Iranian neonates for the first time.Methods: A total number of 580 female newborn infants delivered at 28–42 weeks of gestation were enrolled in the study, and their CL and CW were measured on the first 72 h of birth. Data about birth weight (BW), body length (BL), and head circumference (HC) of newborns; mothers' age; and gestational age (GA) were recorded, too. Results were presented as mean ± standard deviation (SD) for quantitative variables and were summarized by frequency (percentage) for categorical variables. Backward stepwise regression analysis was used for prediction of CL and CW.Results: Among 580 Iranian female newborns studied, 187 were term neonates and the other 393 newborns were preterm. Mean ± SD values of CL were 6.11 ± 0.39 mm in term infants and 5.45 ± 0.64 mm in preterm infants (P < 0.001). Mean ± SD values of CW were 4.22 ± 0.43 in term infants and 3.68 ± 0.53 in preterm infants (P < 0.001). Regression analysis showed that CL was correlated with GA considered by last menstrual period, BL, BW, and HC; and CW was associated with GA, BL, and BW.Conclusion: This study suggests normative values (mean + 1, 2, and 3 SD) of CL and CW according to GA, which can be used as a reference for Middle East's newborns, especially Iranian newborn babies.

Highlights

Assessment of external genitalia by performing a careful physical examination in both female and male infant newborns is crucial to diagnose ambiguous genitalia
Clinical findings in an apparent female newborn infant that raise the possibility of disorder of sex development (DSD) include clitoral hypertrophy of any degree or clitoromegaly which defied clitoral length (CL) or clitoral width (CW) above mean + 2 standard deviation (SD), foreshortened vulva with single opening, and inguinal hernia containing a gonad
Data collected included infants’ CL and CW, birth body weight (BW), body length (BL), head circumference (HC), gestational age (GA) considered by last menstrual period, type of delivery, mother’s age (MA), singleton/twin/multiple pregnancies, and drug and medical history of mother during pregnancy

Summary

Introduction

Assessment of external genitalia by performing a careful physical examination in both female and male infant newborns is crucial to diagnose ambiguous genitalia. Clinical findings in an apparent female newborn infant that raise the possibility of disorder of sex development (DSD) include clitoral hypertrophy of any degree or clitoromegaly which defied clitoral length (CL) or clitoral width (CW) above mean + 2 SD, foreshortened vulva with single opening, and inguinal hernia containing a gonad. All of these findings in apparent female infant must raise suspicion to ambiguous genitalia. Accurate evaluation of external genitalia of female infant newborns, clitoral size, is necessary [4, 5]. The present study aimed to determine clitoral length (CL) and clitoral width (CW) values and establish cutoff measurement to define clitoromegaly in both term and preterm Iranian neonates for the first time

Methods

Results

Conclusion