Clinical Assessment Of Nutritional Status Score Research Articles

Associations between placental pathology and poor intrauterine growth among a cohort of mother-infant singleton pairs in Leyte, the Philippines.

Poor intrauterine growth has negative impacts for child growth and development and disproportionately affects children living in low-resource settings. In the present study, we investigated relationships between placental pathologies and indicators of poor intrauterine growth. We enrolled a longitudinal cohort of 279 mother-infant pairs from Leyte, the Philippines. Placental measures included characteristics, pathological findings, and immunohistochemistry. At birth, intrauterine growth was assessed using anthropometric measures, weight-for-gestational age, and the clinical assessment of nutritional status score (CANSCORE) for determining fetal malnutrition. Multivariate linear regression and log-binomial regression models were applied, controlling for potential confounding factors. Maternal vascular malperfusion (MVM) was related to reduced birthweight (P < 0.0001), birth length (P = 0.002), head circumference (P = 0.001), and weight-to-length ratio (P = 0.016). MVM increased the risk for preterm delivery (P = 0.0005) and small for gestational age (SGA) (P = 0.016). Acute chorioamnionitis (P = 0.013) and MVM (P = 0.021) both led to an increased risk for fetal malnutrition defined by CANSORE<25. Villous tissue activated caspase-3 was associated with lower birth length (P = 0.0006), higher weight-to-length ratio (P = 0.004), reduced risks for SGA (P = 0.011) and low weight-to-length ratio for gestational age (P = 0.004). The present study applied comprehensive measures for intrauterine growth and demonstrates that low placental weight and placental pathology, chiefly MVM, contribute to poor intrauterine growth. A better understanding of the mechanistic role of specific placental pathologies on adverse newborn outcomes will provide opportunities for reducing incidence of poor intrauterine growth and associated long-term morbidities.

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

Background: Early and accurate assessment of the nutritional status of newborns is important to many clinicians because of the potential immediate and late sequelae of malnutrition. Objective: To assess the relationship between different methods of assessing the nutritional status of neonates. Methods: Subjects were consecutive, live, singleton, full term neonates delivered in the hospital. The birth weights, Ponderal index, Mid arm circumference/head circumference ratio, birth weight for gestational age using intrauterine growth charts and Clinical Assessment of Fetal Nutritional Status Score (CANSCORE) were used to determine the nutritional status in the first 24 hours of life. Results: Of 386 subjects, 172 (44.6%) were males and 214 (55.4%) females. Nutritional status assessment using various indices showed the following prevalence of malnutrition: using birth weights, 54 (14.0%) were LBW; MAC/HC ratio showed 56 (14.5%), with PI, 64(16.6%), weight for gestational age,112(29.0%) were SGA and CANSCORE showed 90(23.3%) as malnourished among the babies.MAC/HC showed a better specificity and had a more positive correlation than PI when compared to CANSCORE whilst PI showed a better sensitivity than MAC/HC when evaluated against CANSCORE. Conclusions: Prevalence of FM is high in this study. Intrauterine growth charts and CANSCORE appeared to identify more babies with FM than other methods. CANSCORE in this study has revealed the rising trend in the prevalence of FM when compared with other studies with similar methodology. Early routine assessment of the nutritional status of newborns should be carried out so as to reduce the risk of increased morbidity and mortality associated with fetal malnutrition.

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

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

Assessment of foetal nutrition status at birth using the CANS score

Abstract Introduction Foetal malnutrition (FM) is the result of a loss or failure of intrauterine acquisition of the correct amount of fat and muscle mass, with short and long term implications. As the diagnosis of FM is essentially clinical, the aim of this study was to detect the incidence of FM using the Clinical Assessment of Nutritional Status (CANS) score, and compare the results with the classic anthropometric parameters. Patients and methods Retrospective population of term infants was studied between 2003 and 2014 (n = 14,477). They were classified into adequate weight (AGA), small weight (SGA) and large weight (LGA) for gestational age newborns. The CANS score was performed on all infants enrolled in the study, and the ponderal index (PI) was calculated, considering an FM cut off value of a CANS score Results Using the CANS score, 7.6% (n = 1101) of the population showed FM, 50.3% (n = 538) of SGA, 76.2% (n = 193) subgroup 24 in 49% with PI Conclusions It is worthwhile identifying all newborns with FM due to the risks they may have in the short and long term. CANS score assessment allows a better identification of nutritional status of infants than only using the curves of weight for gestational age.

Valoración clínica del estado nutricional fetal al nacer mediante el Clinical Assessment of Nutritional Status score

IntroductionFoetal malnutrition (FM) is the result of a loss or failure of intrauterine acquisition of the correct amount of fat and muscle mass, with short and long term implications. As the diagnosis of FM is essentially clinical, the aim of this study is to detect the incidence of FM using the Clinical Assessment of Nutritional Status (CANS) score, and compare the results with the classic anthropometric parameters. Patients and methodsRetrospective population of term infants was studied between 2003 and 2014 (n=14,477). They were classified into adequate weight (AGA), small weight (SGA) and large weight (LGA) for gestational age newborns. The CANS score was performed on all infants enrolled in the study, and the ponderal index (PI) was calculated, considering an FM cut off value of a CANS score <25 and PI <2.2g/cm3. ResultsUsing the CANS score, 7.6% (n 1,101) of the population showed FM, 50.3% (n=538) of SGA, 76.2% (n=193) subgroup <p3, and 4.67% (n=559) of AGA. The CANS score was <25 in 7.26% (n=1,043) of newborns with PI ≥2.2g/cm3 (n=14.356), and the CANS score was >24 in 49% with PI <2.2g/cm3 (n=109) ConclusionsIt is worthwhile identifying all newborns with FM due to the risks they may have in the short and long term.CANS score assessment allows a better identification of nutritional status of infants than only using the curves of weight for gestational age.

Determination of Fetal Malnutrition in Preterm Newborns

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.

Fetal malnutrition in infants of smokers and passive smokers assessed by clinical assessment of nutritional status scoring

Aim: Studies have shown that maternal smoking during pregnancy is associated with low birth weight, height and head circumference in newborns. In the present study, along with these anthropometric measures we aimed to determine fetal malnutrition (FM), which is a less known outcome of antenatal tobacco exposure. Materials and methods: Two hundred and sixty-six term singletons without anomalies were evaluated for their birth weight, height, and head circumference and for FM using the Clinical Assessment of Nutritional Status (CANS) scoring. A CANS score equal to or less than 24 is accepted as FM. Results: Smokers' (n = 84) and passive smokers' (n =110) babies showed a birthweight deficit of -220.6 g (95% CI:-403.2 to -37.9) and -160.22 g (95% CI:-364.3 to -43.9), a birth height deficit of -0.42 cm (95% CI:-1.38 to -0.55) and -0.94 cm (95% CI:-2.03 to -0.16) and a head circumference deficit of -1.38 cm (95% CI:-1.91 to -0.86) and -0.89 cm (95% CI:-1.46 to -0.32) respectively, compared to nonsmokers' babies (n = 72). Smokers and passive smokers' babies also revealed decreases in CANS scorings, which were 22.7 (3.9) (P < 0.001) and 24.3 (4.3) respectively, compared to nonsmokers' babies who showed a CANS score of 27.6 (4.4). Babies whose mothers smoked more than 10 cigarettes/day had a much lower CANS score, which was 21 (3.97) (P = 0.013). Conclusion: Our findings suggest that screening for fetal malnutrition is indicated in smoking women's and passive smokers' babies.

Prevalence and problems of foetal malnutrition in term babies at Wesley Guild Hospital, South Western Nigeria

Up to two-thirds of low birth weight babies delivered in the developing countries are also small for gestational age (SGA). Since SGA is common in West Africa, FM is expected to be common in the region. To determine the pattern, prevalence, and problems of FM among term babies delivered at a General Hospital. Subjects were consecutive, live, singleton; full term neonates delivered at the hospital over eight months and were assessed within 24 hours of birth. Each baby was examined for evidence of FM using the Clinical Assessment of Nutritional Status Score (CANSCORE) described by Metcoff. The babies were classified into those with and without FM and the two groups compared. Four hundred and seventy three term singleton live born neonates consisting of 246 males and 227 (48%) females were assessed. Eighty-nine (52%). 18.8% of the 473 babies had FM. FM was commoner in SGA babies than AGAbabies (p < 0.001). A total of 47 (82.5%) of the 57 babies who were SGA had FM while 42 (10.6%) of 396 babies who were AGA had FM (p < 0.001) and none of the 20 LGA babies suffered from FM. Severe birth asphyxia, respiratory distress, meconium aspiration, hypoglycaemia, high haematocrit and hypoalbuminaemia were significantly commoner in babies with FM. Infants with FM had significantly higher mortality and neurological sequelae in the first month of life. FM is a major health problem in Nigeria with considerable morbidity and mortality. Using CANSCORE, the clinician can diagnose cases of FM which may be missed by using intrauterine growth chart.

Comparison between CANSCORE and other anthropometric indicators in fetal malnutrition

Early detection of malnutrition in newborn babies is of major importance in order to prevent associated serious sequelae. Main objective of the study was to compare various anthropometric methods with Clinical assessment of nutritional status score (CANSCORE) in assessing fetal malnutrition. Subjects were consecutive, live, singleton, full term neonates delivered in the hospital. The mean weight, chest circumference, mid arm circumference, and Ponderal index of babies and CANSCORE described by Metcoff were assessed and compared. A total of 442 term singleton live born neonates were assessed. They consisted of 228 [51.6%] males and 214 [48.4%] females. Eighty-three [18.8%] of the 442 babies had fetal FM. The mean weight, mid arm circumference, and Ponderal index of babies with FM were significantly lower than those of babies without FM (p < 0.0001). Though the mean head circumference and the length of the babies with FM were also lower, the differences were not statistically significant (p = 0.50 and 0.79 respectively). However, using intrauterine growth standard alone, 41 (49.4%) of the 83 babies with fetal malnutrition would have been missed while Ponderal Index would also have missed 51 (61.4%) of the babies with FM. CANSCORE is likely to be very useful in the routine screening of babies for anticipatory care.

Catch-up growth in fetal malnourished term infants.

The aim of this study is to show that the Clinical Assessment of Nutritional Status (CANS) score is an effective method to diagnose fetal malnutrition (FM) in term newborns and to monitor the catch-up growth of fetal malnourished newborns. A group of infants have been screened at birth for fetal malnutrition status using the CANS score (malnutrition was defined by a CANS sore cut-off value). The study group (consisting of fetal malnourished and non-malnourished infants) has been monitored after birth by two follow-up exams at 3rd and 6th months. The study showed that the FM group, which is similar to non-FM group in terms of gender and gestational age but different in nutritional status (CANS, weight, length, head circumference) at birth, showed partial catch-up growth, more so in head circumference than in others (weight, length). The study used CANS score to determine malnutrition in term infants and showed that malnourished infants (as defined by this CANS score cut-off value) caught-up partly with respect to the non-malnourished group. Furthermore, our experience showed that CANS score is an easy and effective way to identify fetal malnourished infants, and the scores can be obtained readily by following the established clinical assessment steps.

Suitability of CANSCORE for the assessment of the nutritional status of newborns.

The suitability of Clinical Assessment of Nutritional Status Score (CANSCORE) for the assessment of foetal malnutrition among 372 local Hyderabad newborns was studied. Details of length, weight and body mass index (BMI) at birth were related to total CANSCORE which consisted of scores ranging from 1 to 4 based on the grades of clinical status of hair, cheeks, buttocks, chest, legs, back, neck, arms and skin of anterior abdominal wall. The correlation coefficients of CANSCORE with the length, weight and BMI of newborns indicated that score of hair was least correlated with nutritional status. Normal newborns were found to have the lowest prevalence of foetal malnutrition. In those with retarded measurements of length and weight or BMI, the prevalence of foetal malnutrition was higher. The newborns with retardation of both length and BMI had higher prevalence of foetal malnutrition. The feasibility of the suggested limits of CANSCORE for the foetal malnutrition was assessed. Values of 24 for total CANSCORE and of 22 for "Modified CANSCORE" (score excluding hair as a parameter) were found appropriate for the assessment of foetal malnutrition. Modified CANSCORE is a simple, rapid and quantifiable method for the assessment of foetal malnutrition in term newborns.