Fontanelle Size Research Articles

Ultrasonographic Measurement of Anterior Fontanelle Size in Infants with Deformational Plagiocephaly.

Background/Objectives: We aimed to investigate the relationship between deformational plagiocephaly (DP) severity and anterior fontanelle size and to explore the connection between fontanelle size and developmental delay. Methods: We enrolled 189 (122 boys and 67 girls; mean corrected age, 119.79 days) of the 256 infants who visited our clinic for plagiocephaly between March 2022 and June 2023. This study analyzed the correlation between cranial vault asymmetry (CVA) and anterior fontanelle size as measured using skull anteroposterior (AP) radiography and ultrasonography. The severity of DP was graded from minimal to severe based on the Argenta classification. Infants were grouped according to CVA severity as follows: Group 1 (CVA ≤ 5 mm), Group 2 (5 mm < CVA < 10 mm), and Group 3 (CVA ≥ 10 mm). Additionally, 40 infants underwent the Denver Developmental Screening Test II (DDST-II) for neurodevelopmental delays and were divided into groups based on the presence or absence of developmental delays for fontanelle size comparison. Results: Age showed a significant negative correlation with fontanelle size (correlation coefficient -0.234, p < 0.05), indicating that fontanelle size decreases as infants age. No significant differences in fontanelle size were observed among the three CVA groups (p = 0.074) or between the developmentally delayed and non-delayed groups (p = 0.09). This study found no correlation between CVA and fontanelle size or between fontanelle size and developmental delay. Conclusions: The findings show that, while anterior fontanelle size decreased with age, there was no significant correlation between the fontanelle size and the severity of deformational plagiocephaly or developmental delays.

Determination of Anterior Fontanelle Size among Apparently Healthy Term Newborns in North Central Nigeria.

Anterior fontanelles (AFs) of healthy newborn infants vary widely in size, this being a function of race, geographical location, gender, birth weight, mode of delivery and gestation. Abnormal variations in AF size portend a serious pathology of the cranium or intracranial structures. The established reference value for normal AF size is, therefore, an essential diagnostic tool. This study was conducted to determine the mean AF size and factors that are associated with its variability among apparently healthy term neonates in Lokoja, North Central Nigeria. AF size was measured in 200 healthy inborn term neonates between 24 and 48 h post-delivery using a modified version of Mattur's method. Other parameters measured were head circumference, birth weight and length. Relevant statistical methods were used for data analysis, and P < 0.05 at a confidence interval of 95% was considered statistically significant. Eighty-six (43%) of the babies were males, and the mean birth weight and gestation were 3.09 (0.37) kg and 38.8 (1.2) weeks, respectively. Majority (72%) were delivered spontaneously per vagina. The mean (± SD) AF size of the study neonates was 2.62 (0.72) cm (2.53 [0.61] cm in males and 2.69 [0.79] cm in females). Neither gender nor mode of delivery affected AF size significantly. There was no significant correlation between AF size and occipitofrontal circumference. AF size for term babies in our hospital differs from AF sizes reported from other parts of the world, further reiterating the utility of local/regional neonatal AF reference values.

A morphometric study of anterior fontanel in eastern Indian population and its clinical correlation

Introduction: The fontanels are soft membrane covered gaps and the meeting of more than two cranial bones placed side by side. There are six fontanels, of which anterior fontanel is most prominent. We tried to determine the anterior fontanel dimension of the neonates of different gestational age. This in turn will help in diagnosing newborns with serious medical conditions and ensuring their prompt care. Objectives: Estimation of neonatal anterior fontanel area, for use in neonatal screening. Methods: A cross sectional study was conducted in a tertiary care hospital with 530 consecutively live born new born of 28 -41 weeks gestation. After three days of life anterior fontanel area was measured. The values were summarized using descriptive statistics, including percentile values. Results: In index study, we deducted anterior fontanel dimensions of newborns of gestational age ranging from 28 to 41 weeks. The mean anterior fontanel size was 3.20 ± 1.71. Anterior fontanel variation with gestational age showed that anterior fontanel area increases with increase in gestational age. However, another study with greater number of participants and in a community setting may be helpful. Conclusion: Anterior fontanel area can be used as a tool for identifying newborns with grave ailments. Abnormal fontanel measurement can be either large or small anterior fontanel. These are associated with many important consequences. Detecting them early will help in seeking appropriate medical guidance.

Tuticaj telesne težine na razvoj sekundarnih centara osifikacije i termina zatvaranja velike fontanele kod odojčadi

Introduction: during the infant development, the organ growth is influenced by genetic factors, diet, hormones and many neuropeptides. The secondary ossification center in the hip joint begins to form around the 4th month of life. Primary dentition begins at the age of 5-6 months with the emergence of the central incisor in the maxilla. At birth, 6 fontanelles are present between the plate bones of the cranium. The largest is the anterior or large fontanelle. Objective of our research is to analyze the development of the secondary ossification center in the femoral head in relation to dentition and closure of the anterior fontanelle closure as well as influence of childrens' birth weight and current weight on these processes. Methodology: The study included 284 infants, male and female, aged 3 to 8 months. Clinical examination of the musculoskeletal system, anthropomentric measurements and ultrasonographic findings of the hip joint were performed at the Pediatric Clinic of the Clinical Hospital Center Pristina in Gracanica. Results: The development of secondary ossification centre correlated with child's age, dentition, anterior fontanelle closure, birth weight and delivery method, as well as actual body weight. Anterior fontanelle size was inversely related to age, body weight and secondary ossification. Conclusions: According to regression analysis, body weight is the only factor that has a direct and independent impact on the onset and progression of ossification process. Every additional kilogram of a child's body weight accelerates secondary ossification by 1.3-3.77 times.

Determining Anterior Fontanel Size and Associated Factors Among Term Neonates on the First Day of Life Born at Jimma University Medical Center (JUMC), Southwest Ethiopia: A Linear Regression Model.

BackgroundKnowledge of the normal variation in AF size may be helpful to cue early diagnosis of congenital hypothyroidism, hyperthyroidism, cardiac disease, meningitis, degree of dehydration or provide a clue to disorders of neural and skeletal development. However, the data is scarce. Therefore, this study was aimed to determine AF size and associated factors among term neonates on the first day of life born in Jimma University Medical Center (JUMC), Southwest Ethiopia.MethodologyAn institution-based cross-sectional study design was used to consecutively sample term and health newborns. Descriptive statistics, one-way ANOVA, independent samples t-test and correlation were implemented. Finally, multiple Linear regressions were used to see the association of the dependent and independent variables at 95% confidence interval. The significance level was declared at <0.05 p-value.ResultsThe mean AF size of the study population was 3.018 cm with standard deviation (±SD) of 0.909 cm (range 0.4–5.50cm). A multiple linear regression analysis revealed that neonatal birth weight (B=0.001, 95% CI: 0.000–0.001, p=0.000), crown heel length (B=0.048, 95% CI, 0.018–0.078, p=0.002), labor duration (B= −0.028, p=0.001, 95% CI: −0.45; −0.012), and gender of the neonates (B=−0.275, 95% CI: −.441; −.109, p=0.001) were statistically significantly associated with AF size. In a multiple linear regression analysis AF size was explained by independent variables by 54.3%.ConclusionsAF size of the study population was 3.018 cm with a standard deviation (±SD) of 0.909 cm. Birth weight, crown heel length, duration of labor, and gender of the neonate were significantly associated with AF size.

Anterior Fontanel Size Among Term Newborns: A Systematic Review and Meta-Analysis.

Background: Anterior fontanel is an integral element of an infant craniofacial system. There are six fontanels in the newborn skull, namely anterior, posterior, two mastoid, and two sphenoid fontanels. The anterior fontanel is the largest, prominent, and most important for clinical evaluation. Sex, race, genetics, gestational age, and region are the principal factors that influence anterior fontanel size. There exist inconclusive findings on the size of anterior fontanel in newborns. Therefore, this systematic review and meta-analysis aimed to determine the pooled mean size of anterior fontanel among term newborns and to identify the pooled mean difference of anterior fontanel size between males and females. Methods: PubMed/Medline, Google Scholar, Science Direct, JBI Library, embase, and Cochrane Library databases were systematically searched. All essential data were extracted using a standardized data extraction format. The heterogeneity across studies was assessed using the Cochrane Q test statistic, I2 test statistic, and p-values. A fixed-effect model and random effect model were used to estimate the pooled mean size of anterior fontanel and the pooled mean difference between male newborns and female newborns, respectively. To deal with heterogeneity, sub-group analysis, meta-regression analysis, and sensitivity analysis were considered. JBI quality appraisal checklist was used to evaluate the quality of studies. Results: In this meta-analysis, 8, 661 newborns were involved in twenty-six studies. Among studies, 13 conducted in Asia, 7 in Africa, 5 in America, and 1 in Europe. The pooled mean size of anterior fontanel was 2.58 cm (95% CI: 2.31, 2.85 cm). The pooled mean size of anterior fontanel for Asia, Africa, America, and Europe region was 2.49, 3.15, 2.35, and 2.01 cm, respectively. A statistically significant mean difference was detected between male and female newborns (D + L pooled MD = 0.15 cm, 95% CI: 0.02, 0.29 cm). Conclusion: The pooled estimate of this review does provide the mean value of the anterior fontanel size in the newborns. There was a statistically significant mean fontanel size difference between male and female newborns. Therefore, male newborns had a significantly larger mean size than female newborns.

The Size of Anterior Fontanelle and Its Determinants at Birth Among Neonates in Northern Ethiopia: A Cross-Sectional Study.

BackgroundFontanels are anatomical features of the infant human skull comprising any of the soft membranous gaps between the cranial bones that make up the calvaria of a neonate. Various factors are taught to be responsible for the differences in the size of the fontanel at birth. Accordingly, this study is performed to examine the size of the anterior fontanel, associated factors, and the clinical significance in Northern Ethiopia at birth.Methods and MaterialsA Cross-sectional study was conducted in a sample of 425 neonates. The data were analyzed using SPSS version 21. Descriptive and summary statistics were presented in the form of tables and figures. All the data were presented as mean ± S.D. The association between dependent variables and independent variables was explored by using Pearson’s chi-square test and logistic regressions. P-values <0.05 were considered to be statistically significant.ResultsThe mean anterior fontanel size for the study population was 3.07 cm with a 95% confidence interval (3.00, 3.14). For a unit increase of head circumference of a neonate, the odds of having abnormal fontanel increase by 52.6%. Term neonates were 74.4% less likely to have abnormal fontanel size than preterm. Vaginally delivered neonates were 64.2% less likely to have abnormal fontanel size than neonates born by caesarean section. Low birth weight neonates were at risk of abnormal fontanel size. The odds ratio of the normal weight of neonate at birth was 0.327473 [95%, CI, (0.153364, 0.6992422)].ConclusionGestational age, mode of delivery, head circumference, and birth weight are the most important determinant factors associated with anterior fontanel size.

Temporal mapping of the closure of the anterior fontanelle and contiguous sutures using computed tomography, in silico models of modern infants.

The aim of this study is to quantify and statistically model the age-related decline in the fibrous connective tissue interface of the anterior fontanelle in modern Australian infants, using three-dimensional, semi-automated computed-assisted design protocols. Non-linear regression with variance models, using power functions, combined with quantile regression of the 5th and 95th population percentiles, were utilised to assess absolute anterior fontanelle surface area (AFSA) as a function of age, using multi-slice cranial computed tomography scans obtained from 256 infants aged <30months (males: n=126, females: n=109) from Brisbane children's hospitals. Normalised AFSA (NFSA), standardised for variation in cephalic size, followed a progressive decline from birth, the greatest velocity change occurring between the 3-6 and 6-9 month cohorts. Growth of the neurocranium is the most significant within the first 8months postpartum, with a mean increase of 19.03mm in maximum cranial length and 10.04mm in breadth. Directionality of fontanelle closure, quantified using spline curves refutes fundamental assumptions that the anterior fontanelle is consistent with a quadrilateral, and contiguous sutures exhibit constant velocity of closure. The present study provides normative values for fontanelle size and diameters as well as new predictive non-linear models for age substantiation, screening of developmental abnormalities and indicators of suspected child maltreatment in modern infants aged birth to 30months.

Modeling of Neonatal Skull Development Using Computed Tomography Images

Neonatal skull anatomy and its evolution have received less attention with respect to the brain anatomy in neuroscience and neuroanatomy studies. Meanwhile, their influence on normal brain development and their impact on the results of functional brain studies have been demonstrated by several researches. Such disesteem is due to the weak appearance of the cranial bones, fontanels and sutures in images acquired by MRI which presents actually the only available aperture for observing the neonatal head volume in details. This paper presents an unprecedented retrospective CT-based study on modeling the neonatal skull and its development during the first weeks of life in a standard space defined by the available neonatal MRI model. We create two neonatal head atlases for the age ranges of 39-40 and 41-42 week's gestational age using symmetric group-wise normalization method. The created atlases allow direct observation of ossification patterns and precise three-dimensional measurement of anatomical features from neonatal skull during development. Development of the neonatal skull has been examined here using nineteen CT scans of neonates with two-week gestational age ranges of 39 to 40 and 41 to 42. Deformation-based morphometry method is applied with the use of Jacobian determinant maps to identify growth patterns and observe ossification during specified time interval. Precise three-dimensional measurements of anterior fontanel size, scalp eliminated head circumference and the area corresponding to the fontanel-sutures were performed by extracting fontanels and sutures.

The Effects of Helmet Therapy Relative to the Size of the Anterior Fontanelle in Nonsynostotic Plagiocephaly: A Retrospective Study.

Helmet therapy is an important nonsurgical approach for patients with nonsynostotic plagiocephaly, but its effectiveness may depend on certain anatomical features. We retrospectively examined the effects of helmet therapy according to the size of the anterior fontanelle. Two hundred patients with nonsynostotic plagiocephaly who underwent helmet therapy between 2016 and 2018 were included. Data regarding age at treatment onset and treatment duration were collected. Patients were divided into two groups depending on the age at treatment initiation: the 12–23 weeks group and the >23 weeks group. Patients were also divided based on the anterior fontanelle size to analyze the effects of helmet therapy according to the severity of plagiocephaly in each group as the change in the cranial vault asymmetry index (CVAI). Therapeutic effects were evaluated using the cranial vault asymmetry (CVA), CVAI, anterior symmetry ratio, posterior symmetry ratio (PSR), and overall symmetry ratio at baseline and treatment completion. Treatment initiation at age 12–23 weeks resulted in better effects than that after age 24 weeks. There were no sex-dependent differences in therapeutic effects. Greater changes in the CVA, CVAI, and PSR were associated with larger anterior fontanelles. Therefore, the anterior fontanelle size could be a prognostic factor for estimating helmet therapy outcomes.

Outcome of Choroid Plexus Cauterization with Endoscopic 3&amp;lt;sup&amp;gt;rd&amp;lt;/sup&amp;gt; Ventriculostomy vs Ventricular Shunting in Management of Hydrocephalus Secondary to Neural Tube Defect

Background: Different surgical management of infants suffering neural tube defects (NTD) associated hydrocephalus were reported in the literature. Great debate whether combining endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) is more effective than ventriculoperitoneal (VP) shuntfor management of congenital hydrocephalus secondary to neural tube defects ininfants younger than 1 year of age. Purpose: To evaluate and compare the therapeutic efficacy of ETV combined with CPC versus VP shunts in infants with infantile hydrocephalus associated with NTD. Methods: Thirty infants with infantile NTD associated hydrocephalus (de novo), were equally divided and randomly allocated to each intervention group either ETV/CPC or VP shunts). They were monitored for at least 6 months for any sign of raised intracranial pressure (rICP) and/or hydrocephalic metrics (fontanelle quality, HC, and ventricular size) were also documented and compared between two groups. Statistical Analysis: The association between intervention group and outcome was tested with Chi-square test and P=0.05 or less was considered statistically significant. Results: Of the total thirty patients included in the study, thirteen patients (43.3%) were male and seventeen were female (56.7%) with mean age of 80.3±11.5 days. Twenty patients (66%) were under 6 months of age. The overall success rate in 1-year follow-up was 54% and 60% for VP shunt and ETV/CPC, respectively; with the difference being not statistically significant. Conclusion: Combined ETV-CPC is considered a successful surgical option for treatment of infantile hydrocephalus associated with NTD; achieving success rate better than VPS implantation.

Anterior fontanelle size among term neonates on the first day of life born at University of Gondar Hospital, Northwest Ethiopia.

BackgroundAnterior fontanelle is the largest, prominent and most important fontanelle, which is used for clinical evaluation. It is mainly characterized by its size and shape variation and is possibly influenced by gender, race and genetics. Understanding the variation of anterior fontanelle is used for recognition of different medical disorders and abnormal skeletal morphogenesis.ObjectiveTo determine the mean size of anterior fontanelle among term neonates on the first day of life born at University of Gondar Hospital, Gondar Town, Northwest Ethiopia, 2018.MethodsDescriptive cross sectional study design was undertaken in 384 term and apparently healthy neonates, using standard methods. Descriptive analysis, student t-test, one way ANOVA and Pearson correlation coefficient were implemented.ResultsIn this study, the mean size of anterior fontanelle in term neonates was 3.00 ± 0.62 cm (range 1.70–5.50 cm). The mean size of anterior fontanelle was 3.10 ± 0.66 cm for males, and 2.88 ± 0.57 cm for females. There was statistically significant difference in anterior fontanelle size in neonates of different genders (p<0.001), mode of delivery (p<0.001) and duration of labour (p = 0.006). However, the size of anterior fontanelle was not significantly affected by the birth order, onset of labour and socio-demographic variables of the mother except occupation of the mother (p = 0.01). There was a significant positive correlation between the mean size of anterior fontanelle with birth weight (r = 0.11; p = 0.04) and head circumference (r = 0.17; p = 0.001).ConclusionsAt term, male neonates had significantly larger anterior fontanelle than female neonates and anterior fontanelle size has a direct relationship with birth weight and head circumference.

Hyperphosphatasia with mental retardation syndrome type 4 In two siblings-expanding the phenotypic and mutational spectrum

Hyperphosphatasia with mental retardation syndrome (HPMRS) (OMIM # 239300), is an autosomal recessive disease with phenotypic variability, ranging from mild nonsyndromic intellectual disability to syndromic form with severe intellectual disability, seizures, elevated alkaline phosphatase, brachytelephalangy and facial dysmorphism, Six subgroups of HPMRS were defined in which pathogenic mutations affect genes involved in either synthesis or remodeling of the anchor proteins. Among these, PGAP3 mutations are associated with HPMRS type 4. We report two siblings with a novel homozygous variant in PGAP3 expanding both the phenotypic findings and the mutational spectrum of HPMRS type 4. Developmental delay, hypotonia, facial dysmorphism were the consistent findings with HPMRS in our patients. Large anterior fontanel size, gum hypertrophy, pes equinovarus, concentric ventricle hypertrophy, frontoparietal atrophy and dysphagia were the findings of our patients that have been reported for the first time in this syndrome. Although there is an extensive list of differential diagnoses in patients with developmental delay and hypotonia, the recognizable pattern of facial features, parental consanguinity and mild to moderate serum ALP elevation should be sufficiently suggestive of HPMRS type 4.

Evaluation of fontanel size variation and closure time in children followed up from birth to 24 months.

OBJECTIVE Anterior fontanel size and closure time can be useful clinical signs for the early diagnosis of diseases. Knowing age-related normal variations is important to decide on further investigations. The authors of this study aimed to describe fontanel size variation according to age, determine fontanel closure time, and identify the optimal method for assessing fontanel size. METHODS For this prospective cohort study, 321 healthy term babies who fulfilled the inclusion criteria were consecutively recruited. Percentile charts for the mean anterior fontanel size and oblique measurements from birth to 24 months of age were created. RESULTS The mean fontanel closure time was 9.7 ± 5.0 months (girls 10.3 ± 4.7 months, boys 9.2 ± 5.1 months). No differences were observed between the traditional method and oblique measurements. Early fontanel closure was not associated with microcephaly. CONCLUSIONS Oblique measurements can be used because they are as accurate as the traditional method. Children with fontanels measuring above the 95th percentile should be monitored closely and investigated further for potentially associated diseases.

Anterior Fontanelle Size in Healthy Indian Late Preterm and Full Term Newborns.

To measure the size of the anterior fontanelle (AF) in healthy late-preterm and term newborns and correlate it with birth weight, gestational age, gender, occipito-frontal circumference, small for gestational age status and birth weight z-score. This was an observational study carried out from October 2013 through April 2015 at a tertiary care hospital. Newborns ≥ 34 wk gestation were enrolled. Fontanelle edge was palpated with index finger and size calculated by adding anterior-posterior and transverse diameters and dividing by two. A total of 1010 neonates were enrolled. The mean AF size was 2.23 ± 0.52cm (mean ± SD). There was a significant decrease in the size of the AF with advancing gestational maturity on one-way ANOVA (F = 31.30) (P < 0.001) and also by increasing birth weight (F = 20.34) (P < 0.001). There was no significant difference in the mean AF size between males; 2.21 ± 0.54cm and females; 2.25 ± 0.55cm (mean ± SD) (P = 0.575). There was a strong correlation between AF size with increasing birth weight; correlation (r) = 0.985. In small for gestational age neonates the AF was larger, 2.27 ± 0.55 (mean ± SD) and a strong correlation between birth weight z-score and AF size was noted (r = 1.012). The mean AF size in late-preterm and term Indian newborns in a mixed community hospital was 2.23 ± 0.52. A strong correlation was found between AF size with increasing birth weight and with birth weight z-score in small for gestational age babies.

Cord serum25-hydroxyvitamin D is not associated with cranial anthropometrics in infants up to 6months of age. An Odense Child Cohort study.

Skull changes are poorly described in vitamin D insufficiency [serum 25-hydroxyvitamin D (s-25(OH)D) 25-50nmol/L]. We aimed to investigate factors associated with cranial anthropometrics in infants, especially s-25(OH)D. In infants 2.5-6months old from the Odense Child Cohort, associations between cord and pregnancy s-25(OH)D and anterior fontanel area (n=765), head circumference (HC, n=1776) and head shape (n=1527) were investigated along with other factors. Age was corrected for preterm birth. The mean (SD) s-25(OH)D in early pregnancy was 65.97 (21.33) nmol/L; late pregnancy 78.61 (27.18) nmol/L; and cord 47.1 (21.7) nmol/L. At median (IQR) age 3.7 (2.5-5.9) months, the fontanel area was 225 (0-1690) mm2, and mean (SD) HC was 41.5 (1.5) cm. Asymmetric/flat head shape was present in 846 infants (55.3%). No associations were found between cord, early or late pregnancy s-25(OH)D and any cranial measure by univariate or adjusted analysis. Among significant, independent associations in multivariate analysis, fontanel area was associated inversely with gestational age (GA); HC was associated directly with GA, maternal pre-pregnancy overweight and caesarean section and inversely with smoking; and asymmetrical head shape showed a novel association with male sex: adjusted OR=1.54 (95% CI 1.25; 1.89), p<0.001. Other associations with asymmetrical head shape included parity 3+, gestational age and maternal age 30+years (all protective). In conclusion, neither pregnancy nor cord s-25(OH)D was associated with fontanel size, HC or asymmetrical head shape despite a high prevalence of cord s-25(OH)D<50nmol/L. Lower GA was associated with larger fontanel size, lower HC and asymmetrical head shape, and boys more frequently had asymmetrical head shape, probably due to heavier heads.

Relationship between the Anterior Fontanel Size and Occipito-frontal Circumference

Relationship between the Anterior Fontanel Size and Occipito-frontal Circumference

Norms for size and closure time of anterior fontanelle: a study on babies in Nagpur region

Abstract Background and aims : Anterior fontanelle development in children is affected by several factors ranging from physical to geographical. While the impact of factors such as gestational age (GA) and gender are clearly established, the influences of region and ethnicity vary in the published literature. The objectives of the study were: 1. To measure the anterior fontanelle size (AFS) and closure time of babies aging from newborn to two years of age in respect to its gender and term status in Nagpur babies. 2. To evaluate the relationship of our fmdings with growth parameters. Methods : Measurements were done on 808 babies according to Popich and Smith method. Measurements on newborn were done after 48 hours of birth. Z-test of significance and Pearson's correlation coefficient are used for analysis. Results : Mean AFS ranged from 4.95±2.15 to 0.94±0.05 cms in preterm babies and 4.24±2.21 to 1.32±0.21 cms in full term babies. Mean AFS ranging from 4.48±2.26 to 1.31±0.22 and 4.02±2.20 to 1.24±0.13 cms were observed in male and female babies respectively. Study revealed no significant difference in AFS between full term and preterm &amp; male and female babies. Around 20% fontanels are closed around sixth month. Less than 1% fontanels were open around 22-24 months. No significant difference in closure time was found. AF size had significant correlation with growth parameters of full term babies (weight r = - 0.37, p = 0.00) (head circumference r = - 0.30, p = 0.00) (crown heel length r = - 0.39, p = 0.00). AF closure time showed a significant relationship with growth parameters (weight r = 0.77, p = 0.00) (head circumference r = 0.72, p = 0.00) (crown heel length r = 0.85, p = 0.00). Conclusion : AF sizes obtained in this study are recommended for use as local values for reference in assessing term and preterm babies born in Nagpur.

Evaluation of anterior fontanel size and area in the newborn using CT images

The newborn's skull consists of bones and fibrous, membrane-covered tissue composed of fontanels and sutures. Newborns have six fontanels at birth. Clinical assessment of the size and other variations of fontanels after birth are very important because fontanels with abnormal size and shape are indicators of several disorders such as increased intracranial pressure. The most important fontanel for clinical examination and diagnosis in newborns is the anterior fontanel. It has a rhomboid-like shape and is situated at the junction of the two parietal and two frontal bones. A clinical method commonly used to measure anterior fontanel size was first described by Popich and corresponds to the mean value of the length (anteroposterior dimension) and the width (transverse dimension). The length and width are measured on the skin of the newborn's head. In this study, we propose a method for extraction of the anterior fontanel in order to determine its dimensions on 3D computed tomography (CT) images of newborns. The proposed algorithm was applied to CT images from eleven newborns with a gestational age of 39 to 45 weeks. The mean anteroposterior and transverse diameters were 3.51 cm and 3.19 cm, respectively. The mean anterior fontanel size and area were 3.35 cm and 10.5 cm 2 , respectively.

Statistical characteristics of anterior fontanelle size at birth of term Sri Lankan new borns: a descriptive cross sectional study

Assessing the anterior fontanelle size is an important component of routine neonatal examination. For meaningful interpretation of fontanelle size, normal reference values are essential. Normal values for the fontanelle size in Sri Lankan newborns are not available. To investigate characteristics of anterior fontanelle size at birth in Sri Lankan babies. A descriptive cross sectional study was carried out between October and November 2010. Horizontal and vertical dimensions of the anterior fontanelle were measured in 2215 normal term babies, between 12 to 24 hours after birth. A practical and simple method was used to measure fontanelle size. Average fontanelle size was calculated by adding horizontal and vertical dimensions and dividing by two. Mean of the average fontanelle size for the total sample was 2.55 cm (for males 2.57 cm and for females 2.52 cm). Longitudinal dimension was significantly higher than the horizontal in both sexes (p<0.001). Frequency distribution curves of fontanelle size followed a normal distribution in both sexes. The ninety seventh centile and third centile for the average fontanelle size were 4.5 cm and 0.9 cm respectively. Babies with an average anterior fontanelle size more than 4.5 cm or less than 0.9 cm need further follow up. Further studies are needed to evaluate the accuracy of these cut off values.