DETERMINATION OF FETAL MALNUTRITION IN TERM AND PRETERM NEONATES AT THE LAGOS UNIVERSITY TEACHING HOSPITAL USING CANSCORE AND ANTHROPOMETRY

Abstract

Several studies have documented the adverse effects of fetal malnutrition on a
newborn’s wellbeing. Assessment of the nutritional status of an infant at birth is
important for early identification of malnourished neonates to aid proactive
management.
This study was undertaken to assess nutritional status of term and preterm
newborns at birth using CANScore and three commonly used anthropometric indices
for assessing nutritional status (i.e. PI, MAC/HC ratio, and Birth weight). All babies
born during the six months of study period and who met the study criteria were
recruited. A total of 422 newborns were consecutively recruited and analysed. There
were 282 term and 140 preterm babies. Eight of the term babies were of low birth
weight while 108 of the preterm babies were of LBW. The mean birth weight was
3300±500g (range 2200g – 4800g) for term babies and 1700±360g (range 938g –
3950g) for preterm babies. The mean length was 49.4±2.3cm for term babies and
43.2±5.0cm for preterms.
CANScore identified 13.5% and 34.3% of the term and preterm babies respectively
as FM. The corresponding figures for anthropometric indices were: PI – 10.3% and
30.7% for term and preterm babies respectively; MAC/HC ratio identified 2.8% and
12.1% of the term and preterm respectively, while birth weight identified 2.5% and
3.6% of term and preterm babies respectively as FM.
On comparing the anthropometric indices with CANScore, both PI and MAC/HC ratio
identified as FM 18.4% and 13.2% respectively, of the term babies identified as
malnourished by CANScore. PI also identified as malnourished, 9.0% of the babies
which CANScore identified as well nourished. MAC/HC ratio identified as
malnourished, 1.2% of the babies classified as well nourished by CANScore. Only
one of the term SGA babies (2.6%) was found to be malnourished by CANScore
while it identified 13.4% of the term AGA babies as FM.
Among the preterm babies, all the SGA and 31.8% of the AGA babies were identified
as FM by CANScore. Over Twenty one percent (21.7%) of the preterm newborns
that were identified as malnourished by CANScore were also found as such by PI.
Both CANScore and PI detected a significantly large numbers of FM in the study
sample compared with birth weight and MAC/HC ratio. MAC/HC ratio in the present
study had the highest agreement with CANSCORE. Out of the eight term babies with
low MAC/HC, 5 (62.5%) had visible features of FM identified by CANSCORE while
41% of preterm babies with low MAC/HC had identifiable features of FM. There is
higher prevalence of FM in preterm neonates compared to term neonates. This is
significant because FM may have contributed to the preterm delivery.
The use of more than one method of detecting malnutrition is advocated as there is
as yet no gold standard for detecting FM. CANScore has proved to be a simple
clinical tool for identifying FM and when used in conjunction with anthropometry will
ensure that most malnourished newborns are detected at birth.

DETERMINATION OF FETAL MALNUTRITION IN TERM AND PRETERM NEONATES AT THE LAGOS UNIVERSITY TEACHING HOSPITAL USING CANSCORE AND ANTHROPOMETRY