PREVALENCE AND RISK FACTORS FOR FETAL MALNUTRITION IN NEWBORNS IN UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN

PREVALENCE AND RISK FACTORS FOR FETAL MALNUTRITION IN NEWBORNS IN UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN

Abstract

Fetal malnutrition (FM) is defined as failure to achieve adequate quantum of fat and muscle mass
during intra-uterine growth. It is associated with both immediate and long term morbidity and
mortality. Fetal malnutrition is present in 60% of small for gestational age infants, and 10% of
appropriate for gestational age (AGA) infants. Fetal malnutrition is known to be associated with
perinatal problems and long term central nervous system sequelae.
There is scanty information on the prevalence and risk factors for fetal malnutrition in newborns
in this environment.

This study determined the prevalence and risk factors for fetal malnutrition in term and preterm
neonates in Ilorin .
This was a cross sectional and descriptive study involving 260 term and 355 preterm consecutively
recruited neonates. Sociodemographic parameters, maternal booking records and anthropometric
parameters were determined in the newborns. Data generated was analysed using IBM SPSS
version 20.0 software package and the level of significance was put at p –value < 0.05.
The prevalence of fetal malnutrition in term neonates was 24.6% by Clinical Assessment of
Nutritional Status (CAN) score, 16.5% by Midarm circumference / Head Circumference
(MAC/HC ) ratio and 13.7% by Ponderal Index, whereas the prevalence of fetal malnutrition in
preterm neonates was 37.2% by CAN score, 16.1% by MAC/HC ratio, and 46.2% by Ponderal
index. Using weight for gestational age, 5.08 % of the term babies were Large for Gestational Age
(LGA), 85.8% were Appropriare for gestational Age (AGA), and 9.3% were Small for Gestational
Age (SGA). However, in the preterms 2.0% were LGA, 319 89.9% were AGA, and 8.2%
were SGA. The two groups were comparable in the distribution of LGA, AGA, and SGA.
Among the term AGA, 21.7% had FM, while 67% of the SGA had FM. In the preterms, 36.4% of
the AGA and 55 % of the SGA had FM.
Term male babies were significantly more malnourished than females, (p=0.029 ), but in the
preterms the gender prevalences were comparable. The identified risk factors for malnutrition
include maternal age less than 20 years (p=0.0009) and above 35 years , (p=0.034) primiparity
(p=0.007) and Body Mass Index (BMI) ≤18.5 Kg/m2 (p= 0.036) in the mothers. The commonest
risk factors significantly associated with fetal malnutrition in term neonates are maternal age <20
years, primiparity, and Small for gestational age. Preterm neonates had a higher risk for fetal
malnutrition.
In conclusion, the prevalence of FM in term babies was highest using CAN score [(24.6%)
compared to MAC/HC ratio and Ponderal Index] whereas in preterms FM rate was highest using
PI [(46.2%) compared to CAN score] . Therefore, in assessing for fetal malnutrition, CAN score
should be used for term neonates and PI for preterms. Maternal age <20 and >35 years, primiparity
, BMI≤ 18.5Kg/m2 , and SGA babies are to be assessed for FM . AGA neonates should not be
overlooked. All preterms should be assessed for FM routinely.

PREVALENCE AND RISK FACTORS FOR FETAL MALNUTRITION IN NEWBORNS IN UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN

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