Standard curves for mid arm circumference and mid-arm/head circumference ratio in newborns

One Thousand singleton neonates, between 28 and 44 weeks of estimated gestational age (EGA) were measured within 48 hours of their birth for upper mid-arm circumference (MAC), head circumference (HC) and birth weight (BW). Regression analysis was used to draw standard curves for MAC versus EGA and mid-arm circumference/head circumference ratio (MAC/HC) versus EGA. Correlation coefficients were 0.961 for MAC versus EGA and 0.889 for MAC/HC versus EGA (p < 0.001). MAC, MAC/HC and HC were also highly correlated with birth weight (p < 0.001). These standard curves make available a discriminating method for evaluation of intra-uterine growth and a noninvasive technique for following somatic protein status in growing preterm infants.     

Exclusive breastfeeding and infant growth studies: reference standards for head circumference, length and mid-arm circumference/head circumference ratio for the first 6 months of life

This paper presents the development of reference standards for head circumference (HC), length and mid-arm circumference/head circumference (MAC/HC) ratio for the evaluation of exclusively breastfed infants. A total of 219 exclusively breastfed term appropriate-for-gestational age (AGA) infants were studied and analysed from 1 June 1995 to 31 May 1997 at the Neonatal Follow-up Clinic, University Teaching Hospital, Benin City, Nigeria. Head circumference and length measurements were recorded for the infants at each postnatal completed month. MAC/HC ratios were also computed for each infant at each completed postnatal month. There was a progressive increase in the mean measurements at the completed months with increasing postnatal age and the differences between the mean measurements of length and head circumference at the 4th and 6th completed months were significant (p < 0.001). The head circumference, length and MAC/HC ratio had significant correlations with postnatal age. The standards represent the regression lines of the anthropometric measurements and MAC/HC ratio on postnatal age with the corresponding 95 per cent confidence limits. The standards identified 95 per cent (for head circumference), 93 per cent (for length) and 94 per cent (for MAC/HC ratio) of exclusively breastfed healthy infants as having normal infant growth for age.     

A new device to measure short-term growth of head circumference in newborn infants

We have developed and tested a new instrument to measure the occipitofrontal head circumference of newborn infants more accurately. The intra- and interobserver variability was determined. The results indicate that the head circumference of newborn infants can be measured with an accuracy of 1 mm.     

Intrauterine growth curves in north Indian babies: weight, length, head circumference and ponderal index

Intrauterine growth (weight, length, head circumference, Ponderal index) was studied in 2875 consecutive live born babies. Weight, length and head circumference growth curves did not show any significant difference when compared to previous growth curves made 20 years back from this centre. Norms and curves for ponderal index are provided for the Indian babies and were comparable with figures from Western studies. However, the 90th centile values were found to be low between 32-38 weeks of gestation.     

Mid-arm circumference and mid-arm/head circumference ratios: standard curves for anthropometric assessment of neonatal nutritional status

Two hundred four neonates, 25 to 42 weeks estimated gestational age (EGA), were measured on day 2 or 3 of life for upper mid-arm circumference (MAC) and head circumference. Regression analysis was used to construct standard curves for MAC versus EGA and mid-arm circumference/head circumference ratio (MAC/HC) versus EGA. Correlation coefficients were 0.93 for MAC versus EGA, and 0.84 for MAC/HC versus EGA. MAC, MAC/HC, and head circumference were also highly correlated with birth weight. These measurements may more accurately assess intrauterine growth and body proportionality at birth than weight, length, and head circumference.     

Mid-arm circumference/head circumference ratios for identification of symptomatic LGA, AGA, and SGA newborn infants

Mid-arm circumference/head circumference ratios (MAC/HC) and birth weights obtained in 73 neonates were studied to compare which of these growth measurements could more accurately predict risk of metabolic complications resulting from either acceleration or retardation of fetal growth. The MAC/HC ratio was more sensitive than birth weight in distinguishing symptomatic large for gestational age (LGA) infants who were born to diabetic mothers from other LGA infants who were asymptomatic, and symptomatic from asymptomatic small for gestational age infants. In addition, the MAC/HC ratio identified symptomatic appropriate for gestational age (AGA) infants born to diabetic mothers and AGA infants with signs and symptoms of growth retardation. The MAC/HC is more useful than birth weight in assessing newborn infants at risk for the metabolic complications associated with fetal growth disorders.     

Assessment of gestational age: the value of a maturity scoring system for head circumference and mid-arm circumference

Over a 10-month period, 508 newborn infants were studied in three hospitals to develop a simple maturity scoring system for head circumference and mid-arm circumference (MAC). Maturity scores were based on the 95 per cent confidence intervals on the mean measurements of the parameters for gestational age groups. Combined maturity scores had slightly better correlation with gestational age than scores for MAC and head circumference separately. The model had 90 per cent accuracy in estimating gestational age. It is a simple and reliable method, and is recommended for routine use particularly in developing countries.     

Value of the measurement of arm circumference/head circumference in the evaluation of the nutritional status of infants and young children

In 1970, Kanawati and McLaren proposed a nutritional criterion based on the arm circumference/head circumference (AC/HC) ratio, valid from 3 months to 4 years of age. For these authors, there were 4 situations: normal nutrition (ratio greater than 0.31), slight undernutrition: (0.31 greater than ratio greater than 0.28), medium undernutrition: (0.28 greater than ratio greater than 0.25) and severe undernutrition (ratio less than 0.25). A longitudinal study was undertaken on 45 children admitted in our unit for nutritional assistance (total parenteral nutrition and enteral nutrition). Weight, arm circumference and triceps skinfold were measured at regular intervals during their stay in hospital (total: 141 measurements). There was a strong correlation (p less than 0.001) between the values of AC/HC and weight for age, weight for height, triceps skinfold and arm circumference. There was no correlation between AC/HC, height for age and head circumference for age. Furthermore, this criterion seemed to be independent from the degree of hydratation in cases with dehydratation or oedemas (Kwashiorkor). AC/HC ratio is a simple and reliable criterion for nutritional follow-up. It is easily reproduced and independent from sex and age between ages 3 months and 4 years.     

Correlation of head circumference and crown-rump length in newborn infants. A potential indicator of congenital maldevelopment.

A study of 305 consecutive neonatal autopsies done by two prosectors showed a high correlation between the head circumference (HC) and crown-rump length (CR). The calculated formula can be stated approximately as HC equals 0.9 CR + 2.5 cm, and the two measurements are for all practical purposes equal in the immediate neonatal period, regardless of race, sex, age and body weight. When the HC was found to be significantly larger than CR, hydrocephalus and certain types of chondrodystrophy were present. When the HC was significantly smaller than CR, there was a higher incidence of congenital heart disease, especially hypoplastic left heart syndrome, and congenital central nervous system disorders other than hydrocephalus. From a practical point of view, a significant difference is a discrepancy of more than 2.5 cm. 102 consecutive living neonates were also similarly studied. It appears that the CR length when carefully measured under standardized condition is more reliable than the crown-heel length.     

Longitudinal growth of head circumference in term symmetric and asymmetric small for gestational age infants

Aims

To study longitudinal growth pattern of head circumference of full-term symmetric and asymmetric small for gestational age (SGA) infants of the two sexes during first year of life.

Study Design

Mixed-longitudinal growth research design.

Subjects

Head circumference amongst full-term 100 symmetric, 100 asymmetric as well as 100 appropriate for gestational age (AGA) infants was measured at birth, 1, 3, 6, 9 and 12 months of age using standardized technique and instrument.

Results

The mean head circumference of male symmetric SGA infants measured significantly (p ≤ 0.001) smaller than asymmetric SGA infants while, in female symmetric SGA infants it measured shorter beyond 6 months. As compared to AGA infants, head circumference in symmetric and asymmetric SGA infants measured significantly smaller in size. Growth velocity for head circumference amongst symmetric and asymmetric SGA male infants did not show statistically significant differences. Rate of head circumference growth remained significantly higher amongst female asymmetric SGA infants than the symmetric ones between 3 and 6 months while, a reversal of trend was observed between 9 and 12 months.

Conclusion

The better growth attainments for head circumference of male and female asymmetric SGA infants than their symmetric SGA counterparts during first postnatal year of life may be attributed to the continuation of influence of “head sparing” experienced by asymmetric SGA babies during prenatal life.     

German head circumference references for infants, children and adolescents in comparison with currently used national and international references

Aim: To present valid head circumference (HC) percentiles from early infancy to 18 years and to compare them with percentiles currently used in Germany by Prader, as well as to international WHO and CDC references. Methods: Nationally representative sample of 17,158 children and adolescents aged 0.25–17.98 years (KiGGS study 2003–2006) with standardized HC measurement. HC references were created using Cole’s LMS method. Results: The median growth of HC is largest in the first year of life. Adult HC is reached at age 16 years in girls, while in boys, HC growth continues through age 17 years and adult HC have to be derived from future KiGGS follow‐up examinations. KiGGS percentiles are quite similar from early infancy to early school age compared to older Prader references, but higher thereafter (maximum difference of median HC: girls 1.4 cm, boys 0.9 cm). KiGGS percentiles are also higher than WHO and CDC percentiles over most of the compared age range, but differences are less pronounced compared to Prader. Conclusion: The KiGGS HC references presented here for boys and girls aged 4 months through 17 years are more valid than currently used German references. Because of the similarity of KiGGS and the currently used reference by Prader in early infancy, the currently used Prader reference for 0–4 months could complement KiGGS to cover the entire age range from birth to the end of adolescence.