[Assessment of foetal nutrition status at birth using the CANS score]

Fetal Malnutrition and Associated Factors among Term Newborn Babies at Birth in South Gondar Zone Hospitals, Northwest Ethiopia

Background

Undernutrition contributes to almost half of all under-five deaths. Fetal malnutrition (FM) has been implicated in both short- and long-term consequences among fetal, neonatal, and adult life. Currently, Ethiopia lacks information on the prevalence of fetal malnutrition and its associated factors. This study, therefore, is aimed at assessing the prevalence of FM at birth and its associated factors in South Gondar zone hospitals, northwest Ethiopia.

Methods

A cross-sectional study was carried out from November 1, 2019, to April 30, 2020, among four hospitals of South Gondar zone. All women with their live newborns who met the eligibility criteria were included. Clinical assessment of nutritional status including other anthropometric measurements was done immediately after delivery. The newborn was declared as fetal malnourished if the clinical assessment of nutritional status cut-off point is less than 25. Data were collected by trained clinical midwives. Besides bivariate regression analysis, a multivariable logistic regression analysis was done to identify associations.

Results

A total of 1592 mothers with their live newborns participated in this study. The prevalence of fetal malnutrition was 21.7% (95% CI: 19.7-23.9). Intimate partner violence (AOR: 1.97, 95% CI: 1.52-2.56), placental weight less than 512 grams (AOR: 2.76, 95% CI: 2.13-3.57), and small for gestational age (AOR: 1.96, 95% CI: 1.46-2.62) were significantly associated with fetal malnutrition.

Conclusions

The prevalence of fetal malnutrition was a public health problem in this study. Intimate partner violence, placental weight, and small for gestational age were found the most significant variables. To avert fetal malnutrition, positive family relation and additional or balanced nutritional supplementation during pregnancy are critical. We recommend researchers do clinical follow-up research which comprises a detailed investigation of placental, maternal, and fetal factors including genes.

Screening and assessment tools for early detection of malnutrition in hospitalised children: a systematic review of validation studies

OBJECTIVE

The aim of the present study was to identify all currently available screening and assessment tools for detection of malnutrition in hospitalised children, and to identify the most useful tools on the basis of published validation studies.

DESIGN

Systematic review.

DATA SOURCES

PubMed, CINAHL and MEDLINE were searched up to October 2017.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies in English that reported sensitivity, specificity and positive/negative predictive values (PPVs/NPVs) in the paediatric population were eligible for inclusion.

DATA EXTRACTION AND SYNTHESIS

Two authors independently screened all of the studies identified, and extracted the data. The methodological qualities of the studies included were assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.

RESULTS

The 26 validation studies that met the inclusion criteria for this systematic review used eight screening and three assessment tools. The number of participants varied from 32 to 14 477. There was considerable variability in the chosen reference standards, which prevented direct comparisons of the predictive performances of the tools. Anthropometric measurements were used as reference standards in 16 of the identified studies, and full nutritional assessment in 5. The Pediatric Yorkhill Malnutrition Score (PYMS) screening tool performed better than Screening Tool for the Assessment of Malnutrition and Screening Tool for Risk On Nutritional status and Growth when compared in terms of anthropometric measurements, especially for body mass index (Se=90.9, Sp=81.9) and triceps skinfold thickness (Se=80.0, Sp=75.0). However, low PPVs indicated the problem of overprediction of positive cases, which was typical for all of the studies that used anthropometric measurements as the reference standard.

CONCLUSIONS

This systematic review identifies the need for definition of the gold standard for validation of screening tools. Anthropometry measurements using WHO or Centers for Disease Control and Prevention growth charts should be considered as the possible reference standard in future validation studies. We would recommend the use of PYMS for hospitalised paediatric patients without chronic conditions, in combination with full nutritional assessment.

PROSPERO REGISTRATION NUMBER

CRD42017077477.

Bioelectrical impedance vector values in a Spanish healthy newborn population for nutritional assessment

INTRODUCTION

Vector bioimpedance analysis (BIVA) can be very useful for the evaluation of body composition, hydration, and nutritional status in infants and newborns. The objective of this study was to determine the impedance vector distribution for a group of healthy newborn Spanish children.

METHODS

This was a cross-sectional, descriptive study conducted with 154 healthy, Spanish newborns (gestational age: 37-41 weeks) aged 24 to 72 hours (79 males, 75 females). Weight, height, and cephalic-circumference were determined. Resistance and reactance were measured with a single-frequency impedance analyzer at 50 kHz (tetrapolar analysis). The newborns' specific 95% confidence intervals of the mean vectors and the 95%, 75%, and 50% tolerance intervals for the individual vector measurements were plotted using R and Xc components standardized by the subjects' lengths. The mean impedance vectors were compared with Hotelling's-T² test for vector analysis (significance level: P < .05).

RESULTS

The newborns exhibited gender-related differences in the mean impedance vector (mean [SD] R/H: 833.6 [97.5] Ohm/m in males vs 918.2 [107.7] Ohm/m in females; mean [SD] Xc/H: 91.3 [34.7] Ohm/m in males vs 95.6 [23.2] Ohm/m in females). No statistically significant differences in the mean impedance vectors were observed according to days of life. Lower values of resistance and slightly higher reactance values were observed in the healthy Spanish newborns compared to Italian newborns.

CONCLUSIONS

New tolerance ellipses were constructed for healthy Spanish newborns. These data allow detecting alterations in the hydration status and cell mass in term newborns in the first 3 days of life.