CROWN HEEL LENGTH MEASUREMENT USED FOR IDENTIFICATION OF LBW BABIES

The present study was undertaken at the Neonatal Unit, Department of Pediatrics, S.N. Medical College, Agra; from September 2005 to August 2007 to find out foot length measurement as an effective screening tool in the identification of low birth weight babies. Foot-length measurement is a cheap, easy to use, less prone to errors with no requirement of a technical aid or expertise and there is no necessity for any form of equipment or facility. The incidence of LBW babies was 45.82% with 65.9% Term SGA and 34.1% pre-term babies. Mean values for crown heel length, occipito-frontal circumference, chest circumference, mid-arm circumference and foot length were cm, and respectively.


Introduction:
LBW is the single most important factor determining the survival chances of the child. Many of them die during their 1st year. The infant mortality rate is about 20 times greater for all LBW babies than for other babies. The lower the birth weight, the lower is the survival chance. Many of them become victims of protein-energy malnutrition and infection. LBW is thus an important guide to the level of care needed by individual babies. 1-3 LBW also reflects inadequate nutrition and ill-health of the mother. There is strong and significant positive correlation between maternal nutritional status and the length of pregnancy and birth weight. A high percentage of LBW therefore points to deficient health status of pregnant woman, inadequate prenantal care and the need for improved care of newborn. 4 The Neo-natal mortally rate (NMR) of 43 per 1000 live births in India is exceeding high when compared to < 5 in developed countries. At least 17 million infants are born every year with low birth weight, representing about 16% of all newborns in developing countries. Nearly 80% of all intrauterine growth retarded newborns who are low birth weight and full term are born in Asia 5 (mainly south-central Asia, with Bangladesh having the highest rate in the world (50%). Although there are many qualitative and quantitative limitations to available data, it is clear that many developing countries exceed the internationally recommended cut-off levels which should trigger public health action. Incident rates of > 15% for low birth weight 6 and > 20% for intrauterine growth retardation indicate a major public health problem.

ANTHROPOMETRIC MEASUREMENTS:
The study was conducted on five hundred and fifty newborns of either sex. The newborns were taken from the Neonatal Intensive Care Unit (NICU) of Department of Pediatric and those present in the post-natal and post-operative ward of Department of Obstetrics and Gynaecology, S.N. Medical College and Hospital. Agra. The study was conducted from September 2005 to August 2007.
Anthropometric measurements including Birth weight6, foot-length7 was recorded for all the newborns.

HISTORY:
A detailed maternal history from all cases was taken 8 -10 .  Age of mother at marriage and 1 st pregnancy.  Socio-economic status.  Educational status of mother.
 Nutritional intake before and after the onset of pregnancy.  Birth order of the newborn.  Maternal weight and height.

Birth Weight :
Recorded on a beam type detects scale with an accuracy of 25 grams. The newborn was measured within 24 hours without clothes after correction of zero error. A minimum of three observations were taken to avoid observational error 6 .

Foot length :
Foot-length was measured with a 15 cm long steel tape. Heel of the neonates was fixed against vertical small tip of the tape and foot length estimated against the tip of the big toe after straightening the foot 7 .

STATISTICAL ANALYSIS:
The statistical tests applied were [11][12] :  Pearson's coefficient of correlation  Combination matrix  Regression analysis  Paired 't' test  Chi-square test The statistical analysis was carried out by using SPSS version 12.1 for windows.

3.1Observations:
The present study was conducted in the Department of Pediatrics, S.N. Medical College & Hospital, Agra. Five hundred and fifty newborns of either sex were studied. Anthropometric measurements including birth weight and foot-length were recorded on all the newborns within 24 hours of delivery. The study group newborns comprised a majority i.e. 464 (84.37%) terms babies and only 86 (15.6%) were preterm.

SUMMARY AND CONCLUSION:
The present study was undertaken at the Neonatal Unit, Department of Pediatrics, S.N. Medical College, Agra; from September 2005 to August 2007 to find out foot length measurement as an effective screening tool in the identification of low birth weight babies. Various anthropometric measurements were recorded on 550 (Five hundred fifty) newborns within 24 hours of birth.The incidence of LBW babies was 45.82% with 65.9% Term SGA and 34.1% pre-term babies. Mean values for crown heel length, occipitofrontal circumference, chest circumference, mid-arm circumference and foot length were cm, and respectively.Foot length of 6.26, 6.88 and 7.4 cm were identify from linear regression analysis as the cutoff point corresponding to a birth weight of 1500, 200 and 2500 gms respectively. Highest correlation (r = 0.863) was observed with foot length with regards to birth weight as compared to other anthropometric measurements.