I heartily agree that neonatal nurses have "more important pursuits. The physician, not the nurse, should be measuring the infant.
The physician an eager young neonatologist or an old bag-toting doctor can identify the small-for-gestational-age infant with intrauterine growth retardation and with small chest circumference compared with a "normal head" vs the infant of gestational diabetic mother with relatively large chest-to-head ratio.
White babies' head circumferences are usually equal to or larger than their chest circumferences, while the reverse is usually found in African American babies.
Finally, noting at discharge an enlarging head and no change in chest circumference has enabled me to pick up several cases. Nichols MM. Routine Chest Measurement in the Newborn. In order to facilitate and validate the interpretation of CC data in newborn NB , the aim was to study the relation between CC and other anthropometric variables and develop a predictive equation for CC in a population of full-term newborns.
Cross-sectional study, carried out with full-term infants. Bivariate analysis was performed between CC and HC, weight, length and type of delivery, followed by multiple linear regression analysis, including variables that were significant in the bivariate analysis. For the linear regression model, the predictive equation of CC was The results show a positive correlation between CC and weight, length and HC, and based on the linear regression model, the predictive equation for CC is based only on weight and HC.
Peer Review reports. Assessment in perinatology uses anthropometry as an essential tool to monitor growth and evaluate the nutritional and functional status of newborns NB. It is an economical, non-invasive and easy-to-execute tool that can improve understanding of growth patterns and their variations [ 1 ]. Studies in different populations suggest the use of anthropometric parameters is an important substitute for early identification of low-weight newborns [ 2 , 3 , 4 ].
Of these variables, head circumference HC , chest circumference CC and abdominal circumference AC exhibit good correlation with the health status and well-being of children and are widely used as indicators of health, performance and survival [ 5 , 6 ]. CC, HC and AC are simple, reliable and logistically viable tools in field conditions that can be used on a large scale in both domiciliary care and high-complexity environments due to their accessibility.
These resources, whose aim is early detection of developmental changes and prevention of newborn deaths [ 2 ], are important methods, capable of predicting the need for early referral of low-birth-weight babies for extra care, given that after surviving the critical neonatal period, they may experience compromised physical and mental growth [ 2 ].
Alternative measures to identify low birth weight have been recommended by the World Health Organization WHO [ 9 ] since the last decade. Furthermore, it is important to consider that CC is easier to measure, because the nipple line can be clearly and objectively established as a reference point, making its identification operationally feasible when compared to HC, or even a scale to estimate weight [ 7 ].
Although over the years a number of studies have used CC as a sensitive tool to identify the health status of infants, establishing a good reference for clinical practice in neonatology [ 10 , 11 ], a particularly important aspect for this population is the lack of data on normal values and prediction equations. Thus, in order to facilitate and validate the interpretation of CC data in NB, the aim was to study the relation between CC and other anthropometric variables and develop a predictive equation for CC in a population of full-term newborns.
This is a cross-sectional observational study, conducted at Ana Bezerra University Hospital, located in Northeastern Brazil, between April and November The medical-assistance service, which provides dedicated prepartum and postpartum care for the mother-infant dyad promotes maternal-infant bonding, where both remain close to each other and are cared for by a multiprofessional team. There are 51 licensed beds, 9 delivery rooms and the postpartum nursery can accommodate up to 32 beds.
The neonatal team consists of 10 staff physicians and 4 rotating pediatric residents, 10 nurses, 4 physical therapists, 3 nutritionists, 2 speech therapists and 7 multiprofessional residents. We have used WHO child growth pattern, which shows physical growth curves, achievement windows and performance milestones [ 12 ].
Children with values found within the median of the WHO reference population were considered for the study. The measures of CC and HC were obtained with a non-stretchable tape measure while NB were in the supine position; to assess CC, the tape was wrapped around the head midway on the occipital bone, and for HC, the tape was wrapped under the axillary area around the back to meet at the mid-sternal area at the nipple level.
Respiratory rate RR was measured by observing chest expansion, counting the number of breaths per minute. The 1 and 5-min Apgar scores and type of delivery were recorded on the medical chart. The Kolmogorov-Sminorv test was applied to determine data normality.
Descriptive statistics for all the variables were expressed as mean and standard deviation, according to sex, and analyzed using the Mann-Whitney test for quantitative variables and the chi-squared test for categorical variables. Bivariate analyses were carried out applying simple linear regression.
Moreover, regression diagnoses were conducted for all linear analyses, including collinearity tests, with no significant deviations. A total of NB were assessed and 31 were excluded due to sleepiness and persistent crying. There was no statistical difference between hemodynamic measures and RR, or type of delivery, when the sample was considered separately by sex, as shown in Table 1. However, weight, length, HC and CC were higher in the boys, exhibiting a statistically significant difference.
Table 2 shows the bivariate analysis between CC and the following variables: type of delivery, weight, length and HC. There was no statistical difference between CC and type of delivery, but it was significant for length, weight and HC.
When the significant bivariate analysis variables were included in the multiple linear regression analysis, only weight and HC remained as predictors of CC, as exhibited in Table 3. From the regression model, the predictive equation of CC is Monitoring and assessing NB development is essential to promoting health and preventing complications, thereby guaranteeing higher newborn survival rates [ 14 , 15 ].
Healthy growth is reflected in a physical increase in body size, measured in centimeters or grams, and results in a rise in the number and size of cells and in their degree of cellular differentiation, for the development and execution of organic and functional activity [ 16 ].
These events occur simultaneously to preserve and maintain harmonious relations at the same magnitude and proportion of brain, spine, rib cage, and limb development, in addition to other body segments [ 17 , 18 ]. The circumferences measured separately in the present study are within normal ranges [ 12 ], showing a positive correlation between CC, length and HC, regardless of sex, with weight and HC as the main predictors of CC.
In the present study, the newborns exhibited adequate weight for gestational age, and satisfactory HC and CC, with higher measures in the group of boys. However, the difference in CC between the girls and boys was not statistically significant, and similar to normal growth patterns reported in the literature [ 6 ]. In a longitudinal study, Jaldin et al. These authors obtained higher CC values in boys, albeit not exceeding 1 cm above the average for the age under study, corroborating the present study.
Streja et al. In this perspective, a contextualized assessment of the level and quality of NB development and formulation of predictive equations are indispensable [ 27 , 28 , 29 , 30 ]. The practical utility of the equation for neonatologists may be useful.
Note that we frequently update this list! And most importantly — remember these measurements are just averages and every child grows at a different rate. But remember, if you have access to the child — or even to one of their pieces of clothing — all the better! In any case, adding a way to extend the wearing time is a great idea. Children tend to grow in spurts, and their height and arm length will often increase more quickly. Yadao, MD. Comments 2. Sort by: Newest. Newest Oldest.
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