Comparative Assessment of Fetal Malnutrition by Anthropometry and CAN Score

Objectives: Fetal malnutrition (FM) implies soft tissue wasting at birth with significant postnatal consequences and morbidity, and is identified by clinical assessment (CAN score) and anthropometry. No previous studies have been done to study all these parameters and evolve a screening method. The aim of this study was identifying the incidence of FM using CAN score and compare the nutritional assessment with anthropometry and evolve a screening tool for rapid assessment of FM.
Methods: Prospective study in Government district maternity hospital. 300 term newborns were assessed by CAN score and anthropometry recorded. The newborns were classified as per weight for age. Ponderal index (PI), Body mass index (BMI) and midarm circumference/head circumference ratio (MAC/HC) calculated and compared to CAN Score for accuracy in identifying FM.
Findings: Incidence of FM was 24%. Newborns identified malnourished by PI, BMI, MAC/HC were evaluated by CAN score and significant number of them (31/78 in PI, 60/121 in BMI, 51/81 in MAC/HC) were found well nourished. Similarly those recognized as normal by PI, BMI, MAC/HC were malnourished by CAN score(25/222 in PI, 11/179 in BMI, 42/219 in MAC/HC) with statistical significance(0.0001). BMI had the highest sensitivity and 11 neonates with normal BMI had low CAN score ann 9 of them had normal PI also  making a combination of BMI and PI a good indicator of normal nutrition.
Conclusion: FM is best identified by CAN Score. BMI is the best screening tool for malnutrition and when coupled with PI will identify most normally nourished newborns.