Study related to paediatrics

8/13/2019 Study related to paediatrics

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A STUDY OF CORRELATION OF

FOOT LENGTH AND

GESTATIONAL MATURITY INNEONATES

By

Dr. DEEPA S., MBBS

Dissertation S!"itte# to t$e

Ra%i& Gan#$i Uni&ersity o' Hea(t$ S)ien)es, *arnata+a, Bana(ore

In -artia( '('i(("ent

o' t$e reire"ents 'or t$e #eree o'

DOCTOR OF MEDICINEIn

PAEDIATRICS

Un#er t$e i#an)e o'

Dr. /I0AY*UMAR B., MD,DCHPro'essor

DEPARTMENT OF PAEDIATRICS

MYSORE MEDICAL COLLEGE AND RESEARCH INSTITUTE

MYSORE1234 456

APRIL 5464


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RA0I/ GANDHI UNI/ERSITY OF HEALTH SCIENCES,

*ARNATA*A, BANGALORE

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled 7A STUDY OF CORRELATION

OF FOOT LENGTH AND GESTATIONA L MATURITY IN NEONATES8 is a

bonafide and genuine research work carried out by me under the guidance of

Dr. /I0AY*UMAR B., MD,DCH, Professor, Department of Paediatrics, Mysore

Medical College and Research Institute, Mysore.

I have not submitted this previously to this niversity or any other niversity for

the award of any degree or diploma.

Date! Dr. DEEPA S.

Postgraduate in PaediatricsPlace! Mysore Mysore Medical College and Research Institute,

Mysore


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iii

AY*UMAR B., MD,DCH

CERTIFICATE BY THE GUIDE

"his is to certify that the dissertation entitled 7A STUDY OF CORRELATION

OF FOOT LENGTH AND GESTATIONA L MATURITY IN NEONATES8 is a

bonafide research work done by Dr. DEEPA S. , in partial fulfillment of the

re#uirement for the degree of Doctor of Medicine in Paediatrics.

I have immense pleasure in forwarding this dissertation to Ra$iv %andhi

niversity of &ealth 'ciences, (arnataka, )angalore.

Date! Dr. /I0Professor

Place! Mysore Department of Paediatrics,

Mysore Medical College and Research Institute,

Mysore.


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Dr. B. *RISHNAMURTHY, MD,DCH Dr. D. /EN*ATESHA, MD

Professor and &ead Director*Dean,

Department of Paediatrics, Mysore Medical College and

Mysore Medical College and Research Institute,

Research Institute, Mysore.

Mysore.

Date! Date!

Place! Mysore Place! Mysore

iv

ENDORSEMENT BY

THE HEAD OF THE DEPARTME NT AND DIRECTOR9DEAN

"his is to certify that the dissertation entitled 7A STUDY OF CORRELATION OF

FOOT LENGTH AND GESTATIONAL MATURITY IN NEONATES8 is a

bonafide and genuine research work done by Dr. DEEPA S. under the guidance of

Dr. /I0AY*UMAR B., MD,DCH, Professor, Department of Paediatrics, Mysore

Medical College and Research Institute, Mysore.

I have immense pleasure in forwarding this dissertation to Ra$iv %andhi

niversity of &ealth 'ciences, (arnataka, )angalore.


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v

RA0I/ GANDHI UNI/ERSITY OF HEALTH SCIENCES,

*ARNATA*A, BANGALORE

COPYRIGHT De)(aration

!yt$e )an#i#ate

I hereby declare that the Ra$iv %andhi niversity of &ealth 'ciences, (arnataka,

)angalore shall have the rights to preserve, use and disseminate this dissertation in print

or electronic format for academic*research purpose.

Date! Dr. DEEPA S.

Postgraduate in Paediatrics

Place! Mysore Mysore Medical College and Research Institute,

Mysore

RA0I/ GANDHI UNI/ERSITY OF HEALTH SCIENCES


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vi

AC*NO:LEDGEMENTS

I owe a great debt of gratitude to my respected teacher and guide,

Dr. /i%ay+"ar B., Professor, Department of Paediatrics, Mysore Medical College and

Research Institute, Mysore for his advice, appropriate guidance, constant supervision and

encouragement provided to me throughout the period of this study. I e+press my deep

sense of gratitude to him for his utmost patience and keen interest in completing my

dissertation successfully.

I wish to thank with due respect and deep gratitude to Dr. B. *ris$na"rt$y

, Professor and &ead, Department of Paediatrics, Mysore Medical College and Research

Institute, Mysore, for his precious timely suggestions and advice that helped me to a great

e+tent.

I am e+tremely grateful and wish to e+tend my sincere thanks to Dr. S#$a

R#ra--a and Dr. *"ar G.M. , Professors, Department of Paediatrics, Mysore

Medical College and Research Institute, Mysore, for their valuable guidance and

suggestions.

I e+press my deep sense of gratitude and sincere thanks to Dr. Sa&it$a M.R.

, ssistant Professor, for her invaluable help in preparing this dissertation.

I wish to e+press my sincere regards to Dr. Us$a+iran C.B. and Dr. Man%nat$

, -ecturers, for their kind cooperation and timely help.

I wish to thank Dr. S$ai(a%a B. , 'enior 'pecialist, for her help and support.


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I also e+press my gratitude to the Dire)tor9Dean, Mysore Medical College and

Research Institute S-erinten#ent, Cheluvamba &ospital and the /thical Committee for

allowing me to conduct this study.

I am most e+tremely thankful to my parents and husband, for their moral support

during the study period.

I wish to thank Dr. Lan)y D;So


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LIST OF ABBRE/IATIONS

% 1 ppropriate for gestational age

)PD 1 )iparietal diameter

)2t 1 )irth weight

CC 1 Chest circumference

C&- 1 Crown heel length

cm3s4 1 Centimeter3s4

0- 1 0oot length

g 1 %ram

% 1 %estational age

&C 1 &ead circumference

IC 1 Intensive care unit

IMR 1 Infant mortality rate

I%R 1 Intra uterine growth retardation

(cal 1 (ilocalories

(g 1 (ilogram

-)2 1 -ow birth weight

-% 1 -arge for gestational age

-MP 1 -ast menstrual period

p 1 Probability value

P&C 1 Primary health centre

r 1 Correlation coefficient

'% 1 'mall for gestational age

") 1 "raditional birth attendants

'% 1 ltrasonography

5-)2 1 5ery low birth weight

2&6 1 2orld &ealth 6rganisation

viii


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ABSTRACT

BAC*GROUND AND OB0ECTI/ES

'ince decades attempts have been made to find an alternative measurement for

gestational age and birth weight estimation of the newborns. ppropriate and timely care

of a low birth weight newborn is important but this is difficult in developing countries

since most of the deliveries are conducted at home where ade#uate facilities to weigh a

newborn does not e+ist. 0oot length has been studied by various authors as pro+y

measurement which can be measured easily in sick and preterm newborns. "his study

was done to find correlation of foot length with gestational age and other anthropometric

measurements 3birth weight, head circumference and crown heel length4.

METHODOLOGY

'tudy sample of 788 newborns were selected by simple random sampling

techni#ue born at Cheluvamba &ospital attached to Mysore Medical College and

Research Institute, Mysore from December 988: to ;ovember 9887. )abies with limb

deformities were e+cluded from the study group. %estational age was assessed by

;ew )allard score and babies were grouped into term, preterm and post


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RESULTS

In the study male newborns were >?@ and female A:@. In the study group

98? babies 39>.A@4 were low birth weight babies. >98 newborns 3B>@4 had birth weight

in the range of 9.>


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P % 6.

I. ODU 0 E

9. Dl/ A

OF

s. ST

:.

!7.

E8.

i4 )--RD CORE 1

ij) 5) CO GO

iii) E

iv4 "& PP/D E

) TER HART E

+i


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LIST OF TABLES

Ta!(e

No.

Tit(e Pae

No.

6 Identifiable causes of preterm birth 6>

5 0actors often associated with intrauterine growth retardation 5?

@ 'e+ distribution of babies based on their birth weight 2

Descriptive statistics of birth weight under different categories 2?

2

Distribution of babies according to their maturity and weightDescriptive statistics of head circumference for different groups of

babies>

64

66

Descriptive statistics of crown heel length for different groups of

babies

Correlation between foot length and other variables for preterm %

34

36

65 Correlation between foot length and other variables for preterm '% 3@

6@ Correlation between foot length and other variables for term % 32


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Ta!(e

No.

Tit(e Pae

No.

6 Correlation between foot length and other variables for term '% 33

62 Correlation between foot length and other variables for term -% 3>

6 Correlation between foot length and other variables for post


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LIST OF FIGURES

Fire

No.Tit(e Pae

No.

6 "he vicious cycle of low birth weight babies in developing countries 5>

5 ;ewborn maturity rating and classification 3;ew )allard 'core4 @

@ 'liding calipers used for measuring foot length 26

Demonstration of measurement of foot length using sliding caliper 26

2 Demonstration of measurement of head circumference using a fle+ible, 25non Mean birth weight with respect to birth weight groups 2>

64 Classification of newborns according to their maturity 4

66 Classification of newborns according to their weight


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1

INTRODUCTION

/arly in this millennium, India and ;ations around the world committed

themselves to achieve the Millennium Development %oals. %oal factor aims to

reduce under > mortality by 9*?rd

between E8. "his means reducing

under > mortality to ?B per E888 live births and the Infant Mortality Rate to

9:*E888 live births. "oday, while there have been encouraging signs, IndiaHs IMR

remains high at >7*E888 livebirths.

"he most challenging part of infant mortality is the large proportion of

new born deaths, contributing to an estimated BA@ of all infant deaths, mostly

in the first week of life.E

Ma$or causes of neonatal mortality are diseases

associated with preterm birth, low birth weight babies3-)24 and lethal congenital

anomalies.

"hus birth weight is an important indicator of survival, future growth and

overall development of the child. It is associated with socio


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"his alternative measurement should be easy to be conducted even by

ine+perienced health care staff and should have a very little intra and inter

observer variability.>

"he techni#ue used for measuring such a parameter should

be simple so that even an untrained health care staff can do the measurement

reliably. 0oot length is one such parameter which can be measured easily in

preterm and sick neonates without disturbing thebaby.

"his study is being done to find a correlation between foot length,

gestational age and other anthropometric measurements.


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4

OB0ECTI/ES

E. "o study the correlation of foot length and gestational age among preterm,

term and post


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5

RE/IE: OF LITERATURE

Histori)a( As-e)ts

In E7A, the first world health assembly recogni=ed the importance of

prematurity as a worldwide cause of infant deaths and adopted an international

definition of prematurity, i.e. a baby whose birth weight is less than 9>88 g. "he

2&6 e+pert group on prematurity endorsed this international definition but

reali=ed that it would not be applicable in each and every country.B

In many parts of the world the international definition proved useful for

separating off babies which re#uired some form of special care, but in other

countries the use of this standard resulted in unusually high proportions of

premature babies, many of whom were not born preterm and did not seem to

re#uire any special care. "his led to local adoption of various low birth weight

standards which created confusion and prevented comparisons.

"he time for re88 gm and less at birth were born after ?: weeks of gestation but with a low

birth weight. In view of the convincing evidence that many of the babies included

in the international definition were not born prematurely, an e+pert committee on

maternal and child health 32&6, EBE4 recommended that concept of

prematurityH should give way to that of low birth weightH.


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'ince decades many authors have studied the utility and reliability of

anthropometric parameters as an alternative for gestational age and birth weight

assessment.

Parameters such as chest and arm circumference and length of the baby

and its correlation with birth weight were analy=ed in a study done by

;ikorn Dusitsin.:

"his study was done to find an alternative to birth weight

measurement so that it can be used at primary health care level in developing

countries like India, where ma$ority of births are conducted at home and the

measurement of birth weight is very difficult due to nonB cm4 and a mid arm

circumference of 7. cm which corresponded well with birth weight of 9.> kg and

a home made measuring tape has been devised based on mid arm circumference to

detect birth weights with cut off values for 9>88 g, 9888 g to 9>88 g and 9888 g in

different shades of colour for illiterate birth attendants.9

'harma K; et al concluded that gestational age had a good correlation with

birth weight and crown heel length. "hey also concluded that birth weight had a

very good correlation with mid arm circumference and chest circumference. "hey

have suggested these measurements as an alternative to birth weight and

gestational age assessment.7

)hatia )D et al. concluded that there is a good

correlation between arm circumference and birth weight.


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7

Dubowit= -M' et al. in E:8 described LClinical assessment of gestational

age in the new born infant.E8

)allard K- et al. described a simplified score of fetal

maturation of newly born infantsEE

and in EE published L;ew )allard score,

e+panded to include e+tremely premature infants.E9

;eela K et al. in EE described usefulness of calf circumference as a

measure for screening low birth weight infants.E?

De


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8

Platt -D et al in their study described that the ultrasonic measurements of

fetal foot length gave a reliable assessment of anatomical fetal or neonatal foot

length and was highly correlated to the gestational age of the fetus.E7

(umar %P et al. have reported that gestational age of the fetus can be

estimated from hand and foot length. "hey found that the period of gestation in

weeks can be obtained from foot length by multiplying foot length by ?.A7B? and

adding 7.7BA.E

&ern 2M et al. correlated fetal measurements, especially fetal foot length

with fetal age, as measured by -ast Menstrual Period 3-MP4, for specimens

obtained after dilatation and evacuation and abortion. 0etal measurements,

including weight, knee


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especially when other parameters do not accurately predict gestational age as in

conditions like hydrocephalus, anencephaly and short limb dysplasia.9?

Mhaskar R et al in their study of fetuses in the age group E? to A9 weeks

gestation demonstrated a strong correlation between foot length and gestational

age.9A

Daga 'R et al. have suggested foot length corresponding to ?A weeks

gestational age as a cut


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%ohil et al found significant relationship between foot length and other

body parameters 3birth weight, crown heel length and head circumference4.

&ighest correlation in preterm babies was with crown heel length and weight, and

in term babies with head circumference. "hey concluded that foot length could be

useful in deriving the surface area more accurately than from birth weight alone

for the calculation of drug dosage and fluid re#uirements in preterms.?9

Madhulika et al. studied E888 live born babies of various gestational ages

to establish normal anthropometric limb standards in newborns. 5arious limb

anthropometric measurements 3upper arm length, hand length, hand breadth, little

finger length, leg length4 were taken and their correlation with gestational age was

analy=ed. 0oot length correlated best with gestational age amongst all the

measurements 3rG8.A4. "hey have suggested that limb standard can be of use in

determining gestational age, intrauterine growth rate and early detection of various

syndromes with abnormal skeletal growth rate as their characteristic features.??

Merlob P et al. in their study have suggested lower limb anthropometry

3total lower limb length, leg length and foot length to be helpful in evaluation of

disproportionate short stature in neonatal skeletal dysplasia. "hese lower limb

standards will help the clinician to discriminate unusual lengths and ratios in

newborns.?A

study was done by (ulkarni et al. to know the range of values for the

foot length in infants from 9B


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other anthropometric indices 3birth weight, length4 and foot is usually accessible

for measurement even in preterms nursed in incubators.?>

'hepard "& et al have described a scatter diagram correlating foot length

and gestational age.?B

/mbleton ;D et al in their study used foot length as a predictor of

nasotracheal tube length. "hey found foot length to be a good predictor of

nasotracheal distances than body weight, gestational age and head circumference.

"hey have concluded foot length as a reliable and reproducible predictor of

nasotracheal tube length and an e#uivalent predictor to birth weight estimation

which can be very useful in sick unstable infants.?:

Kohnson MP et al. in their study found that the 3legNarm length4*foot length

ratio was significantly shortened for fetuses with trisomy 9E, on direct necropsy

measurements.?7

Droste ' et al. used ultrasonographic foot length measurement to generate

regression lines for adrenal gland weight.?

Malas M et al. studied about the growth of the upper 3width of the

shoulder and the length of the arms, forearms and hands4 and lower 3width of iliac

crest, knee condyles, feet, and heels and the length of the thighs, legs and feet4

e+tremities of "urkish fetuses during the fetal period. 'tatistically significant

correlations found between foot


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13

mato M et al in EE did a study to compare foot length and

intermamillary distance to gestational age assessment using obstetrical dates,

physical criteria of )allard score and evaluation of anterior vascular capsule of the

lens. "hey concluded that the appropriate use of biometric parameters in the early

postnatal period can be used to improve assessment of gestational age in very low

birth weight infants.AE

Mer= / et al in their study have established age


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is important. More accurate tables of these measurements allow for greater

precision in correlating gestational duration and foot length.AA

In a study done by 'hambhu 'haran 'hah et al., foot length was found to

be best correlating with birth weight 3r G 8.9, p F 8.88E4 and foot length was

recommended as a pro+y measurement to birth weight assessment.A>

Mullany -C et al. conducted a study to compare the validity of chest

circumference and foot length as surrogate anthropometric measures for

identification of low birth weight and very low birth weight infants. "hey

concluded that for identification of very low birth weight infants, foot length

performed well and may be preferable to chest circumference as the former

measure does not re#uire removal of infant clothes.AB


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FETAL GRO:TH AND DE/ELOPMENTA:,A7

"he most dramatic events in growth and development occur before birth.

"hese changes are overwhelmingly somatic, i.e. the transformation of a single cell

into an infant. "he uterus while offering a degree of protection is affected

by social, psychological and environmental influences. "he comple+ interplay

between these forces and the physical transformations occurring in


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B. Feta( Perio#

0rom th

week onwards fetal somatic changes consist of increase in cell

number and si=e and structural remodelling of several organ systems.

)y E8th week, the face is recogni=ably human. "he midgut returns from the

umbilical cord into the abdomen rotating counter


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dendrites and the elaboration of synaptic connections continue at a rapid pace,

making the central nervous system vulnerable to teratogenic or hypo+ic influences

throughout gestation.

BEHA/IOURAL DE/ELOPMENT

Muscle contraction first appears around 7 weeks, soon followed by lateral

fle+ion movements. )y E?


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"he wide range of outcomes observed reflects the comple+ interactions

among biologic and social risk and protective factors.

INFANTS OF LO: BIRTH :EIGHT

s per 2&6 criterion, a low birth weight baby is one with a birth weight

of less than 9>88 g 3upto and including 9A g4 irrespective of the period of

gestation. "his definition has less practical significance in countries like India as

most -)2 infants are mature by gestation.

INCIDENCE

In accordance with 2&6 criterion for -)2 about ?8


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A. In)i#en)e

bout E8


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B. Aetio(o,y

"he mechanisms initiating normal labour are not clearly understood and

much less are known about the factors that initiate labour before term. "here may

be spontaneous onset of premature labour or it may be induced by the obstetrician

to safeguard the interests of the mother or thebaby.

S-ontaneos

"he cause of premature onset of labour is uncertain in most instances. "he

known causes include poor socio


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C. P$ysio(oi)a( Han#i)a-sA

6. Centra( ner&os syste"

"he immaturity of nervous system is e+pressed as inactivity and lethargy,

poor cough refle+ and incoordinated sucking and swallowing in babies weighing

less than E788 g or born before ?> weeks of gestation. Resuscitation difficulties at

birth and recurrent apneic attacks are common. Retrolental fibroplasias due to

o+ygen to+icity is limited to babies with a gestation of less than ?> weeks. 6n the

other hand, they are more resistant to to+ic effects of hypo+ia as compared to the

term babies. "hey are e+tremely vulnerable to develop intraventricular8,>E,>9

Premature infants are vulnerable to a wide spectrum of morbidity.

E. Developmental disability

a. Ma$or handicaps 3cerebral palsy, mental retardation4

b. 'ensory impairments 3hearing loss, visual impairment4

c. Minimal cerebral dysfunction 3language disorders, learning

disability, hyperactivity, attention deficit, behaviour disorders4.

9. Retinopathy ofprematurity

?. Chronic lung disease

A. Poor growth

>. Increased rates of post neonatal illness and rehospitali=ation.

B. Increased fre#uency of congenital anomalies.

:. Increased risk of child abuse and neglect.

II. INFANTS :HO ARE SMALL FOR GESTATIONAL AGE

De'inition

"here is no uniform definition of '%, although most reports define it as

two standard deviation below the mean for gestational age or as below the tenth

percentile. number of Lnormal birth curves have been defined using studies of

large infantpopulations.>8

5arious names have been applied to these infants, vi=. light


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insufficiency syndrome, etc.?

In developing countries three


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dermatoglyphics. "heir cell population is also reduced, resulting in permanent

mental and physical growth retardation.

@. Mie# s"a(('orestationa( ae !a!ies

"hey are the outcome of adverse intrauterine environmental influences

operating from early or mid pregnancy. "hese infants, though small for the period

of their gestation, neither look obviously malnourished or grossly hypoplastic.

"hey show varying degrees of reduction in cell population and si=e.

Ta!(e 5= Fa)tors o'ten asso)iate# it$ intraterine rot$ retar#ationA:

6. Feta(

Chromosomal disorders 3e.g. utosomal trisomies4

Chronic fetal infections 3e.g. cytomegalic inclusion disease, congenital

rubella, syphilis4

Congenital anomalies syndrome comple+es

Radiation in$ury

Pancreatic hypoplasia

Multiple gestation

5. P(a)enta(

Decreased placental weight or cellularity orboth

Decrease in surface area

5illous placentitis 3bacterial, viral,parasitic4

Infarction

bruption

Previa

"umour 3chorioangioma, hydatidiform mole4

"win transfusion syndrome

@. Materna(

"o+emia

&ypertension or renal disease, orboth

&ypo+ia 3high altitude, cyanotic cardiac or pulmonary disease4

Malnutrition or chronic illness

'ickle cell anaemia and other hemoglobinopathies

Drugs 3narcotics, alcohol, cigarettes, cocaine, antimetabolites4


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'hort and light

ndernourished mother

3illiteracy,poverty4

'mall 'mall

boy girl

Q 'mall uterus ;eglect and ill health

Poor nutritional Poor nutrition during

stores, anaemia, childhood

fre#uentpregnancies

-ack of schooling

and education

Poor adolescent

growth spurt

Fire 6= T$e &i)ios )y)(e o' (o !irt$ ei$t !a!ies in #e&e(o-in )ontriesA

Cases

0rom the table 9, it is obvious that cause may rest with the mother, placenta

or the fetus itself. Infant with intrauterine growth retardation has small placenta

but fetoplacental ratio is unaffected and varies between >.>!E to B!E

6. Materna( Ma(ntritionA

Relatively high incidence of small


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affecting fetal growth. 'mall newborn baby of these mothers may grow up to

become a small girl due to altered growth potential and e+posed to further

deleterious effects of socio


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demonstrated that supplementation of iron and folic acid during last trimester of

pregnancy is associated with increased mean weight of the off


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3. Birt$ or#er

Primiparas have a higher percentage of -)2 babies than women of other

parity. 6n the other hand, birth weight is also adversely affected in grand

multipara women 3i.e. para ? and more4.A

?. Se

0emale infants weigh lesser than male infants of comparable gestational

age.

>. Mis)e((aneos )ases

a. Materna( s!stan)e a!se like smoking, tobacco chewing and alcohol

consumption cause -)2 babies. "he incidence of low birth weight doubles if the

pregnant woman smokes more than 98 cigarettes per day. If a pregnant woman

chews A88 mg of tobacco everyday, the birth weight of the baby is reduced by

upto >A9g compared to control women. If a mother consumes two alcoholic drinks

everyday during pregnancy, the birth weight of the baby is reduced on an average

by E>>g.A

!. A(tit#e= ltitude is not a simple variable but involves cosmic radiation,

decreased partial pressure of o+ygen, increased ultraviolet radiation, decreased

humidity and temperature. &igher the altitude more the incidence of -)2.

MANAGEMENT OF THE SGA INFANT AT BIRTH

a. De(i&ery= /arly delivery is necessary if the risk to the fetus of remaining

in utero is considered greater than the risks of prematurity. %enerally

indications for delivery are arrest of fetal growth, fetal distress, andpulmonary

maturity near term, especially in a mother with hypertension. If there is poor

placental blood flow, the fetus may not tolerate labour and may re#uire

caesarean delivery.


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'% infants are at risk for perinatal problems and often re#uire speciali=ed

care in the first few days of life. "herefore, if possible, delivery should occur at a

centre with a high risk care nursery. "he delivery team should be prepared to

manage fetal distress, perinatal depression, meconium aspiration, hypo+ia,

hypoglycemia and heat loss.

!. In t$e nrsery

i Ne!orn ea"ination= "he infant should be evaluated for any of the causes

listed in table 9 especially chromosomal abnormalities, malformations and

congenital infection.

6. Infants who had growth restriction due to factors influencing the last

part of pregnancy 3e.g. maternal renal disease, pre


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ii Pat$o(oi) ea"ination o' t$e -(a)enta 'or in'ar)tion or )on,enita(

in'e)tion "ay !e $e(-'(.

iii Genera((y sero(oi) s)reenin 'or )onenita( in'e)tion is not in#i)ate#

n(ess $istory or ea"ination sests in'e)tion as a -ossi!(e )ase.

i& E&a(ation 'or t$e 'o((oin )o"-(i)ations re(ate# to IUGR is #one an#

a--ro-riate(y "ana,e#

E. Congenital anomalies

9. Perinatal depression

?. Meconium aspiration

A. Pulmonary hemorrhage

>. Persistent pulmonary hypertension

B. &ypothermia

:. &ypoglycemia

7. &ypocalcaemia

. cute tubular necrosis*renal insufficiency

E8. Polycythemia

EE. "hrombocytopenia

E9.;eutropenia

). S-e)i'i) Manae"ent )onsi#eration

i. Fee#in= '% infants in general re#uire more calories per kg than % infants

for Lcatch


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ii. 'erum calcium levels may be significantly depressed in preterm '% infants

and*or those who have e+perienced hypoperfusion.

iii. "he serum sodium concentration may also be low.

Lon ter" -ro!(e"s o' SGA in'ants>8,>9,>?,>A

It is difficult to determine specific effects of I%R because there are often

overlapping effects from prematurity and asphy+ia, and also because of the

multifactorial etiologies involved. "hese infants are at risk for poor postnatal

growth and neurologic and developmental handicaps. "hese handicaps occur even

in the absence of specific fetal disease 3e.g. chromosomal abnormalities4. "his is

especially true in those who suffered perinatal asphy+ia or hypoglycemia 3orboth4

at birth. 0or any weight group the total percentage of infants who either die before

one year of age or are handicapped at one year is similar for '% and %

infants. &owever, '% infants have less risk of neonatal death compared with

preterm % infants of same birth weight but a greater risk of morbidity at one

year of age.

0inally, some adults who were '% at birth appear to have a higher risk of

coronary heart disease and related health problems, including hypertension,

non


51/135

36

9. "he health of mother and fetus should be assessed throughout pregnancy by

ultrasound and non8

?. /arly delivery should be considered if fetal growth ispoor.


52/135

37

LARGEFORGESTATIONAL AGE INFANTS

De'inition

"he newbornHs birth weight is two standard deviations above the mean or

above the ninetiethpercentile.

Aetio(o,y

E. Constitutionally large infants 3infants of largeparents4

9. Infants of diabetic mothers 3e.g. classes , ) and C4

?. 'ome post term infants

A. )eckwith2iedemann and other syndromes Marshall


53/135

38

POSTMATURITY>8

De'inition

"he newbornHs gestational age e+ceeds A9 weeks.

Aetio(o,y

"he cause of prolonged pregnancy is unknown in most cases. "he

following are known associations.

E. Anen)e-$a(y! n intact fetal pituitary adrenal a+is is involved in the initiation

of labour. Disruption in this a+is causespostmaturity.

9. "risomies EB and E7

?. 'eckel syndrome 3bird< headed dwarfism4

A. /rroneous estimation of gestational age.

SYNDROME OF POSTMATURITY

Postmature infants usually have normal length and head circumference. If

they have postmaturity syndrome, however, they would have begun to lose weight.

'% infants also may have these signs and symptoms and postmature infants may

also be '%.

Postmature infants are classified clinically as follows.

E. 'tage E

a. Dry, cracked, peeling, loose and wrinkled skin.

b. Malnourished appearance

c. Decreased subcutaneous tissue

d. 6pen eyed and alertbaby.


54/135

39

9. 'tage 9

a. ll features of stage E

b. Meconium staining of amniotic fluid

c. Perinatal depression 3in some cases4

?. 'tage ?

a. "he findings in stage E and 9

b. Meconium staining of cord and nails

c. higher risk of fetal, intrapartum or neonatal death

RIS*

"here is an increase in mortality with postmaturity. It was shown that

careful induction of delivery or caesarean section after A9 weeks resulted in a

decreased mortality compared with the results seen following conservative

e+pectant therapy.

MANAGEMENT

E. Prepartum management

a. Careful estimation of true gestational age, including date from

ultrasonic e+amination.

b. Careful monitoring of fetal wellbeing.

9. Intrapartum management involves use of fetal monitoring and preparation for

possible perinatal depression and meconium aspiration.

?. Postpartum management

a. /valuations for complications related to postmaturity the following

conditions occur more fre#uently in postmature infants.

i. Congenital anomalies


55/135

40

ii. Perinatal depression

iii. Meconium aspiration

iv. Persistent pulmonary hypertension

v. &ypoglycemia

vi. &ypocalcemia

vii. Polycythemia

b. /arly feeding for proper nutritional support is important.

s both I%R babies and preterm babies are very delicate and re#uire

speciali=ed care starting from day one of life to prevent all the above said

complications it becomes very important to identify low birth weight babies and

preterm babies at the earliest. )ut as statistics show most of the neonatal mortality

occurs in rural setting i.e. ?>.> per E888 live births compared to the >.: per E888

live births in urban settings. 2hen no medical care facilities are available neonatal

mortality is >?.B per E888 live births compared to 99.9 per E888 live births in a

place where all three levels of neonatal care are available. ;eonatal mortality is

EE8 per live births in low birth weights compared to ?8 per E888 live births in

average si=ed babies.?

"hese statistics tell neonatal mortality is A times greater in

very small babies compared to average babies, and B times more in rural setting

compared to urban setting and 9.> times more in a place where no medical care

facilities are available compared to a setup with all three levels of health care

available.

2here ade#uate surveillance and treatment are not possible locally, or the

response to treatment is unsatisfactory, infants should be referred to an appropriate


56/135

41

health care establishment. 'urveillance and referral are even more important for

very


57/135

42

GESTATIONAL AGE ESTIMATION AT BIRTH

OBSTETRIC INFORMATION>8

"he review of following obstetric data helps in gestational age assessment

atbirth.

. "he clinical estimate of gestational age is usually made through careful history

of the -MP. "he gestational age is calculated from the first day of the -MP.

"his, accompanied by physical e+amination forms the baseline criteria for

estimating gestational age. &owever, the maternal recall of the first day of the

-MP is fraught with error.>>

n additional ob$ective assessment then becomes

necessary.

). ltrasonic estimation of gestational age.>B

%estational age assessment is done

by the retrospective study of antenatal ultrasound e+amination. /arly second

trimester ultrasound e+amination is considered the gold standardH in the

estimation of gestational age. "he accuracy with which gestational age canbe

estimated by biparietal diameter 3)PD4 decreases with increasing gestational

age. "he length of the calcified fetal femur is often measured and used in

validating )PD measurements or used alone in circumstances where )PD

cannot be measured 3e.g. deeply engaged fetal head4 or is inaccurate 3e.g.

hydrocephalus4.

C. Date of first recorded fetal activity L#uickening is first felt at appro+imately

EB


58/135

43

NE:BORN INFORMATION

Ne Ba((ar# S)ore

"he tone, posture and physical appearance of the baby are considered to

make a composite score. "his composite score is used to assess the newbornHs

likely gestational age in the period immediately after birth. 30igure 94

Fire 5= Ne!orn "atrity ratin an# )(assi'i)ation Ne Ba((ar# S)ore

'ource! )allard et al., ;ew )allard 'core, e+panded to include e+tremely premature infants. K PediatrEEEE!AE:


59/135

44

CLASSIFICATION OF INFANTS BY

GESTATIONAL AGE AND BIRTH :EIGHT

I. Infant classification by gestational age 3independent of birth weight, 2&6

E>84

Pre88 g

less than that of merican newborn of same gestational age. It was assessed by

Indian workers that 9888 g or less should be taken as the criterion of -)2 of

Indian infants.>:

5ery low birth weight. 35-)24! FE>88 g

/+tremely low birth weight ! FE888 g

Impossibly or incredibly low birth weight ! F :>8 g

III. Classification of infants depending on both gestational age and birth weight


60/135

45

0or each gestational age, a newborn can be appropriate for gestational age

3%4, small for gestational age 3'%4 or large for gestational age 3-%4.

5arious criteria 3i.e. cut


61/135


62/135

47

CHEST CIRCUMFERENCE

It is measured at the level of nipple * at the level of fourth costosternal

$oint.9,E>

"here is less chance of systematic or random error in estimation of chest

circumference for the following reasons.

E. "he level at which it is measured is based on bony land marks.

9. It has got larger cross section compared to other anthropometric measurements

such as mid arm circumference.

MID1ARM CIRCUMFERENCE>:,>7,>

"o identify the position of the mid


63/135

48

PROPORTIONALITY INDICES

"he most commonly used inde+ of neonatal body proportionality relates

birth weight to length.

RohrerHs Ponderal inde+ is e#ual to one hundred times the birth weight 3in

grams4 divided by the cube of birth length 3cm?4.

)irth weight 3in g4

RohrerHs Ponderal Inde+ G + E88)irth length 3in cm4

?

6ther proportionality indices that relate head circumference to length

3&C*length4 or chest circumference to length 3CC*length4 for e+ample have been

studied occasionally but further research would be needed to show that they offer

any advantage over the indicators previously mentioned.B

OTHER MEASUREMENTS

'kin fold thickness It has been used to assess newborn adiposity. 'ince

measurement of skin fold thickness is relatively imprecise, it is not currently

recommended for purposes of routine assessment.B


64/135

49

METHODOLOGY

MATERIALS

A Sor)e o' Data

"he study sample of 788 live newborns were selected by simple random

sampling techni#ue born at Cheluvamba &ospital attached to Mysore Medical

College and Research Institute, Mysore from December 988: to ;ovember 9887

3one year4.

In)(sion Criteria

-ive newborns of different gestational ages within :9 hours of birth.

E. Pre


65/135

50

METHOD OF COLLECTION OF DATA

Data was collected using standard proforma meeting the ob$ectives of the

study.

a Gestationa( ae assess"ent was done using modified )allardHs score

3nne+ure 3i44.

! Foot (ent$ was measured using sliding calipers which is having an accuracy

of a millimeter. 0oot length was measured from posterior most prominence of foot

to the tip of the longest toe of the right foot. t the time of measuring ventral

surface of foot was straightened out using gentle pressure. "he length of foot was

documented in centimeters.


66/135

51

Fire @= S(i#in )a(i-ers se# 'or "easrin 'oot (en,t$

Fire = De"onstration o' "easre"ent o' 'oot (ent$ sin s(i#in )a(i-er


67/135


68/135

53

# Cron $ee( (ent$ was measured using infantometer. n assistantHs help was

sought to do the length measurement. )abyHs lower limbs were straightened out

before doing the measurement. Measurement was documented in centimeters.

Fire = De"onstration o' "easre"ent o' )ron $ee( (ent$ sin,

in'anto"eter


69/135

54

e :ei$t o' t$e !a!y was measured using electronic weighing scale. "he scale

offered an accuracy of > gms. ll the dress of baby was removed before

weighing.

Fire 3= Birt$ ei$t "easre# sin e(e)troni) ei$in s)a(e

)abies were grouped into preterm, term and post


70/135

55

number of babies in this group were very less to be statistically significant. "here

were no babies in preterm -% group.

"he correlation between foot length and other parameters such as

gestational age, birth weight, head circumference and crown heel length was

analy=ed by applying correlation and regression analysis. Correlation coefficient

3r4 values and R s#uare 3r94 values were derived for the seven groups of babies

who have undergone analysis. 'catter diagram was plotted to demonstrate the

correlation between foot length and other anthropometric parameters.

Regression e#uation was derived to predict gestational age from foot length

in various groups ofbabies.


71/135

56

RESULTS

Ta!(e @= Se #istri!tion o' !a!ies !ase# on t$eir !irt$ ei,$t

Birt$ei,$t

+,

Ma(e Fe"a(e Tota(

N"!er N"!er N"!er

F 9.> E8B E?.? : E9.E 98? 9>.A

9.>


72/135


73/135

Ta!(e = Des)ri-ti&e statisti)s o' !irt$ ei$t n#er #i''erent )ate,ories

Birt$

ei,$t

+,

N"!er

o'

s!%e)ts

Ran,e MeanStan#ar#

De&iation

>2 )on'i#en)e

inter&a( 'or "ean

Loer!on#

U--er!on#

F 9.> 98? 8.:


74/135

2.8221

1.9696

Meanofbirthweight

Fire >= Mean !irt$ ei$t it$ res-e)t to !irt$ ei$t ,ro-s

3.65194

3.5

3

2.5

2

1.5

1

0.5

0

3.5

Birth weight

"he figure shows the mean of birth weight with relation to birth weight

groups.


75/135

Fire 64= C(assi'i)ation o' ne!orns a))or#in to t$eir "atrity

729!"

12415.5!"

60475.5!"

#er$ %re-ter$ %o&t-ter$

Pie chart showing the classification of newborns according to their

maturity.

Fire 66= C(assi'i)ation o' ne!orns a))or#in to ei$t1'or1estationa( a,e

35?

[email protected]

64565.?

AGA

SGA

LGA

Pie chart showing the classification of newborns according to weight


76/135

Ta!(e 2= Distri!tion o' !a!ies a))or#in to t$eir "atrity an# ei,$t1'or1

estationa( a,e

Matrity

AGA SGA LGA Tota(

No. No. No. No.

"erm >8 B?.B :9 .8 9? 9. B8A :>.>

Pre term EE8 E?.: EA E.7 8 8 E9A E>.>

Post term >? B.B EB 9.8 ? 8.A :9 .8

"otal B:9 7?. E89 E9.7 9B ?.? 788 E88

6f the total 788 newborns, "erm %, "erm '% and "erm -% were

>8 3B?.B@4, :9 3.8@4 and 9? 39.@4 respectively.

Preterm % and preterm '% were EE8 3E?.:@4 and EA 3E.7@4,

respectively.

Post


77/135

'($berofnewborn&

Fire 65= Distri!tion o' !a!ies a))or#in to t$eir "atrity an# ei,$t1'or1

estationa( a,e

550 509

500

450

400

350

300

250

200

150

100

50

0

110

53

72

14 1623

0 3

)*) +*) ,*)

eight-for-ge&tationa age

#er$

%re ter$

%o&t ter$


78/135

Ta!(e = Des)ri-ti&e statisti)s o' 'oot (ent$ 'or #i''erent ro-s o' !a!ies

Matrity

N"!er

o'

s!%e)ts

Ran,e MeanStan#ar#

De&iation

>2 )on'i#en)e

inter&a( 'or "ean

Loer!on#

U--er!on#

Preterm

'% EA A.::E 8.:88 >.:A:7 B.>BB>

Preterm

% EE8 A.>BA9 B.>7: B.78?8

"erm

'% :9 >.AB :.E>::

"erm

% >8 B.::8? 8.??:? :.>AE8 :.>:

"erm

-% 9? :.?? 7.99A?

Post:E cms, respectively. "he mean

foot length for term %, '% and -% was :.>:8?, :.8AE: and 7.8?E cms,

respectively. "he mean foot length for post


79/135

Preter" Preter" Ter" Ter" Ter" Post1 Post1 Post1

SGA AGA SGA AGA LGA ter" ter" ter"

SGA AGA LGA

Mean'oot(en,t$C)"E

Fire 6@= Mean 'oot (ent$ in #i''erent ro-s o' !a!ies

>

?

3 .6236

2

@

5

6

4

.>3.463

3.234@?.4@>6

3.2???.463

?.53

Matrity Gro-s

"his figure shows the mean foot length for various groups of neonates.

0igure shows that mean foot length increases as the gestational age increases.


80/135

Ta!(e 3= Des)ri-ti&e statisti)s o' estationa( ae 'or #i''erent ro-s o' !a!ies

Matrity

N"!er

o'

s!%e)ts

Ran,e MeanStan#ar#

De&iation

>2 )on'i#en)e

inter&a( 'or "ean

Loer

!on#

U--er

!on#

Preterm

'% EA 97.:9?

Preterm

% EE8 9B> 9.?>:? ??.:888 ?A.>8

"erm

'% :9 ?B


81/135


SGA AGA SGA AGA LGA ter" ter" ter"

SGA AGA LGA

MeanGestationa(a,eCD+sE

Fire 6= Mean estationa( ae o' #i''erent ro-s o' !a!ies

2

4 @[email protected]

@2

@4

52

54

62

64

2

4

@?.3@?.>6>

@>.5635 5 5

Matrity Gro-s

"his figure shows the relation between mean gestational age and various

groups ofbabies.


82/135

Ta!(e ?= Des)ri-ti&e statisti)s o' !irt$ ei$t 'or #i''erent ro-s o' !a!ies

Matrity

N"!er

o'

s!%e)ts

Ran,e MeanStan#ar#

De&iation

>2 )on'i#en)e

inter&a( 'or "ean

Loer

!on#

U--er

!on#

Preterm

'% EA 8.:


83/135


SGA AGA SGA AGA LGA ter" ter" ter"SGA AGA LGA

Mean!irt$Dei,$tC+,E

Fire 62= Mean o' !irt$ ei$t in #i''erent ro-s o' !a!ies

.2@.?3

@.2

@

5.4665.65>>

5.?5?

5.2@6

@.55@

5

6.2

6

4.2

4

6.@>@

Matrity

Gro-s

"his figure shows the relation between the mean of birth weight for

different groups of babies. Post


84/135

Ta!(e >= Des)ri-ti&e statisti)s o' $ea# )ir)"'eren)e 'or #i''erent ro-s o'

!a!ies

Matrity

N"!er

o'

s!%e)ts

Ran,e MeanStan#ar#

De&iation

>2 )on'i#en)e

inter&a( 'or "ean

Loer!on#

U--er!on#

Preterm

'% EA 9E.>


85/135

Ta!(e 64= Des)ri-ti&e statisti)s o' )ron $ee( (ent$ 'or #i''erent ro-s o'

!a!ies

Matrity

N"!er

o'

s!%e)ts

Ran,e MeanStan#ar#

De&iation

>2 )on'i#en)e

inter&a( 'or "ean

Loer

!on#

U--er

!on#

Preterm

'% EA ?A8 A8E A:.EE>? E.::A AB.A?E A:.97:>

"erm

-% 9? A>9 A7.>9E: 9.E9? A:.>:?: A.AB7

Post


86/135

Ta!(e 66= Corre(ation !eteen 'oot (ent$ an# ot$er &aria!(es 'or -reter"

AGA

Ant$ro-o"etri)

&aria!(es

N"!er o'

s!%e)ts

Corre(ation

r

R1sare

r5

-1&a(e

%estational age

3weeks4 EE8 8.7E8 8.B>B 8.888

)irth weight

3kg4 EE8 8.:B> 8.>7B 8.888

&ead circumference

3cms4 EE8 8.:9E 8.>E 8.888

Crown heel length

3cms4 EE8 8.:98 8.>E 8.888

0rom this table, it could be observed that the foot length correlated

significantly 3p F 8.8>4 with gestational age, birth weight, head circumference and

crown heel length. Correlation coefficient 3r


87/135

/ea01ir1($feren1e1$"

*e&tationa.agew2&"

3rownhee..ength1$"

Birthweight2g

"

Fire 6= S)atter #iara" o' t$e -reter" AGA ,ro-

45

40

35

30 *)

25

20

4 6 8

oot ength$"

3.5

3

2.5

2

1.5

1

0.5

0

4 6 8

oot ength$"

B wt

3836

34

32

30

28/

26

24

22

20

4 6 8

oot ength$"

50

45

40

35

30

4 6 8

oot ength$"

/,

"his scatter diagram of the preterm % group shows correlation of foot

length and other parameters like gestational age, birth weight, head circumference

and crown heel length. It is evident from the figure that the foot length correlated

significantly with all the variables. Ma+imum correlation was with gestational age

3r G 8.7E84.


88/135

Ta!(e 65= Corre(ation !eteen 'oot (ent$ an# ot$er &aria!(es 'or -reter"

SGA

Ant$ro-o"etri)

&aria!(es

N"!er o'

s!%e)ts

Corre(ation

r

R1sare

r5

-1&a(e

%estational age

3weeks4 EA 8.:A7 8.>> 8.889

)irth weight

3kg4 EA 8.7E> 8.BB> 8.888

&ead circumference

3cms4 EA 8.:: 8.B?B 8.88E

Crown heel length

3cms4 EA 8.:7B 8.BE7 8.88E

"he foot length correlated significantly 3p F 8.8>4 with all the other

anthropometric variables. Correlation coefficient 3r4 which indicates strong positive association between them.


89/135


*e&tationa.agew2&"

Birthweight2g"

3rownhee..ength1$"

Fire 63= S)atter #iara" o' t$e -reter" SGA ,ro-

39

37

3533

31 *)

29

27

25

4 6 8

oot ength$"

2.5

2

1.5

1

0.5

0

4 6

oot ength$"

Bt

34

32

30

28

26/

24

22

20

4 4.5 5 5.5 6 6.5 7 7.5

oot ength$"

4846

44

42

40

38

36

34

32

30

4 6

oot ength$"

/,

"his scatter diagram of the preterm '% group shows correlation of foot

length and other parameters. "his figure shows significant correlation of foot

length with all the four parameters, ma+imum being with birth weight 3r G 8.7E>4.


90/135

Ta!(e 6@= Corre(ation !eteen 'oot (ent$ an# ot$er &aria!(es 'or ter" AGA

Ant$ro-o"etri)

&aria!(es

N"!er o'

s!%e)ts

Corre(ation

r

R1sare

r5

-1&a(e

%estational age3weeks4

>8 8.AA8 8.EA 8.888

)irth weight

3kg4 >8 8.A> 8.9A> 8.888

&ead circumference

3cms4 >8 8.?>E 8.E9? 8.888

Crown heel length

3cms4 >8 8.A>9 8.98> 8.888

0rom this table, it could be observed that the correlation of foot length with

other anthropometric variables was significant 3p F 8.8>4. Correlation coefficient

3r


91/135


*e&tationa.age

w2&"

3rownhee..ength1$"

Birthweight2

g"

Fire 6?= S)atter #iara" o' t$e ter" AGA ,ro-

43

42

41

40

39

38 *)

37

36

35

6.5 7 7.5 8 8.5 9

oot ength$"

4

3.5

3

2.5

2

1.5

6.5 7 7.5 8 8.5 9

oot ength$"

B wt

37

35

33

31

/29

27

25

6.5 7 7.5 8 8.5 9

oot ength$"

5553

51

49

47

45

43

41

39

37

35

6.5 7.5 8.5

oot ength$"

/,

"his scatter diagram shows correlation of foot length and other variables in

term % group. 0oot length correlated significantly with all the variables,

ma+imum being with birth weight 3r G 8.A>4.


92/135

Ta!(e 6= Corre(ation !eteen 'oot (ent$ an# ot$er &aria!(es 'or ter" SGA

Ant$ro-o"etri)

&aria!(es

N"!er o'

s!%e)ts

Corre(ation

r

R1sare

r5

-1&a(e


:9 8.A7E 8.9?9 8.888

)irth weight

3kg4 :9 8.B:> 8.A>B 8.888

&ead circumference

3cms4 :9 8.>A? 8.9> 8.888

Crown heel length

3cms4 :9 8.B?B 8.A8A 8.888

"he foot length correlated significantly 3p F 8.8>4 with gestational age,

birth weight, head circumference and crown heel length. ll the parameters

showed positive correlation coefficient 3r4.


93/135

hea01ir1($feren1e1$"

*e&tationa.age

w2&"

3rownhee..ength1$"

Birthweight2

g"

Fire 6>= S)atter #iara" o' t$e ter" SGA ,ro-

40.5

40

39.5

3938.5

38

37.5

37

36.5

36

35.5

*)

5 5.5 6 6.5 7 7.5 8 8.5

oot ength$"

4

3.5

3

2.5

2

1.5

1

0.5

0

5 7

oot ength$"

Bt

36

34

32

30

28

26 /

24

22

20

5 5.5 6 6.5 7 7.5 8 8.5

oot ength$"

5048

46

44

42

40

38

36

34

32

30

5 7

oot ength$"

/,

"his scatter diagram shows correlation of foot length and other parameters

like gestational age, birth weight, head circumference and crown heel length in

term '% group of babies. It can be observed that foot length correlated

significantly with all the parameters. Ma+imum correlation was with birth weight

3r G 8.B:>4.


94/135

Ta!(e 62= Corre(ation !eteen 'oot (ent$ an# ot$er &aria!(es 'or ter" LGA

Ant$ro-o"etri)

&aria!(es

N"!er o'

s!%e)ts

Corre(ation

r

R1sare

r5

-1&a(e


9? 8.977 8.87? 8.E7?

)irth weight

3kg4 9? 8.8A 8.889 8.79B

&ead circumference

3cms4 9? 8.9EA 8.8AB 8.?97

Crown heel length

3cms4 9? 8.EA9 8.898 8.>E7

"here was no correlation between foot length and any of theparameters.


95/135


*e&tationa.age

w2&"

Birth-eight2g"

3rownhee..ength1$"

Fire 54= S)atter #iara" o' t$e ter" LGA ,ro-

40.5

40

39.5

39

38.5

38

37.5

*)

7 7.5 8 8.5 9

oot ength$"

4.6

4.4

4.2

4

3.8

3.6

3.4

3.2

3

7 7.5 8 8.5 9

oot ength$"

B wt

36

35.5

35

34.5

34

33.5

33

32.5

32

31.5

/

7 7.5 8 8.5 9

oot ength$"

5352

51

50

49

48

47

46

45

44

7 7.5 8 8.5 9

oot ength$"

/,

"his scatter diagram of term -% group shows correlation of foot length

and other parameters like gestational age, birth weight, head circumfernece and

crown heel length. "he figure shows no correlation between foot length and any of

theparameters.


96/135

Ta!(e 6= Corre(ation !eteen 'oot (ent$ an# ot$er &aria!(es 'or -ost1ter"

AGA

Ant$ro-o"etri)

&aria!(es

N"!er o'

s!%e)ts

Corre(ation

r

R1sare

r5

-1&a(e

%estational age

3weeks4 >? 8.8?: 8.88E 8.:9

)irth weight

3kg4 >? 8.A9A 8.E78 8.889

&ead circumference

3cms4 >? 8.9:> 8.8:> 8.8A:

Crown heel length

3cms4 >? 8.EAB 8.89E 8.9:

"he foot length correlated significantly 3p F 8.8>4 with birth weight and

head circumference. "here was no correlation of foot length with gestational age

and crown heel length. Correlation coefficient was more with birth weight

3r G 8.A9A4 among post


97/135

Ta!(e 63= Corre(ation !eteen 'oot (ent$ an# ot$er &aria!(es 'or -ost1ter"

SGA

Ant$ro-o"etri)

&aria!(es

N"!er o'

s!%e)ts

Corre(ation

r

R1sare

r5

-1&a(e

%estational age

3weeks4 EB 8.?A 8.E>> 8.E?E

)irth weight

3kg4 EB 8.B7> 8.A:8 8.88?

&ead circumference

3cms4 EB 8.E?8 8.8E: 8.B?9

Crown heel length

3cms4 EB 8.9BE 8.8B7 8.?97

0rom this table, it could be observed that foot length correlated 3p F 8.8>4

only with birth weight 3r G 8.B7>4. "here was no correlation between foot length

and other variables.


98/135

Ta!(e 6?= Reression eation o' estationa( ae on 'oot (en,t$

Matrity De-en#ent &aria!(e Reression eation

Preterm % 0oot length %GEE.A::BN?.?7>E 0-

Preterm '% 0oot length %GE.7B?BN9.?B>> 0-

"erm % 0oot length % G 97.89ANE.?9?9 0-

"erm '% 0oot length %G?E.:>?EN8.7E7 0-

"erm -% 0oot length %G??.79EN8.B:8? 0-

PostN8.?9B 0-

Post


99/135

DISCUSSION

"he early identification of low birth weight babies is an important pre

where E888

newborns were studied, showed a birth weight range of 8.7>@ term babies. (ulkarni et al.?>

study

showed E:.>@ preterm and 79.A@ term neonates. Kames et al.?E

study showed

:B.A@ term and ?.B@ preterm neonates. 'hambhu 'haran 'hah et al.A>

study

showed 9.@ term, B.:@ preterm and 8.A@ post


101/135

study which showed E?.9@ small for gestational age, 7A.7@ appropriate for

gestational age and 9.E@ large for gestational agebabies.

"erm %, '% and -% in present study were B?.B@, @ and 9.@,

respectively. Preterm % and '% were E?.:@ and E.7@, respectively.

Post@ and 9@, respectively, preterm % and '% babies were B@ and 8.:@,

respectively and post.A:8? cm and 7.8?E cm for term '%, %

and -%, respectively. "he foot length for post


102/135


103/135

% which is similar to present study. Kames et al.?E

study showed mean

head circumference for term % and term '% as ?A.8? 9.77 cm and

?9.B E.?9 cm, respectively which is comparable to present study.

"he crown heel length of the preterm neonates in the present study ranged

from ?9 cm to A cm with a mean crown heel length of A8.9E cm and A9.7 cm for

preterm '% and preterm % respectively. "his is comparable to %ohil KR

et al.?9

study which showed a mean crown heel length of A9.: 9.87 cm for

preterm babies. "he crown heel length of term neonates ranged from ?7 cm to

>9 cm with a mean of AA.7 cm, A:.E cm and A7.> cm for term '%, term %

and term -%, respectively. "his is comparable to %ohil KR et al.?9

study which

showed mean crown heel length of term '% as AB.9E E.9? cm and of term

% as A7.?B ?.E? cm. Kames et al.?E

study also showed similar results with

mean crown heel length in term % neonates as >E.87 9.8> cm and in term

'% neonates as AB.>7

E.BE cm.

"he present study was done to assess the correlation of foot length with

gestational age. lso, other body parameters like birth weight, head circumference

and crown heel length were also assessed for the correlation with foot length.


104/135

St#iesFoot (ent$ to !irt$ ei$t )orre(ation r1&a(e

Preter" Ter" AGA Ter" SGA

Kames et al.?E

3E9?babies4 8.> 8.7 8.E

%ohil KR et al.?9

3?>?babies4 8.9 8.> 8.B

'hambu 'haran 'hah

et al.A>

3E888babies4 8.9 8.7B 8.BA

Present study

3788babies4

Pre1ter" Ter" Post1ter"

SGA AGA SGA AGA LGA SGA AGA

8.7E> 8.:B> 8.B:> 8.A> 8.8A 8.B7> 8.A9A

Foot (ent$ to estationa( ae )orre(ation r1&a(e



8.:A7 8.7E8 8.A7E 8.AA8 8.977 8.?A 8.8?:

St#ies

Foot (ent$ to )ron $ee( (ent$ )orre(ation

r1&a(e


Kames et al.?E

3E9?babies4 8.B 8.E 8.77

%ohil KR et al.?9

3?>?babies4 8.9 8.A7 8.BB

'hambu 'haran 'hahet al.

A>3E888babies4

8.7 8.:E 8.B8

Present study

3788babies4



8.:7B 8.:98 8.B?B 8.A>9 8.EA9 8.9BE 8.EAB

St#ies

Foot (ent$ to $ea# )ir)"'eren)e )orre(ation

r1&a(e


%ohil KR et al.?9

3?>?babies4 8.7A 8.BA 8.:A

'hambu 'haran 'hah

et al.A>

3E888babies4 8.7> 8.B: 8.A9

Present study

3788babies4



8.:: 8.:9E 8.>A? 8.?>E 8.9EA 8.E?8 8.9:>

Ta!(e 6>= Corre(ation o' 'oot (ent$ it$ !irt$ ei$t an# estationa( ae in

&arios st#ies r1&a(e

Ta!(e 54= Corre(ation o' 'oot (ent$ an# )ron $ee( (ent$ in &arios st#ies

r1&a(e

Ta!(e 56= Corre(ation o' 'oot (ent$ an# $ea# )ir)"'eren)e in &arios

st#ies r1&a(e


105/135

In the present study, in pre4 with gestational age, birth weight, head circumference and

crown heel length. Correlation coefficient 3r4, head circumference 3r G 8.:9E4 and crown heel length

3r G 8.:984.

In preterm '% neonates, foot length correlated significantly 3p F 8.8>4

with all the parameters. &ighest correlation of foot length was with birth weight

3r G 8.7E>4 followed by head circumference 3r G 8.::4, crown heel length

3r G 8.:7B4 and gestational age 3r G 8.:A74.

In the present study, in term % neonates, foot length correlated

significantly 3p F 8.8>4 with all the parameters gestational age 3r G 8.AA84, birth

weight 3r G 8.A>4, head circumference 3r G 8.?>E4 and crown heel length

3r G 8.A>94.

In term '% babies also, the foot length correlated significantly 3p F 8.8>4

with other anthropometric variables. Correlation coefficient 3r4, head

circumference 3r G 8.>A?4 and crown heel length 3r G 8.B?B4. Ma+imum correlation

was with birth weight.

Kames et al.

?E

study showed that there was a positive linear correlation

between foot length and other indices of body si=e 3birth weight, head

circumference, crown rump length and crown heel length4 in light


106/135

between foot length and birth weight 3r G 8.>4 and foot length and crown heel

length 3r G 8.B4 waspronounced.

In light


107/135

crown heel length in preterm '%, preterm %, term '% and term %

babies and with birth weight in post in preterm % and r G 8.7E> in preterm '%4.

In term babies also, foot length correlated significantly 3p F 8.8>4 with

other anthropometric variables. "he correlation of foot length to birth weight and

crown heel length 3r


108/135

CONCLUSION

'ignificant correlation was observed between foot length and gestational

age in different groups of newborns 3preterm %, preterm '%, term % and

term '%4. 0oot length also correlated with other parameters like birth weight,

head circumference and crown heel length significantly.

"he correlation 3r value4 of foot length with gestational age and other

parameters was higher in preterm neonates 3r G 8.7E8 in preterm % and

r G 8.:A7 in preterm '%4 than in term 3r G 8.AA8 in term % and r G 8.A7E in

term '%4 neonates. "erm '% babies showed higher correlation 3r value4 of foot

length with gestational age and other parameters than term % babies. "he foot

length is an efficient screening tool in identifying low birth weightbabies.

"he highest correlation 3r value4 of foot length was with gestational age

in preterm % babies 3r G 8.7E84 and with birth weight in preterm '%

babies 3r G 8.7E>4. "erm % 3r G 8.A>4 and term '% 3r G 8.B:>4 babies

showed higher correlation of foot length with birth weight. In post


109/135

SUMMARY

"his study was done to know the relationship between foot length,

gestational age and birth weight among preterm, term and post


110/135

:. 6f 788 neonates studied, the mean foot length was :.A9?> cm with a standard

deviation of 8.>:99.

"he mean foot length of pre:8? cm and 7.8?E cm, respectively.

"he mean foot length of post


111/135

E?. In term % and term '% babies, the foot length correlated significantly

3p F 8.8>4 with all the parameters. &ighest correlation was with birth weight in

both term % babies 3r G 8.A>4 and term '% babies 3r G 8.B:>4.

"here was no correlation between foot length and any of the parameters in

term -%babies.

EA. In post


112/135

BIBLIOGRAPHY

E. "hacker ;. Integrated management of neonatal and childhood illness! new

hope for child survival. PresidentHs Page. Indian Paediatrics 988:AA!EB7394!99?


113/135

E8. Dubowit= -M', Dubowit= D, %oldberg C. Clinical assessment of gestational

age in the newborn infant. "he Kournal of Paediatrics E:8::!E


114/135

E. (umar %P, (umar (. /stimation of gestational age from hand and foot

length. Medicine, 'cience and the -aw E???3A4!A78.

98. &ern 2M. Correlation of fetal age and measurements between E8 and 9B

weeks of gestation. 6bstetrics and %ynecology E7A KanB?3E4!9B


115/135

9:. Daga 'R, Daga ', Dighole R5, Patil RP. nganwadi workerHs participation

in rural newborn care. Indian Kournal of Pediatrics E?B8!B9:


116/135

?7. Kohnson MP, Michaelson K/, )arr M, "readwell MC, &ume R0, Dombrowski

MP, et al. Combining humerus and femur length for improved ultrasonographic

identification of pregnancies at increased risk for trisomy 9E. merican Kournal

of 6bstetrics and %ynecology E> prE:93A4!E99.

?. Droste ', 0it=simmones K, Pascoe


117/135

AB. Mullany -C, Darmstadt %-, (hatry '(, -ecler# 'C, "ielsch KM. Relationship

between the surrogate anthropometric measures, foot length and chest

circumference and birth weight among newborns of 'arlahi, ;epal. /uropean

Kournal of Clinical ;utrition 988:BE!A8


118/135

>B. 2ariyar , "in 2, &ey /. %estational assessment assessed. rchives of

Disease in Childhood E: pp. 9EB:. Chard K. /vidence of growth retardation in neonates of apparently normal

weight. /uropean Kournal of 6bstetrics, %ynaecology and Reproductive

)iology E9A>3E4!>7. &ossain MM, &abib &, Dupont &-. ssociation between birth weight and

birth arm circumference of neonates in rural /gypt. Indian Kournal of

Paediatrics EABE!7E. 'auerborn R, 6niminga RM, (one ), 'ama R, 6epen C, /brahim %K.

;eonatal mid


119/135

ANNEKURE i

NE: BALLARD SCORE

'ource! )allard et al., ;ew )allard 'core, e+panded to include e+tremely

premature infants. K Pediatr EEEE!AE:


120/135

ANNEKURE ii

LUBCHENCO INTRAUTERINE GRO:TH CUR/ES

'ource! -ubchenco -6, &ansman C and )oyd /. Intrauterine growth in length and

head circumference as estimated from live births at gestational ages from

9B to A9 weeks, Pedaitrics EBB?:!A8?4


121/135

ANNEKURE iii

PROFORMA

'erial ;o. !

;ame !

IP ;o. of mother !

Date of e+amination !

ge 3in hrs4 !

'e+ ! Male 0emale

%estational age 3as per )allardHs score4! weeks

Preterm*"erm*Post


122/135


123/135

S(.

No.Mot$er;s Na"e In

1-atient

n"!er

Gestationa(a

,eCDee+sE

Foot(e

n,t$C)"sE

Hea#)ir)"'eren)eC)"sE

CroDn1$ee((en,t$C)"sE

Birt$D

ei,$tC+,E

A--ro-riate

'or,estation

S"a(('or,estationa(a,eCSGA

E9Lar,e'or

Pre1ter"PTE9Ter"CTE9Post1ter"PostTE

E 'uvarna E97EA 0emale ?7 :.> ?? A7 ?.8 % "

9 (omala E9:7 Male A8 :.B ?? A 9.B % "

? %eetha E9:7A Male ?7 :.> ?A A7.> 9.> % "

A 'ahana E9:78 0emale A8 :.7 ??.? A 9.B % "

> Ra$eswari E9B:7 Male A8 :.7 ?9.7 A.9 9.: % "

B 'akamma E9:: Male ?7 :.B ?? A 9.> % "

: Mangala E9:B 0emale A8 :. ?A.> A 9.:> % "

7 'hilpa E9798 0emale ?B :.? ?? A7 9.A % P"

-akshmi E9799 0emale A8 7.8 ?A A.> 9.:> % "E8 Man$ula E9:A Male A9 7.9 ?> >8 ?.9> % Post "

EE 5eena E978B Male A8 :.B ?A A 9.>> % "

E9 %owri E9:A Male ?7 :.: ??.> A7.> 9.B % "

E? Mahalakshmi E??8 Male A8 7.9 ?A >8 ?.> % "

EA Devamani E?9 0emale ?7 :.B ?9.> A:.> 9.: % "

E> 'hyla$a E?97 0emale A8 :. ?A.> A ?.9 % "

EB Pramila E?9B Male ?7 B. ?9 A> 9.9 '% "

E: %owri E?9A Male A8 :.8 ?9 A> 9.9 '% "

E7 'owmya E?E: 0emale ?7 :.A ?9.> A: 9.> % "

E sha E?98 Male ?7 :.7 ??.> A7.> ?.8 % "

98 'udha E?E> 0emale ?7 :.B ?A A7 9.: % "

9E &ema E?9> Male ?7 :.> ?? A7 9.B % "

99 Mani E?9: Male A8 :.: ??.> A7 9.B % "

9? 'udha E?E9 0emale A8 7.9 ?> A ?.7> -% "

9A Ra$eswari EA?BB 0emale ?7 :.7 ?A A7.> 9. % "

9> Roopa EA99 0emale ?7 :.> ?? A:.> 9.> % "

9B 'avitha EA9B7 Male ?7 :.B ?A A7 9.> % "

9: (alavathi EA?8A 0emale A8 7.> ?> >8 ?.7 -% "

97 'hahana EA?EA 0emale A8 7.9 ?> A ?.9 % "9 Meenakshi EA?E8 Male ?7 :.: ?A A7 9.> % "

?8 -alitha EA?EB 0emale A8 7.8 ?A.> A7.> 9.: % "

?E "ulasi EA9>8 0emale A9 7.? ?>.> >8 ?.9 % Post "

?9 'amina )anu EA9?9 0emale A8 7.E ??.> A 9.:> % "

?? 'iddara$amma EA9>7 Male A8 :.7 ?> A7.> 9.:> % "

?A Man$ula EA9:9 0emale A8 :.: ?> A7 9.:> % "

?> Diana E?EB Male ?7 :.> ?> A7 9.> % "

?B %ayathri EA:AA 0emale A9 7.A ?A.> >8 ?.> % Post "

?: ;ethra EA799 0emale A8 :. ?A.9 A7.7 ?.9 % "

?7 'hobha EA7A> Male A8 7.E ?A.: A.> ?.9> % "

? 5asantha EA7A7 Male A8 7.8 ?A.> A 9.:> % "

A8 ;aveena (umari EA7A: 0emale ?7 :.: ?A A 9.B % "

AE ;ethravathi EA7>8 Male ?7 :.7 ??.> A7 9.> % "

A9 -avitha EA7 0emale ?7 :.7 ?9.> A7.> 9.> % "

A? mmayya EA7AB Male ?7 :.: ?9.> A:.> 9.> % "

AA -akshmi EA78 0emale A8 7.? ?? A 9.: % "

A> Deepa EA7>9 Male ?7 :.> ?9.> A7 9.: % "

AB Chandrakala EA7>E 0emale A8 7.8 ?? A7.> 9.B % "

A: ;andini EA7>? Male ?7 :.: ?? A7 9.B % "A7 nupama EA7>7 0emale ?7 :.A ?? A7 9.> % "

A "hriveni E>EE8 0emale ?7 :.B ??.> A7.> 9.7 % "

>8 Chandrika EA78 0emale A9 7.? ?>.9 >8 ?.B % Post "

>E 'hobha EA:7 Male A8 :.7 ?9.: A:.> 9.:> % "

>9 'uvarna EA>8 Male A8 7.8 ?A.> A7.> ?.9> % "

>? 'asikala EAAE Male ?7 :.A ??.> A 9.> % "

>A Ro$a EA> 0emale ?7 7.9 ?> >8 ?.9> % "

>> yesha E>887 0emale ?7 7.E ?A A ?.8 % "

>B Padma EAA7 0emale ?7 B.: ?E.> AB 9.8 '% "

>: -akshmi EAA8 Male A8 :.B ?9.> AB.> 9.B % "

>7 'uma E>E87 0emale ?7 :.? ?9.> A: 9.9 '% "

> Rekha E>E88 0emale A8 7.E ?A >8 ?.9 % "

B8 sha E>EE8 0emale A8 :.7 ?? A 9.7 % "

ANNEKURE &

MASTER CHART


124/135

S(.

No.Mot$er;s Na"e

In1-atientn"!er

Gestationa(a,eCDee+sE

Foot(en,t$C)"sE



Birt$Dei,$tC+,E

A--ro-riate'or,estationa(

r,estationa(a,eCSGAE9Lar,e'or,estationa(

re1ter"PTE9Ter"

TE9Post1ter"PostTE

BE Rani E>E89 0emale ?7 :.> ?? A: 9.> % "

B9 (umari EA>9 0emale ?B :.8 ?E AB 9.E % P"

B? 5ani EBA>8 0emale A8 7.A ?A.> >8 ?.9> % "

BA Prema EBA97 0emale A8 7.9 ??.7 A ?.8 % "

B> sha EBAAA 0emale ?7 :.B ??.: A7 9.> % "

BB Madhumalathi EBA>9 Male ?7 :.> ??.> A7 9.> % "

B: Divya EB?78 Male A8 :.> ?9.> A7 9.B % "

B7 Roopa EBABA 0emale ?7 :.8 ?E.> A: 9.9 '% "

B 'avitha EB?9 0emale A8 7.9 ?A.> A.> ?.9> % "

:8 -akshmi EB?A 0emale ?7 :.? ?E.> A:.> 9.> % "

:E sha EB?B Male A9 7.A ?>.9 >8 ?.: % Post "

:9 sma )anu EB978 Male ?7 :.7 ?A.> A7 9.B % "

:? ;ethravathi EB97A Male A8 :. ?> A ?.E % ":A 'avitha EB9:9 Male A8 7.E ?> A7.> ?.8 % "

:> )havya E>E98 0emale ?7 :.B ?? A7 9.> % "

:B nupama E>E97 0emale A8 :.7 ?? A7.> ?.8 % "

:: 5eena E>EE7 0emale A9 7.E ?A A.> ?.9 % Post "

:7 'udha E>EE: Male A9 7.9 ??.> A7.> ?.8 % Post "

: Chandramma E>EEE Male ?7 :.A ?9.> A7 9.A % "

78 -akshmi E>EE 0emale A8 7.> ?> >8 ?.7> -% "

7E 'hah "a$ E>EE9 Male ?7 :.A ??.9 A:.> 9.> % "

79 Dhakshayini E>88A Male A8 :.B ??.E A7.> 9.7 % "

7? "amilarasi E>8E8 Male A9 7.? ?A.> >8 ?.> % Post "

7A -akshmi E>EEA Male ?7 B.> ?9.> A? 9.8 '% "

7> Divya EA77 Male A8 :.> ??.> A7 9. % "

7B Rukmini EA Male A8 :.: ??.> A7 ?.8 % "

7: sha E>EEB 0emale ?7 :.7 ?A A: 9. % "

77 5asantha E:7EE 0emale A8 :.B ?A A ?.8 % "

7 Pushpalatha E:B:7 Male ?7 :.? ??.> A7 9.> % "

8 'asirekha E:B7A 0emale A8 :.8 ?E.> A> 9.E '% "

E n$u E:7E9 Male A8 :.> ?A A7 9.: % "

9 gma E:B:B 0emale A8 :.B ??.> A7 9.: % "? %eetha E::EE 0emale ?7 :.B ?? A7 9.: % "

A n$um )anu E:B>> Male A8 :.: ??.> A7.> 9.7 % "

> )havani E:7EA Male A9 7.9 ?> A.> ?.:> % Post "

B (avitha E:7E> Male ?7 B. ?9.> AB.> 9.9 '% "

: ;andini E:79A 0emale A8 :.B ?? A ?.E> % "

7 'araswathi E:799 0emale A8 :.B ?? A ?.8 % "

'ubhalakshmi E:79? Male A8 :.> ??.> A ?.E % "

E88 'araswathi E:7E7 0emale A9 7.A ?A >8 ?.9> % Post "

E8E (rupa E:B?? 0emale ?7 :.9 ??.> A:.> 9.> % "

E89 Prameela E::7? Male A8 :.> ?A A7.> 9.:> % "

E8? Chandramma E::8 0emale A8 :.7 ?A A ?.8 % "

E8A 'ubhalakshmi E:::8 Male A8 :.: ?A.E A 9.7 % "

E8> 'araswathi E::E 0emale A8 :.: ?A A.> ?.8 % "

E8B ;andini E::: Male A9 7.8 ?A >8 ?.9> % Post "

E8: Mamatha E:7>: 0emale A9 7.8 ??.7 A ?.9> % Post "

E87 'hemeem E:77> 0emale A8 :. ?A A ?.8 % "

E8 Rekha E:::9 0emale ?7 :.? ??.7 A7.> 9.> % "

EE8 )hagya E:EB 0emale ?7 :.> ??.9 A7.> 9.7 % "

EEE nupama E::B7 0emale ?7 :.: ??.A A7 9.: % "EE9 "hasim )anu E:A> Male ?7 :.7 ?A A ?.E % "

EE? Padma E::9 0emale A8 :.7 ?A >8 ?.9> % "

EEA Man$ula E::BE 0emale ?A B.7 ?9 AB E.:> % P"

EE> -atha E:>:> Male ?7 :.9 ?9.7 AB.7 9.9 '% "

EEB Radhika E:B77 Male A8 7.8 ?B A.> ?.B % "

EE: Keevaratna E::B8 0emale ?7 :.8 ?9.> AB 9.8 '% "

EE7 Prabha E::B> Male ?7 :.9 ?9.> A: 9.A % "

EE Padma E::B7 0emale A9 :.7 ??.> A ?.9> % Post "

E98 Madevamma E:7E8 0emale ?7 :.? ?? A7 9.A % "

E9E 'hashi E:78A 0emale ?7 :.> ??.9 A7 9.B % "

E99 isha E:B8 Male ?7 :.A ??.B A7 9.7 % "

E9? 'hashi E:BE Male A9 7.8 ?> A7.> ?.B % Post "

E9A (usuma E::B9 Male ?7 :.A ?? A7.> 9.7 % "

109


125/135

S(.

No.Mot$er;s Na"e

In1-atientn"!er

Gestationa(a,eCDee+sE

Foot(en,t$C)"sE



Birt$Dei,$tC+,E

A--ro-riate'or,estationa(

r,estationa(a,eCSGAE9Lar,e'or,estationa(

re1ter"PTE9Ter"

TE9Post1ter"PostTE

E9> Preethi E:B7A Male ?7 :.? ?9.> A7 9.B % "

E9B 'avitha E:7EA Male A8 :.B ??.> A 9.7 % "

E9: Pavithra E:7E9 Male ?7 :.? ?? A7.> 9.> % "

E97 &emavathi E:7EB 0emale A8 :.7 ?A.9 >8 ?.9> % "

E9 Kyothi E:7E? 0emale A9 :.7 ?A.? >8.> ?.B % Post "

E?8 -akshmi E:7E7 Male A8 :.7 ?A.9 A.> ?.> % "

E?E 'avitha E:798 Male ?7 :.> ?A A.> 9. % "

E?9 Maryleena E:7E> Male ?7 :.> ??.9 A7 9.B % "

E?? 'hwetha E:7A8 Male A8 :.: ?A A ?.E % "

E?A -akshmi E:799 Male ?7 :.E ?9 AB.> 9.9 '% "

E?> Mallika )anu E:79A Male ?7 :.B ??.> A ?.8 % "

E?B Chanchala E:79> 0emale ?7 :.9 ?9.E AB.> 9.9 '% "

E?: 5asantha E:7?8 0emale A8 :.: ?A A ?.9 % "E?7 Kayasheela E:78A 0emale ?7 :.B ??.B A ?.E % "

E? 'afeen "a$ E:787 0emale A8 :.: ?A A.> ?.8 % "

EA8 Mahalakshmi E7A?8 Male ?7 :.A ??.> A ?.8 % "

EAE nitha E7A9B Male ?7 :.A ??.> A ?.8 % "

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