UTILITY OF CLINICAL ASSESSMENT OF NUTRITIONAL STATUS SCORE
(CAN SCORE) IN DETECTING FETAL MALNUTRITION
Agal P*, Kamath N
Kasturba Medical College, Mangalore
There are various methods to determine nutritional status of newborns at birth like weight for gestational age, Ponderal Index (well documented in various books and has been used by many authors like Miller and Hassanein, Man Mohan, Georgieff etc.), mid arm/head circumference ratio etc.; but each has its own drawbacks. Since neonatal morbidity and mortality is more closely related to nutritional status of newborn at birth, a Clinical Assessment of Nutritional status score (CAN score) ( which contains the examination for nine clinical signs viz. hair, cheeks, neck, arms, chest, abdomen, back, buttock and legs) was developed by Metcoff to differentiate malnourished from appropriately nourished babies. This score has been tested and approved by various other authors like Deodhar and Jarad, Kashyap and Dwivedi etc.
Detection of fetal malnutrition by Clinical Assessment of Nutritional status score (CAN score) of term neonates at birth and its comparison with other methods (Ponderal Index and weight for gestational age) of determining intrauterine growth.
MATERIALS AND METHODS
A cross-sectional study was carried out on 200 full term, healthy neonates in two hospitals affiliated to Kasturba Medical College, Mangalore within the time period of 2 months. Neonatal anthropometrical measurements (weight, height, age etc.) were calculated as per standard procedures. Newborns were classified for weight against gestational age as Small for Gestational Age (SGA) and Appropriate for Gestational Age (AGA) on the basis of intrauterine growth curves. Ponderal Index [weight (gm)/length (cm3) x 100] was calculated. CAN score was applied and compared with other methods. All data were statistically analyzed.
We found that, in a sample of 200 term neonates, CAN score of <25 identified 165(82.5%) babies as well nourished and 35 (17.5%) as malnourished. On comparing with weight for gestational age, CAN score identified malnutrition in 8% of 75 AGA babies and 76.8% of 125 SGA babies were found to be well nourished. Ponderal Index (PI) identified malnutrition (PI<2.25) in 8 %( 16 out of 200) neonates out of which CAN score detected only 62.5% as fetally malnourished and 37.5% as well nourished. Also 13.58% newborns classified as well nourished (PI≥2.25) by applying Ponderal Index was found to be malnourished by CAN score. Taking CAN score as gold standard method for detecting fetal malnutrition, the sensitivity and specificity of weight for gestational age was found to be 82.85% and 41.81% respectively and that of Ponderal Index 28.57% and 96.36% respectively.
CAN score, which is a simple clinical index for identifying fetal malnutrition, is a good indicator for the same in comparison to other methods of determining intrauterine growth retardation like weight for gestational age and Ponderal Index.