Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, 2, Wanglang Road, Bangkok-Noi District, Bangkok, 10700, Thailand.
Siriraj Institute of Clinical Research, Faculty of Medicine Siriraj Hospital, Mahidol University, 2, Wanglang Road, Bangkok-noi District, Bangkok, 10700, Thailand.
BMC Pediatr. 2023 Sep 27;23(1):490. doi: 10.1186/s12887-023-04315-4.
Measuring the maximum occipitofrontal circumference only once at birth or within 24 h after birth may lead to misclassifications of microcephaly. This study compared the head circumference (HC) of newborns at birth or within 24 h after birth to their third day of life (DOL3) as well as evaluated maternal- and infant-specific factors associated with increased HC by DOL3.
This prospective study included 1131 live births between February and May 2019 with a gestational age > 27 weeks. All newborns had their HC measured at birth or within 24 h after birth as well as on DOL3 before discharge. HC measurements were performed by trained personnel using non-elastic tape measures. The World Health Organization (WHO) and Fenton Growth Charts were used as reference ranges for interpretation of full-term and preterm neonates, respectively.
Paired sample t-test analyses found a statistically significant increase in HC measured on the DOL3 compared with HCs of the same newborns at birth or within 24 h of birth. The mean HC increase was 0.17 cm (95% confidence interval [0.13, 0.21], P < 0.001). The mean ± standard deviation HC within 24 h of birth and at DOL3 were 33.58 ± 1.53 cm and 33.75 ± 1.37 cm, respectively. Thirty-two newborns had HCs less than the third percentile (< P3) at birth, 25 of which had HC ≥ P3 at DOL3. After adjusting for mode of and presentation at delivery, newborns whose mothers experienced labor pains (β = 0.31, P < 0.001) and were either symmetrically (β = 0.59, P = 0.002) or asymmetrically small-for-gestational age (SGA; β = 0.37, P = 0.03) had significantly increased HC at DOL3. On average, newborns whose mothers experienced labor pain had 0.31 cm increases in HC at DOL3. Symmetrical SGA newborns also had an average 0.59 cm increase in HC at DOL3. Parity and gestational age were not associated with changes in HC.
Serial HC measurements on DOL3 or before newborns' discharge is crucial to classifying congenital microcephaly.
仅在出生时或出生后 24 小时内测量最大头围，可能会导致小头症的分类错误。本研究比较了新生儿在出生时或出生后 24 小时内与出生后第 3 天（DOL3）的头围（HC），并评估了与 DOL3 时 HC 增加相关的产妇和婴儿的特定因素。
这是一项前瞻性研究，纳入了 2019 年 2 月至 5 月期间胎龄超过 27 周的 1131 例活产儿。所有新生儿在出生时或出生后 24 小时内以及出院前的 DOL3 时进行 HC 测量。HC 测量由经过培训的人员使用非弹性卷尺进行。世界卫生组织（WHO）和 Fenton 生长曲线分别作为足月和早产儿 HC 解释的参考范围。
配对样本 t 检验分析发现，与同一新生儿出生时或出生后 24 小时的 HC 相比，DOL3 时的 HC 有统计学意义的增加。平均 HC 增加 0.17cm（95%置信区间[0.13，0.21]，P<0.001）。出生后 24 小时和 DOL3 时的平均 HC 分别为 33.58±1.53cm 和 33.75±1.37cm。32 名新生儿在出生时 HC 小于第 3 百分位（<P3），其中 25 名新生儿在 DOL3 时 HC≥P3。调整分娩方式和分娩时表现后，经历分娩疼痛的新生儿（β=0.31，P<0.001）和对称（β=0.59，P=0.002）或不对称性小于胎龄儿（SGA；β=0.37，P=0.03）的新生儿在 DOL3 时 HC 明显增加。平均而言，经历分娩疼痛的新生儿在 DOL3 时 HC 增加 0.31cm。对称 SGA 新生儿在 DOL3 时 HC 平均增加 0.59cm。产次和胎龄与 HC 变化无关。
在新生儿出院前或 DOL3 时进行连续 HC 测量，对于小头症的分类至关重要。
