European Journal of Cardiovascular Medicine

Low birth weight (LBW), defined as a birth weight of less than 2500 grams, is a significant public health concern, particularly in developing regions. LBW is associated with an increased risk of neonatal morbidity and mortality, as well as long-term developmental issues (1). To address this, various anthropometric parameters, such as head circumference (HC) and foot length (FL), have been explored as potential indicators for estimating birth weight in neonates. Early detection of LBW can facilitate timely interventions and improve outcomes (2).

Head circumference is a well-established anthropometric parameter that reflects brain growth and development. It is considered one of the most reliable indicators of overall fetal growth (3). Studies have shown that HC is strongly correlated with birth weight, with some suggesting that it can predict LBW with a reasonable degree of accuracy (4). However, HC alone may not always provide a complete picture of fetal growth, especially in cases of disproportionate growth patterns (5).

On the other hand, foot length, a relatively less explored parameter, has gained attention in recent years as a simple and non-invasive measure for identifying LBW neonates. Researchers have suggested that FL can serve as a surrogate for overall fetal growth, as the development of the foot follows a predictable pattern that is influenced by birth weight (6). Several studies have reported a strong correlation between FL and birth weight, which positions FL as a promising tool for LBW detection in resource-limited settings (7). Some studies suggest that FL may provide an effective alternative in settings where more complex tools for birth weight prediction are unavailable (8).

Both HC and FL have been individually evaluated as potential indicators of LBW, but few studies have compared the two parameters directly in a South Gujarat context. A tertiary care center in South Gujarat presents a unique opportunity to assess the relative efficacy of these anthropometric measures in predicting LBW among neonates. Given the clinical importance of identifying neonates at risk for LBW, it is crucial to determine which of these parameters—head circumference or foot length—shows a better correlation with birth weight.

This study aims to explore the correlation between head circumference and foot length with birth weight and to determine which of the two measures provides a more accurate assessment of LBW in neonates. By evaluating these parameters, we hope to offer insights that could guide clinical practice and improve neonatal care in the region (1.6).

Study Design and Setting

A hospital-based cross-sectional study was conducted at a tertiary care center in South Gujarat. The study aimed to explore the correlation between anthropometric parameters—head circumference (HC) and foot length (FL)—and birth weight in live-born low birth weight (LBW) neonates. The study was carried out over a six-month period, from January 2023 to July 2023, at the designated hospital.

Study Population

The study population comprised 122 live-born neonates who were identified as low birth weight, defined as a birth weight of less than 2500 grams. All neonates included in the study were born during the study period. Inclusion criteria included full-term and preterm neonates with birth weights below 2500 grams, regardless of gender. Neonates with congenital anomalies, major illnesses, or incomplete data were excluded from the study.

Sampling Method

Convenience sampling was used to select the study participants. All neonates born within the inclusion criteria during the study period were recruited consecutively, ensuring that all live-born LBW neonates who were admitted to the neonatal unit were included in the study.

Data Collection

Data was collected by trained research staff using a standardized data collection form. The following information was recorded for each neonate:

1. Demographic Information: Name, age of the mother, and gender of the neonate.
2. Anthropometric Measurements:
• Birth Weight: Birth weight was measured using a digital weighing scale to the nearest 10 grams.
• Head Circumference (HC): The head circumference was measured using a non-stretchable tape measure, placed around the largest part of the head, just above the eyebrows and ears, and over the occipital prominence.
• Foot Length (FL): Foot length was measured from the heel to the tip of the longest toe using a standard measuring tape.

Data Analysis

Descriptive statistics were used to summarize the demographic and clinical characteristics of the neonates. The Pearson correlation coefficient was used to analyze the relationship between head circumference, foot length, and birth weight. The correlation coefficients for HC and FL with birth weight were compared to determine which parameter showed a stronger correlation with LBW.

Chi-square tests were used to assess the distribution of LBW neonates across different categories, and p-values less than 0.05 were considered statistically significant.

Ethical Considerations

Ethical approval for the study was obtained from the institutional ethics committee of the tertiary care center. Informed consent was obtained from the parents or legal guardians of all neonates included in the study. Confidentiality and anonymity of the participants were maintained throughout the study.

Table 1 presents the gender distribution of the 122 live-born low birth weight (LBW) neonates included in the study. Out of the total sample, 54 (44.26%) neonates were female, while 68 (55.74%) were male.

Table 2 shows the distribution of the type of delivery among the 122 low birth weight (LBW) neonates in the study. Out of the total sample, 54 neonates (44.26%) were delivered vaginally, while 68 neonates (55.74%) were delivered via LSCS (Lower Segment Cesarean Section).

Table 3 presents the distribution of parity among the mothers of the 122 low birth weight (LBW) neonates in the study. Of the total, 51 mothers (41.8%) were primipara (first-time mothers), while 71 mothers (58.2%) were multigravida (had more than one pregnancy).

Table 4 presents the Pearson correlation values for birth weight in relation to head circumference and foot length. The correlation between birth weight and head circumference was found to be 0.84 (p < 0.01), indicating a strong positive correlation. The correlation between birth weight and foot length was 0.49 (p < 0.01), suggesting a moderate positive correlation. Both correlations are statistically significant with p-values less than 0.01.

Table 5 presents the area under the curve (AUC) values for the ROC curves of various anthropometric measurements in relation to birth weight. The AUC for head circumference was 0.88 (SE = 0.040, p < 0.01), with the asymptotic 95% confidence interval ranging from 0.798 to 0.952, indicating a high level of accuracy in predicting low birth weight. The AUC for foot length was 0.72 (SE = 0.051, p < 0.01), with the asymptotic 95% confidence interval ranging from 0.625 to 0.791, suggesting a moderate level of accuracy. Both measurements showed statistically significant results with p-values less than 0.01.

Table 6 presents the best cut-off points of anthropometric indicators for detecting neonates with a birth weight less than 2500 grams. For head circumference, the ideal cut-off is <32 cm, with a sensitivity of 90.5%, specificity of 72.4%, and accuracy of 81.4%. For foot length, the ideal cut-off is <8.5 cm, with a sensitivity of 78.2%, specificity of 50.1%, and accuracy of 64.3%. These values highlight the effectiveness of these parameters in identifying low birth weight neonates.

Table 1: Percentage of male and female babies.

Table 2: Percentage of mode of deliveries.

Table 3: Percentage of parity of mothers.

Table 4: Correlation of birth weight to anthropometric measurements.

Table 5: Area under the curve values for ROC curves of various anthropometric measurements.

Table 6: Best cut-off points of anthropometric indicators for detecting neonates with birth weight less than 2500

This study aimed to evaluate the correlation between head circumference (HC) and foot length (FL) with birth weight among neonates in a tertiary care center in South Gujarat. The findings indicated that both HC and FL are significant anthropometric indicators for predicting low birth weight (LBW), with HC showing a stronger correlation.

Head circumference is a widely recognized indicator of fetal growth and development. Numerous studies have shown that HC is closely related to birth weight and can be used to identify neonates at risk for LBW (1). The higher sensitivity and accuracy of HC in this study supports its role as a reliable predictor for LBW. However, while HC provides valuable insights, it may not be as effective in detecting LBW in cases of abnormal fetal growth patterns (2,9).

Foot length, although less commonly used, has emerged as a promising anthropometric measurement in assessing LBW. The study revealed a moderate correlation between FL and birth weight, consistent with findings from previous research that emphasized foot length as a practical, simple, and non-invasive measurement tool (3). While FL is not as strong a predictor as HC, it still offers an advantage in resource-limited settings where more complex diagnostic tools may not be available (4). The relatively lower specificity of FL, however, suggests it may not be as effective at distinguishing between neonates with and without LBW compared to HC.

The ROC curve analysis further reinforced the findings that HC has a higher area under the curve (AUC) than FL, which suggests that HC is a more reliable indicator of LBW. A similar conclusion was drawn in a study by Gupta et al. (5,10), which found that HC had a higher AUC compared to other anthropometric measures. Despite FL's lower AUC, its ability to detect LBW neonates in specific settings, such as in developing countries, should not be overlooked, as it provides an accessible alternative to more invasive or complex methods (6).

The best cut-off points determined in this study further demonstrate the utility of these anthropometric parameters. For HC, a cut-off value of <32 cm was found to have high sensitivity and accuracy, which aligns with other studies where HC has been successfully used for LBW detection (7, 11). Although FL showed lower specificity, it remains a useful measure in neonatal care, especially in screening large populations quickly.

In conclusion, this study highlights the significant role of both head circumference and foot length as anthropometric indicators for predicting low birth weight (LBW) in neonates. While head circumference demonstrated a stronger correlation with birth weight and higher sensitivity, foot length remains a valuable alternative, particularly in resource-limited settings. Both measurements offer practical tools for early LBW detection, which can aid in timely interventions and improve neonatal care outcomes. Further research in diverse populations could help refine these parameters and enhance their clinical applicability.

Conflict of interest: No! Conflict of interest is found elsewhere considering this work.

Source of Funding: There was no financial support concerning this work

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