Indian J. Pediat. 34 : 73.

1967

AN FHROPOMETRIC MEASUREMENTS IN THE NEWBORN* A Study of 1000 Consecutive Livebirths

K . KALRA, N. KI,.qHOREand R.S. DAYAL

Agra

There is a wtde variation in the normal birth weight and length of a full-term infant. Different standards of norms are used in d~fferent parts of the world. The standards formu. lated by Western workers cannot be applied to this country because of wide variations in norm.~.l range of height and weight in different ethnic groups. The causes of such differences are many, viz. poverty, food fads, gastrointestinal and other infections, lack of health educaUon resulting together in malnutrition and growth failure. The literature is replete with norms of various anthropometric measurements In the newborn so far as Western countries are concerned. Some valuable work has been done in Indta also, by Ghosh et al. (1944), Prasad (1955), Paul and Ahluwalia (1957), Lenskaye et al. (1961), Achar and Yankauer (1962), Singh and Venkatachalam (1962) and Athavale (1963). The purpose of the present study was to determine the normal anthropometric w.lues vtz. birth weight, crownheel length, crown-rump length, head circumference and thoracic circumference in a full term newborn in this part of the country and also to know
*From the departments of Pediatrics and Obstetrics and Gynecology, S. N. Med!cal College, Agra.

whether these anthropometric measurements can be useful in labelling a baby as premature.

Material and Methods

The study was undertaken on 500 newborns drawn from the maternity section of this hospital. All the live born babies born by the vaginal route or cesarean section were taken up for this study. The cases were unselected and twins were also included. The date and time of birth of each baby was noted. After a thorough check up, all the anthropometric measurements were made either soon after birth or in a few babies within four hours of birth. Standard techniques were used for recording these measurements, Body weight. The baby was accurately weighed in grams by placing the nude baby on a sensitive weighing machine. Crown-heel length. The baby was placed on the infantometer with legs completely stretched by applying moderate pressure on the knees in such a position that the orbitomental line was perpendicular to the horizontal surface of the board. The fixed piece of the measuring scale just touched the most prominent part of the head i.e., the

INDIAN JOURNAL

OF PEDIATRICS

PLATE I

Fig. 1.- Infant on Infantometer.

Fig. 2 . - - P o s i t i o n on i n f a n t o m e t c r for taking crown-rt, m p length.

KALRA ET A L . - - A N T H R O P O M E T R I C MEASUREMENTS IN THE NEWBORN.

74 INDIAN JOURAL OF PEDIATRICS

VOL. 3 J, N o . 23C

crown and then the sliding piece was slid, closer so as just to touch the heels. This gave the crown-heel length in centimeters (Fig. 1). Crown-rump h,ngth. The length was taken on the same board by raising the legs and knees together with the hip joint flexed. The sliding board was approximated so that it pressed firmly against the buttocks. The crown rump length was then recorded in centimeters. (Fig. 2). Head circumference. This was measured by a malleable Lufkin's steel tape passed round the head at the largest circumference. This level was taken at the supercilliary margins in front, parietal eminence laterally and occipital protuberance behind. The measurements were taken very accurately and repeated if necessary, in cases where caput succedeneum was present at birth. Chest circu~nference. This was taken by the same tape at the level of the nipples. Care was taken so that the tape did not press hard but just touched the perimeter of the thorax thereby eliminating any skin folds. The difference between head and chest circumference was note. Observations Out of five hundred there were 251 males and 249 female babies. Birth weight. The weight o f the babies at birth ranged between 750 gin. to 5200 gin. The mean birth weight of full-term male babies was 3097 gin. and that of females 3039 gm. with an average of 3069 gin. Table I shows the distribution of cases according to birth weight in male and female babies. Three hundred and one babies (60.2 ~o) had birthweight between 2501 and

3500 gin. Only three babies had a birth weight below 1000 gm. and eighteen above 4000 gin. Table 1. Distribution of cases according

to birth weight.
Groups Weight (gm.) Upto--1000 1001--1500 1501--2000 2001--2500 2501--3000 3001--3500 3501--4000 Above 4000 Total Male Female Total

I II III IV V VI VII VIII

1 15 12 27 89 70 27 10 251

2 13 22 40 84 58 22 8 249

3 28 34 67 173 128 49 18 500

Fig. 3 shows the predominence of male babies in the higher birth weight groups. Cro~wn-heellength. It was found that crown-heel length in male and female babies ranged between 31 to 53 cm. The distribution of crown-heel length is shown in Table 2. 361 cases (72.2~o) Table 2.

Distribution of crown-hod length in male and fe~nale babies.

(crn.)
Male Female Total

C.H. length

Below 40 40.1----43 43.1--46 46.1---49 49.1--52 Above 52

19 10 28 100 68 8

13 18 40 127 48 8

32 28 68 227 134 I1

KAI-RA ET AL.--ANTItROPOMETRIC MEASURIr'MENTS IN THE NEWBORN

75

.....

FEMALE ,,~

2o

/I
10

jr/"e'///' /e'

#
~oot'-35oo 5 5 o , . 4 o o o -A -B ~o v E 4 . 0 0 o
G G C,
' i

upro

rsbo
G,

'xoiLoooo
,., 9

' ' 2ool-2~oo ~.~ot-~oeo G G

GROUPS IN GRAMMES

WEIGfIT

Fig. 3.

out of 500 newborns ranged between 46.1 to 52 c m . The number of the female cases b e c a m e less with the increase of crown heel length. The graphical representation is shown in Fig. 4. Head circumference. The observations on the head circumference o f the male and female babies are shown in Table 3. The head circumference of maximum number of babies varied between 30 and 36 cm. The number of male babies was comparatively more in those whose head circumference was more than 33 cm,

Table 3. Distribution o f cases according to head circumference in cm.

Head circumference in
cm.

Male

Female

Total

Below 27 27.1--30 30.1--33 33.1--36 Above 36 Total

8 19 74 147 3 251

6 24 101 115 3 249

14 34 175 262 6 500

76 INDIAN JOURNALOF PEDIATRICS

VOL. 34 No. 230

.... :

T'EMALE~ MALE 5

2~
I I I I I

I I

2O
z ,.I ,.1

I I
I I I !

,.e Z 0

I I
I l I

15
I I

I
I

8
z [-,

I I t
I I

I I l

\
\

/
I

I / \

BELOW4 0
C,,m.

4o'1-4~
C-m.

4-3,1- 4 6
C'm.

ar ~'t- ll-9
~,'m.

4 9 ' 1 - 59e,m,

At30vs
C,,m.

.LENGTH IN CENTIMETRES

Fig.

4.

We tried to correlate the gestational age with other anthropometric measurements and found that the birth weight increased with an increase in gestational period. The gain in weight of female babies was quicker in the gestational period between 28--32 weeks as

compared to male babies, which is inexplicable. The male babies gained more weight after 32 weeks of gestation. The other anthropometrlc measurements showed a similar trend. (Fig. 5). The cases were divided into eight groups according to birth weight and

KAf-,RA I~T AL.--ANTHROPOMErRIC MEASUREMENTS IN THE NEWBO~RN

77
MALE VEMAL~

--

.....

~250~

30oo

2750

25oo
/

2250
Z /
i

p / /

2ooo

J
jf

L750

t$O0

Q # # r '" # S

19.BO

10130

......

~.~

"._

: ......

.._.-

:.:.

.--.

.~

---.

B~tow'2B
wR.~,

29-30
wl~

51-~2
Wits

55-~4
WK$

55-56
N V w S

,aBove

~tKS

37

GESTATIONAL PERIOD IN WEEKS

Fill. 5.

Correlated with other anthropometric measurements. It was observed that with the increase in birth weight the average values for all the anthropometric measurements increased except

for the cephalo-thoracic difference which showed a decline (Table 4). The anthropometric measurements in the full term newborn with the gestational age between 37----42 weeks

78 INDIAN JOURNAL OF PEDIATRICS

VOL. 3 4

No. 230

(according to Ellis 1951) are given in Table 5. The mean values of all the figures' were higher in males as compared to female babies. The difference between the mean values for Table 4.

male and female babies were tested for significance by applying the 't' test. The differences were found to be insignificant even at the 10 ~ level (see Table 5 for 't' values).

Anthropometric values in newborns according to different weight groups.

Weight C.H. Mean 32.9 33.9 42.3 45.4 47.9 48.9 50.4 51.5 C.R. S.D. Mean 2.5 23.0 H. Cir. S.D. Mean 1.9 2.8 2.6 1.6 1.7 3.4 1.5 2.1 25.6 27.7 29.9 31.9 33.2 33.8 34.5 35.0 Th. Cir. Ceph-Th'o. difference

Weight group (gm.)

No. of cases

Mean Up to 1000 1001-1500 1501-2000 2001-2500 2501-3009 300t-3500 3501-4000 Above 4000 3 28 34 67 173 128 49 18 866.6 1325.6 1807.6 2302.8 2809.6 3224.7 3710.3 4346.7

S.D. 42.9 169.8 161.7 256.6 138.2 76.7 165.0 456.7

S.D. Mean 2.7 1.5 2.2 2.3 1.6 1.5 2.0 1.2 19.9 24.1 26.9 29.5 30.8 31.4 32.3 32.3

S.D. Mean S.D. t.4 3.0 2.4 2.3 2.1 1.1 1.4 1.5 517 3.6 3.0 2.4 2.4 2.4 005 1.3 1.! 0.9 0~ 0.9

2..7 25.9 3.2 28.2 3.5 30.2 2.0 32.0

1.9 32.8 2.3 2.0 33.7 34.65

2.2-0.9 2.7 0.6

C.H. = Crown-heel length C.R. = Crown-rump Th. C i r . = Thoracic circumference.

length.

H. C i r . = ' H e a d circumference S . D . = Standard deviation.

Table 5. Nnthropometric measurements in full-term newborns.

Anthropometric measurements Male Mean Birth weight (gin.) Crown-heel length (cm) Crown-rump length (cm) Head circumference (cm) Thorax circumference (cm) C.T. difference
m m

Female S.D. 503.8 5.6 4.2 5.9 0.6 1.1 Mean 3039.5 48.3 30.9 33.4 31.0 2.4 S.D. 672~9 4.7 3.7 2.6 1.8 0.8

Total Mean 3069.2 48.5 32.3 33.5 31.1 2.4 S.D. 590.6 4.8 3.3 4.7 1.4 0.9

't' values ' :k_

3097.1 48.6 32.6 33.6 31.2 2.4

.305 .019 1.6 .133 .447 0.0

t =

XI (
I

-- X2

, I)~

't' values means differenceof means is not significanteven at 1 0 % level,

KALRA El' AL.--ANI-HROPOMEfRIC MEASURE.MENTS IN TIlE NEWBORN

79

We observed that most of the babies wcighing less than 2000 gm. behaved physiologically as prematures. The criteria of physiological maturity were, ability to suck and swallow and the presence of bloro's, rooting, pahnar grasp, Perez and stepping reflexes. The corresponding anthropometric measurements in babies weighing below 2000 gin. were crown-heel length 42.3 cm., crown-rump length 28.2 cm., head circumference 29.9 cm., and thorax circumference 26.9 cm. respectively ; the cephalothoracic difference was more than 3 cm. The cephalothoracic difference was noted to be a more important factor in judging tbe maturity of a newborn. As the gesta: tional age increased the cephalothoracic difference diminished. The difference was 3 cm. or more in premature babies while it was 2.4 cm. or less in full-term infants.

Discussion

The importance of birth weight was reported as early as 1886 by Miller. Later in 1919 Ylppo suggested that besides birth weight, other measurements should be taken in each baby to know the baseline of full-term newbo:'ns and criteria of prematurity. Various workers in Westerr, countries studied the different anthropometric measurements. The average birth weight of Western babies reported by Bakwin and Bakwin ~1952) and Harlem and Lonnum (1957) was 3540 and 3475 gin. respectively, crown-heel length approximately 59 cm. and head circumference 35 cm. The mean values of all these measurements were comparatively higher in males as compared to female babies. 3

In India, work on this subject has been reported by Balfour and Talpade (1930), Nandi (1933), Ghosh el al. (1944), Prasad (1956) Paul and Ahluwalia (1957), Lenskaye et al. (1961), Achar and Yankaver (1962), Singh and Venkatachalam (1962) and Athavale (1963) (Table 6). Paul and Ahluwalia (1957)in their studies reported that the birth weight of full term Indian babies varied from 5 lb. to 9 lb. and 5.5 oz. with an average of 6 lb. 9 oz. in males and 5 lb. 15 oz. in females. There was also a wide variation in other anthropometric values of full term infants. Lenskaye et al, (1961) recorded these measurements in 110 newborns and found that the average birth weight of a full term baby was 3000 gm. and head and thoracic circumference were 33.25 and 29.9 cm. respectively. Singh and Venkatachalam (1962) in their series of 266 newborns reported that the average birth weight of a male baby was 2731 gm. and that of a female 2616 gm. They have recorded these values after 48 hours of birth. The other anthropometric values were nearly the same as observed m the present investigation. The findings in our series are approximately the same as reported by other workers in the tropics as illustrated in Table 6, but our values are still definitely below the observation reported by Western workers (Bakwin and Bakwin, 1952, Lenkskaye e t al. 1961). However, on closer examination of the data it was found that the difference in the mean values between male and female babies was present in all the studies. When the gestational age was correlated with the birth weight it was found that the male infants had a lower birth weight than females till 32 weeks of

8 0 INDIAN JOURNAL OF PEDIATRICS

VOL. 3 4 N o . 230

Table 6. Average birth weight of fullterm babies reported by

various workers in the tropics.

Author Year Average for both sexes 6 lb. 9 oz. (2948 gm.) 5 lb. 10 oz. (2556 gm.) 5 lb. 12 oz. (2618 gin.) 5 lb. 11 oz. (2608 gm.) 6 lb. 10 oz. (3004 gin.) 6 lb. 8 oz. (2962 gm.) -3000 gm. 6.81 lb. (3091 gin.) --6 lb. 6 oz. (2892 gin.) 2762 gin. 2731 gm. 3069 gm. 3097 gin. 6.65 lb. (3023 gm.) 6 lb. 2 oz. (2780 gm.) 2619 gin. 2616 gin. 3039 gin. 6 lb. 9 oz. (2976 gin.) 5 lb. 15 oz. (2696 gm.) 6 lb. 3 oz. (2808 gin.) Average weight of males Average weight of females

Curjel Dass Balfour & Talpade Nandi Ghosh et at. Rao and Bhattacharjee Paul and Ahluwalia Lenskaye et al. Thomson Chopra & Speetjens Arora et al. Singh & Venkatachalam Present series

1920 1924 1930 1933 1944 1952 1957 1961 1962 1963 1963 1962 1965

gestation, but after that period males were born with a higher birth weight, suggesting thereby that till 32 weeks of gestation the female babies lead as far as the growth is concerned. After 32 weeks male babies take over the lead. Almost similar observations were recorded by Mukherji and Biswas (1959) in their series of 1054 Infants with a "shift" of birth weight noted at 38 weeks. An attempt was made to establish a standard of prematurity according to these anthropometric measurements.

The criterion of prematurity as stated by various workers was mainly birth weight. According to Crosse (1~'4'5) and D u n h a m (1946) any baby having a birth weight of 2500 gin. or less should be labelled as premature. Later in 1948, Crosse gave more importance to crown-heel length than birth weight and considered all those babies as prematures who had crown-heel length less than 1889 The expert Group on Prematurity appointed by the W.H.O. in 1950 suggested that "Any baby weighing 2500 gin. or less at

KALRA E I" AL.--ANTHROPOMETRIC MEASUREMEN'IS IN THE NEWBORN

81

birth is regarded as premature regardless of period of gestation." Ellis (I 951) stated that such a limit of weight is not scientifically acceptable since .babies of the same weight may vary considerably in maturity. In the present study we found that most of the babies (54 out of 65) having a birth weight of 2000 gm. or below behaved as prematures. The corresponding crown-heel length was 42.3 cm., crown-rump length 28.2 cm., head circumference 29.9 cm. and cepb.alothoracic difference was more than 3 cm. Many workers in our country have given figures for weight varying between 1750 and 2270 gm. e.g. Das Gupta (1951)--2250 gin., Ghosh and Chandrashekhar (1948)-1800 gin., Chaudhuri (1955)--2270 gm., Rao et al. (1960)--2000 gin., Baxi (1960)--2028 gm., Ghosh and Beri (1962)--1750 gm., Singh and Venkatacb.alam (1962)--2000 gm. and Athavale (1963)--1750 gm. Singh and Venkatachalam and Athavale also suggested the importance of head circumference and cephalothoracic difference in their series. The reports of studies conducted by other workers in the tropics-Amarsingh and Dissanayke (1958), Thomson 1.1962) and DeSilva ( 1 9 6 2 ) had similar findings.

baby except the cephalothoracic difference in both sexes. The mean values of all the measurements were higher in male babies as compared to female babies. An attempt was made to formulate the standard of prematurity on the basis ofanthropometric measurements. Babies with birth weight of 2000 gm. or below behaved physiologically as prematures and their cephalothoracic difference was 3 cm. or more.
We are grateful to Dr. D. D. Joshi, Professor of Statistics, Institute of Social Sciences, Agra University, Agra, for his kind help in statistical analysis of the data.

References
Achar, S. T. and Yankauer, A. (1962). Studies of birth weight in South Indian infants, btdian J. Chld. Hlth. 11, 157. Amar Singhe, P. G. and Dissanayke, P. (1958). Cited by DeSilva (1962). Arora, S., Rajeshwara Rao, N. and Radhakrishan Rao, M . V . (1963). Birth weights of infants in low socio-economic groups in Bombay, IndianJ. ClaM. Hlth., 12, 612, 1963. Athavale, V. B. (1963). Some observations on temperature in the newborn, lndian J. Chld. Hlth., 12, 381. Bakwin, H. and Bakwin, M. (1952). Body built in newborn infants. Hum. Biol. 4, I. Baxi, P. G. (1960). The problem of prematurity. J. Indian reed. Ass. 34. 346. Balfour, M. K. and Talpade, S. K. (1930). The maternity conditions of women mill workers in India. Indian reed. Gaz., 65, 241. Chaudhuri, Amala (1955). Mortality rate and its relationship to maturity weight level, htdian J. Pediat. 22, 145. Chopra, D. R. and Speetjens, A. (1963). Anthropometry of the newborn and incidence of prematurity. Burma reed. J. 11,225. Crosse, V. M. (1957). The Premature Baby, page 1, Fourth Ed. J. A. ChurchillLtd. London. Curjel. (1940). bldian J. reed. Res. 8, 363. Cited by Rao and Bhattacharjee (1952). Das Gupta, B. C. (1951). Report of the enquiry into the bearing of premature and immature births on infant mortality in Bombay (1946-1948). Indian Council o f med. Res. Dass, (1924). Cited by Rao and Bhattacharjee (1952). DeSilva, C.C., Fernando, P. V. D. and Guanarante, C. D. (1962). The search for a prematurity level in Colombo, Ceylon. J. Trop. Pedlar. 8, 29. Durham, E. C. (1955). Premature Infants, Page 3 Second Ed. 1955. Paul. B. Hoeber. Inc. New York, U.S.A.

Summary
A set of six anthropometric measurements viz. body weight, crown-heellength, crown-rump length, head circumference, thoracic circumference anl ceph.alothoracic difference were studied in 500 newborn babies within four hours of birth. All the anthropometric measurements showed a significantly high positive correlation with weight of the

82 INDIAN JOURNAL OF PEDIATRICS Ellis, R. W. B. (1951). Assessment of prematurity by birth weight, crown rump length and head circumference. Arch. Dis. Chldh. 26, 411. Expert Group on Prematurity, W. H. O. (1950). Cited by Crosse (1957). Ghosh, S. and Beri, S. (1962). Standard of prematurity for North Indian babies. Indian ,L Chld. Hlth. 11,210. Ghosh, L. and Chandrashekhar, C. (1948). study on the standards of maturity for Indian infants. Government o f htdia Press, Calcutta. Ghosh, L., Sen. M., and Chandrasekar, C. (1944). A study of the development of Indian infants in the community of Calcutta. Indian J. Pediat. 11, I. Harlem, O. K. and Lonnum, A. (1957). A clinical study of abdominal skin reflexes in newborn infants. Arch. Dis. ChMh. 32, 127. Lenskaye, U. K., Basant, Purl, Chaudhari, Luthra, Dang and Raj Kumari (1961). Physical development of infants in New Delhi in first year of life. Indian ]. Chld. Hlth. 10, 211. Miller (1886). Cited by DeSilva (1962).

VOL. 34 N o . 230 Mukherji, S., and Biswas, S. (1959). Birth weight and its relation to gestational period, sex, maternal age, parity and socioeconomic status. J. Indian reed. Ass. 32, 389. Nandi. G. C. (1933). The normal birth weight and birth length of Bengali infants and their relation to maternal social conditions. Indian ,I. Pediat. 1, 24. Paul, S. S. and Ahluwalia, D. (1957). Report of anthropometric measurements of healthy newborn in Delhi. hldian J. Chld. Hlth. 6, 363. Prasad, L. S. N. (1956). Birth weights and lengths in Bihar State. Indian J. Pediat. 23, 115. Rao, M. N. and Bhattacharjee, B. (1952). Physiological 'norms' in Indians. h~dian J. Pediat. 19, I. Singh, R. and Venkatachalam, P. S. (1962). Anthropometric studies of the newborn. Indian J. reed. Res. 50, 494. Thomson, F. A. (1962). The birth weight of babies in Federation of Malaya. Effect of race and economic changes. J. trop. Pediat. 8, 3. Ylppo, A. 1919 Ztsch KindeJ41eilk. 20, 212, and 24, 111, Cited by Durham.