Diagnostic Utility of the CAN Score and Proportionality Indices and Variations in Neutrophil—and Platelet—Lymphocyte Ratios in Fetal Malnutrition

Abstract

Background

Nutritional status of neonates is best assessed using clinical assessment of nutrition (CAN) score and proportionality indices. The onset of malnutrition that begins in utero, termed fetal malnutrition (FM), can induce a state of inflammation. This study is aimed at estimating the prevalence of FM in different classes of births along with analysis of neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in cord blood as markers of inflammation.

Materials and Methods

It was a cross-sectional, descriptive study. The proportionality indices—body mass index (BMI), ponderal index (PI), and CAN score—were calculated. PI <2.2, BMI<11.2 kg/m², and CAN score <25 were indicators of FM. The Chi-square test was used to test the sensitivity and specificity of CAN score against PI and BMI.

Results

A total of 100 term neonates were included, divided into 3 groups: small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA). Fetal malnutrition was present in 16% of total neonates. The sensitivity and specificity of the CAN score was more than 85% with significant p-value {χ ² = 33 (PI), χ ² = 58.8 (BMI)}. Median NLR in FM was 1.63 ± 0.65, significantly (P < .001) higher than well-nourished neonates. Platelet lymphocyte ratio did not have a significant difference. Clinical assessment of nutrition score showed a positive correlation with maternal (r = 0.806, P < .001) and neonatal BMI (r = 0.368, P < .001).

Conclusion

Proportionality indices and CAN score can be interchangeably used to diagnose FM. The presence of higher NLR values in neonates with FM suggesting an underlying inflammatory process requires closer follow-up.