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Indian Pediatr 2009;46: 339-341 |
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Nutritional Assessment of
Newborns of HIV Infected Mothers |
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J Gangar
From Dr Vaishampayan Memorial Government Medical College,
Solapur, Maharashtra, India.
Correspondence to: Dr J Gangar, 6, Apurva Apartment, Saat Rasta, Near
Chitle Hospital, Solapur 413 001,
Maharashtra, India.
E-mail:
[email protected]
Manuscript received: October 3, 2007;
Initial review completed: January 24, 2008;
Revision accepted: June 9, 2008.
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Abstract
Nutritional status of 50 newborns born to HIV
infected mothers in a tertiary care hospital was compared with that of
babies born to HIV seronegative mothers, as assessed by birthweight, mid
arm circumference to head circumference ratio (MAC/HC), ponderal index
(PI), and clinical assessment of nutritional status (CAN) score. The
incidence of malnutrition in babies born to HIV infected mothers was
36%, 82%, 20%, and 44% using birth weight, MAC/HC, PI, and CAN scores,
respectively, compared to 10%, 56%, 8%, and 22% incidence in babies born
to HIV seronegative mothers, respectively. Rate of fetal malnutrition
was significantly more in babies born to HIV infected mothers.
Keywords: Fetal malnutrition, HIV infected mother.
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P
ediatric AIDS is poised to become a
major public health problem in India(1). Nutritional status of the newborn
is an important indicator which determines the fetal malnutrition and also
neonatal morbidity and mortality in HIV infection(2). Although some data
exist about the deleterious effect of HIV infection on the growth of
infected children, no data exists about the role of nutritional assessment
of newborn of HIV infected mother, subsequent sequelae of the disease or
response to treatment in infants or children. This study is directed
towards nutritional assessment of newborns of HIV positive mother using
anthropometry, Ponderal Index (PI) and Clinical assessment of Nutritional
status (CAN) score.
Methods
The study was carried out on 100 neonates delivered at
Dr VM Medical College and Government Hospital, Solapur, Maharashtra,
India, between January 2006 to December 2006. Fifty liveborn, full
term neonates of HIV infected mothers [confirmed using 3 ELISA tests (COMB
AIDS Kit)] and 50 liveborn, full term, neonates of HIV seronegative mother
were enroled. Only neonates whose hospital stay exceeded 24 hours of age
and with a known gestational age (last menstrual period or earliest
obstetrical ultrasound) were included. None of the mothers had received
antepartum anti retroviral therapy (ART). Mothers with other obstetric and
medical diseases affecting fetal outcome were excluded from the study.
All neonates were weighed nude on an electronic
weighing scale at birth. Length was measured by infantometer. Head
circumference and mid-arm circumference were recorded between 24 hours of
birth using a standard non stretchable tape. Ponderal index [PI=Weight in
grams×100/length 3 (cm)] and MAC/HC
ratios(3-5) were calculated from these measurements. A PI of <2.2 and
MAC/HC ratio <0.27 were considered as malnutrition. CAN score of <25 was
considered malnutrition(6).
Results
In this study 74 neonates born to HIV seropositive
mothers were studied. Out of these 24 stillbirths, preterm and babies born
to mothers with other obstetric or medical diseases were excluded. The
mean birthweight, length, mid-arm circumference and head circumference of
the remaining 50 newborns born to HIV seropositive mothers was 2.6 ±0.4
kg, 46.5±1.7cm,
7.5±1.7
cm, and 32±2.1
cm, respectively, against 2.8±0.4
kg, 48.2±1.3cm,
9.9 ±2.1
cm and 33.7±1.3
cm, respectively in the 50 babies born to HIV seronegative mothers.
Thirty-two babies born to HIV seropositive mothers were appropriate for
gestational age while 18 were small for gestational age (less than 10th
percentile). Table I depicts the relative distribution of
nutritional status in neonates in the two groups as assessed by
birthweight, MAC/HC ratio, PI and CAN score respectively. The risk of
malnutrition (OR) in babies born to HIV seropositive mothers was 5,4,3,
and 10 times compared to babies of HIV seronegative mothers using
birthweight, MAC/HC ratio, Ponderal index and CAN score as criteria,
respectively. The mean weight gain during pregnancy in mothers was 6.5±1.0
kg in HIV seropositive mothers against 7.2±0.8
kg in HIV seronegative mothers. The coefficient of correlation for weight
gain of mothers during pregnancy and birthweight of newborn is high (r=0.91)
as compared to other anthropometrical measurements (r=0.61).
Table I
Nutritional Status of Newborns as Assessed by Different Methods
| |
Birth weight |
MAC/HC ratio |
Ponderal index |
CAN score |
born
to HIV+ |
born
to HIV– |
born
to HIV+ |
born
to HIV– |
born
to HIV+ |
born
to HIV– |
born
to HIV+ |
born
to HIV– |
| Malnourished |
18(36%) |
5(10%) |
41(82%) |
28(56%) |
10(20%) |
4(8%) |
22(44%) |
11(22%) |
| Well nourished |
32(64%) |
45(90%) |
9(18%) |
22(44%) |
40(80%) |
46(92%) |
28(56%) |
39(78%) |
| Z value |
7.34 |
|
6.07 |
|
4.98 |
|
4.97 |
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| P value |
0.0002 |
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<0.01 |
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<0.01 |
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<0.05 |
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Discussion
The mean birthweight of neonates of HIV infected
mothers is lower than that of standard Indian neonatal value of 2.8kg.
Incidence of low birth weight (<2.5kg) in this study is 36% as against
standard 30% incidence of LBW in India(7). A Study by Miller and
Hassanein(3) proposed that a full term infant is growth retarded if his PI
is <2.2. PI relies on the principle that length is spared at the expense
of weight during period of acute malnutrition; weight and length
velocities may be proportionately impaired so neonates with chronic insult
in utero may be misclassified by PI. This attributes the higher
values of PI in this study to chronic insult faced by the fetus in
utero. Meadow and colleagues(8) concluded in their study that the
MAC/HC ratio, independent of birth weight, readily discriminated the late
gestation growth retarded baby. Their study showed that this ratio can be
used as a reliable test to identify neonates whose growth is retarded,
even when their weight does not fall below 10th percentile. The
statistically significant low values in this study indicate the late
gestational insult that neonates of HIV infected mothers face in utero.
The advantage of CAN score is that it is a simple, clinical index for
identifying fetal malnutrition and may have the potential to predict
neonatal morbidity associated with it without the aid of any sophisticated
equipments. The significant increase in PI of neonate of HIV-infected
mother, together with decrease in birth weight, MAC/HC ratio and CAN score
suggests that HIV infection exposes the infant to chronic insult in
utero leading to fetal malnutrition and intrauterine growth
retardation.
The main limitation of this study was confounding
factors like socioeconomic status,
maternal age, parity, nutritional status, micronutrient
deficiencies, clinical status, HIV viral load, CD4 count and
antiretroviral treatment were not taken into consideration, though all
cases were from the same sub-population. Multiple regression analysis
study model for each of the potential confounding factors would be
essential to attribute the findings of this study to HIV infection. Our
results are consistent with several studies in developing countries which
have concluded that infants born to HIV infected mothers tend to have
lower birth weights than do infants of seronegative women(9-13).
Acknowledgments
The author is grateful to the following staff members
of Dr VM Government Medical College, Solapur, Maharashtra, India. Dr PV
Kumavat and Dr DV Kurdukar for their guidance and support during the
research; Dr Nilesh Shewale for scientific advise, Dr Mulje for assistance
in statistical analysis, Dr Suhas Rote and Dr Charusha Salunke for their
cooperation in data collection.
Funding: None.
Competing interests: None stated.
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What This Study Adds?
• Positive maternal HIV infection status is
associated with decreased neonatal birthweight.
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