ANTERIOR FONTANEL SIZE AMONG TERM NEONATES ON THE FIRST DAY OF LIFE BORN AT UNIVERSITY OF GONDAR HOSPITAL, NORTHWEST

Abstract

ABSTRACT Background: Anatomically, there are six fontanels in the newborn skull, namely anterior, posterior, two mastoid and two sphenoid fontanels. The anterior fontanel (AF) is the largest, prominent and most important for clinical evaluation. Variation in size and shape are key features of normal AF. The knowledge of variation of normal fontanel is used for recognition of different medical disorders and abnormal skeletal morphogenesis. Gestational age (GA), gender, race, genetics and region are the principal factors that influence AF size. In Ethiopia, published literature regarding size of AF is scarce. Thus, the present study was undertaken to fill these gaps and to determine the mean size of AF in neonates delivered at University of Gondar Hospital. Objective: To determine the mean size of AF among term neonates on the first day of life born at the University of Gondar Hospital (UoGH), Gondar town, Northwest Ethiopia, 2018 Methods: Descriptive cross sectional study design was undertaken in 384 term (appropriately grown) and apparently healthy neonates born at UoGH, Gondar town from October 01, 2017 to February 15, 2018, using standard methods. Examination included assessment of AF size, birth weight and head circumference (HC). Pregnancy, labour and socio-demographic variables were also recorded. Descriptive analysis, student t-test, one way ANOVA test and Pearson correlation coefficient (r) were used to analyze the data. Results: In this study, the mean size of AF in term neonates was 3.00 ± 0.62 cm (range1.70 – 5.50 cm). The mean size of AF was 3.10 ± 0.66 cm for males, and 2.88 ± 0.57 cm for females. There was significant difference in AF size in neonates of different genders (p<0.001), mode of delivery (p<0.001) and duration of labour (p=0.006). There was no significant difference in AF size in neonates born from mothers of different maternal age (p=0.31), place of residence (p=0.31), marital status (p=0.91), educational status (p=0.18) and monthly income (p=0.09); however, the size of AF significantly affected by the occupation of the mother (p=0.01). Furthermore, non-significant difference in neonates of different GA (p=0.98), birth order (p=0.29) and onset of labour (p=0.40) in mean AF size were found. There was a significant positive correlation between the mean size of AF with birth weight (r=0.11; p=0.04) and HC (r=0.17; p=0.001). Conclusions: This study provides the mean size of AF for UoGH, Gondar term neonates, which can serve as local reference value for clinical use. At term, male neonates had significantly larger AF than female neonates. AF size has a direct relationship with birth weight and HC. Keywords: Anterior Fontanel, anterior posterior dimension, transverse dimension, Neonat