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    Anterior Fontanel Size: Sarla Mattur Ram Kumar G.P. Mathur V.K. Singh Veena Gupta V.N. Tripathi Material and Methods

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    This document describes a study that measured the size of the anterior fontanel in 445 infants between birth and 2 years of age. The main findings were: 1) The mean size of the anterior fontanel was largest in neonates (3.37 cm) and decreased with age, reaching 0.37 cm by 24 months. 2) 40% of infants had closure of the anterior fontanel by 12 months, 70.4% by 18 months, and 91.3% by 24 months. 3) Anterior fontanel sizes in this study were higher on average than reported in some Western and previous Indian studies, which the authors attribute to potentially slower growth in Indian infants.

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    Anterior Fontanel Size: Sarla Mattur Ram Kumar G.P. Mathur V.K. Singh Veena Gupta V.N. Tripathi Material and Methods

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    rvsharma
    51 views4 pages
    This document describes a study that measured the size of the anterior fontanel in 445 infants between birth and 2 years of age. The main findings were: 1) The mean size of the anterior fontanel was largest in neonates (3.37 cm) and decreased with age, reaching 0.37 cm by 24 months. 2) 40% of infants had closure of the anterior fontanel by 12 months, 70.4% by 18 months, and 91.3% by 24 months. 3) Anterior fontanel sizes in this study were higher on average than reported in some Western and previous Indian studies, which the authors attribute to potentially slower growth in Indian infants.

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    This document describes a study that measured the size of the anterior fontanel in 445 infants between birth and 2 years of age. The main findings were: 1) The mean size of the anterior fontanel was largest in neonates (3.37 cm) and decreased with age, reaching 0.37 cm by 24 months. 2) 40% of infants had closure of the anterior fontanel by 12 months, 70.4% by 18 months, and 91.3% by 24 months. 3) Anterior fontanel sizes in this study were higher on average than reported in some Western and previous Indian studies, which the authors attribute to potentially slower growth in Indian infants.

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    © All Rights Reserved
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    51 views4 pages

    Anterior Fontanel Size: Sarla Mattur Ram Kumar G.P. Mathur V.K. Singh Veena Gupta V.N. Tripathi Material and Methods

    Uploaded by

    rvsharma
    This document describes a study that measured the size of the anterior fontanel in 445 infants between birth and 2 years of age. The main findings were: 1) The mean size of the anterior fontanel was largest in neonates (3.37 cm) and decreased with age, reaching 0.37 cm by 24 months. 2) 40% of infants had closure of the anterior fontanel by 12 months, 70.4% by 18 months, and 91.3% by 24 months. 3) Anterior fontanel sizes in this study were higher on average than reported in some Western and previous Indian studies, which the authors attribute to potentially slower growth in Indian infants.

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    of 4

    ANTERIOR FONTANEL SIZE The knowledge of size of anterior fon-

    tanel is useful in evaluating the abnormal


    intracranial situations of failure of calvarial
    and brain growth. An unusually large or
    small size of fontanel may be a clue for the
    identification of intracranial or system dis-
    orders(l-4). The present study was conducted
    Sarla Mattur to determine the size of anterior fontanel in
    Ram Kumar different age periods from newborn period
    G.P. Mathur to 2 years and to find out the age of its
    V.K. Singh closure.
    Veena Gupta
    V.N. Tripathi Material and Methods
    This cross-sectional study included 445
    children between 0-2 years of age belong-
    ing to Kanpur, representing a mixed socio-
    economic strata. The newborn infants in-
    cluded in the study were full term and weighed
    2500 g or more. They were examined after
    ABSTRACT 48 hours of birth and at monthly intervals
    Anterior fontanel size was determined in a upto 12 months of age. Older infants and
    cross-sectional study of 445 infants ranging in age children were drawn from Well Baby Clinic
    from newborn period to 2 years. The mean ante- of L.L.R. Hospital, Kanpur and their
    rior fontanel size in neonates was 3.37 + 0.61 an measurements were taken at the age of 15,
    which decreased to 0.37±0.06cm in 24monthsage 18, 21 and 24 months. The time tolerance
    group. The age of closure of anterior fontanel was of ±15 days was allowed on the day of
    12, 18 and 24 months in 40%, 70.4% and 91.3%,
    examination. The infants with history of birth
    respectively.
    trauma, asphyxia, congenital anomalies,
    Key words: Anterior fontanel. persistent cyanosis, convulsions and systemic
    illness and eventful perinatal period and cases
    with protein energy malnutrition (PEM) were
    excluded.
    For measurement of anterior fontanel,
    the-boundries were traced by careful palpa-
    tion of fronto-pafietal area in midline. The
    four points A, B, C and D were marked on
    From the Departments of Pediatrics and Obstet-
    rics and Gynecology, G.S.V.M. Medical Col-
    the scalp with a sharp point sketch pen,
    lege, Kanpur 208 002. where the boundaries tend to meet at ante-
    rior, posterior, left lateral and right lateral
    Reprint requests: Dr. Sarla Mathur, Professor
    and Head, Department of Pediatrics, G.S.V.M. angles of fontanel, respectively. Then fon-
    Medical College, Kanpur 208 002. tanel anteroposterior diameter or length (AB)
    Received for publication: December 15, 1992;
    and transverse diameter or width (CD) were
    Accepted: September 4, 1993 measured by using the blunt ends of a sliding

    161
    MATHUR ET AL. ANTERIOR FONTANEL SIZE
    ■

    caliper in a sitting child whose head and The majority of the children (92.6%) be-
    arms were restrained by an attendant. Any longed to socio-economic Classes II, III and
    fontanel too small to be measured was IV; 7.4% were from Classes I and V. The
    considered closed. The mean anterior fon- mean values for the size of anterior fontanel
    tanel size was calculated by taking the average were in decreasing order with increasing age.
    of length (AB) and width (CD)(4). The basic Anterior-fontanel was closed as early as 6
    data thus obtained were arranged age wise months of age in a clinically normal child.
    at monthly intervals upto 1 year of age and By 12 months, it had closed in 40% chil-
    at 3 months interval for next 12 months, dren. In 91.3% children it had closed before
    i.e., at 15, 18, 21 and 24 months(4) and 24 months of age (Table I). The mean an-
    mean and standard deviation were calculated. terior fontanel size which is maximum in the
    A percentile grid for the size of anterior newborn (2.2 to 4.5 cm) decreases as the age
    fontanel at 3 monthly age interval was advances; at 24 months its size reduces by
    constructed by applying the method, used by 0.25 to 0.5 cm (Table II & Fig. 1).
    previous workers (5-10). Discussion
    Results The anterior fontanel of the newborn infant
    Out of 445 cases studied, 220 (49.4%) may increase in size after birth, but gener-
    were males and 225 (50.6%) were females. ally diminishes after 6 months(2). In this

    TABLE I-Mean Fontanel Size and Percentage of Closure


    Age Number Anterior fontanel size (cm) %
    (mo) Mean ± SD
    ±
    Newborn 45 3.37 0.61 -
    1 24 3.34 ± 0.57 -
    2 28 3.24 ± 0.52 -
    3 28 3.18 ± 0.60 -
    4 20 3.09 ± 0.78 -
    5 22 .2.83 ± 0.58 -
    6 22 2.64 ± 0.51 4.5
    7 22 2.65 ± 0.58 -
    8 25 2.55 ± 0.67 4.8
    9 30 2.48 ± 0.59 6.7
    10 23 2.37 ± 0.91 8.7
    11 22 2.26 ± 0.73 22.7
    12 20 2.18 ± 0.68 40.0
    15 32 1.47 ± 0.62 56.2
    18 35 1.13 ± 0.45 71.4
    21 24 0.63 ± 0.19 83.3
    24 23 0.37 ± 0.06 91.3

    162
    INDIAN PEDIATIUCS VOLUME 31-FEBRUARY 1994

    TABLE II-Age-wise Percentile for Mean Anterior Fontanel Size


    Percentile
    3rd 10th 25th 50th 75th 90th 95th
    Newborn 2.22 2.58 2.95 3.37 3.78 4.15 4.51
    3 2.05 2.40 2.77 3.18 3.58 3.95 4.30
    6 1.68 1.98 2.29 2.64 3.00 3.29 3.59
    9 1.37 1.71 2.08 2.48 2.87 3.24 3.48
    12 0.90 1.30 1.72 2.78 2.63 3.05 3.45
    15 0.30 0.67 1.05 1.47 1.88 2.26 2.63
    18 0.28 0.54 0.82 1.13 1.43 1.71 1.97
    21 0.27 0.38 0.50 0.63 0.75 0.87 0.98
    24 0.25 0.29 0.32 0.37 0.41 0.44 0.48

    study, the mean size of anterior fontanel at growth-lag in comparison to their western
    different age intervals was higher in com- counterparts. In an Indian study(11), it
    parison to Western(4,6) and few Indian was reported that there was hardly any
    studies(7-8). Our observations are in confor- patency of anterior fontanel beyond the age
    mity with few Indian workers(9-10), who of 18 months. Few Western workers(l,12)
    also observed higher anterior, fontanel size also mentioned age of closure of anterior
    in their subjects. This may be attributed to fontanel between 9-18 months. This
    regional variations or poor socio-economic indicates that the closure of anterior
    status of our subjects indicating general fontanel was delayed in our subjects

    163
    MATHUR ET AL. ANTERIOR FONTTANEL SIZE

    in comparison to western studies which can 5. Tanner JM, Whitehouse RH, Takaishi M.
    be explained by undernutrition prevailing in Standards from birth to maturity for height,
    our subjects. The majority of subjects were weight, height velocity and weight veloc-
    having weight between 3rd and 50th percen- ity: British children, 1965. Part I. Arch
    tile for age. However, we had excluded the Dis Child 1966, 41: 454-471.
    conditions responsible for large anterior 6. Srugo I, Berger A. Anterior fontanel size
    fontanel like rickets, congenital hypothyroid- in healthy Israeli newborn infants. Isr J
    ism, mucopolysaccharidoses, prematurity, and Med Sri 1987, 23: 1137-1139.
    intrauterine growth retardation (IUGR) by
    history, clinical evaluation and anthropom- 7. Katiyar GP, Sen S, Aggarwal KN. Ante-
    etric examination. rior fontanel during infancy. Indian Pedi-
    atr 1975, 12: 1253-1256.
    REFERENCES
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    phia, WB Saunders Company, 1992, pp 9. Indira Bai K, Subrahmanyam MVG, Subba
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    3. Smith DW, Popich GA. Large fontanels 11. Achar ST. Pediatrics in Developing Tropical
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    164

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