Vol.3, No.12, 752-756 (2011)
doi:10.4236/health.2011.312125
C
opyright © 2011 SciRes. Openly accessible at http:// www.scirp.org/journal/HEALTH/
Health
Anthropometric measurements at birth as predictor of
low birth weight
Negar Sajjadian1, Hamideh Shajari1, Farnoosh Rahimi1, Ramin Jahadi2, Michael G. Barakat3
1Department of Neonatology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran;
2Departmnt of Plastic and Reconstructive Surgery, 15 Khordad Hospital, Shahid Beheshti Medical University, Tehran, Iran;
3Biomedical Studies, La Sierra University, Riverside, USA.
Received 22 May 2011; revised 16 July 2011; accepted 20 September 2011.
ABSTRACT
In developing countries, low birth weight (BW <
2500 grams) accounts for 60% - 80% of neonatal
deaths. Early identification and referral of LBW
babies for extra essential newborn care is vital
in preventing neonatal deaths. Studies carried
out in different populations have suggested that
the use of newborn anthropometric surrogates
of birth weight may be a simple and reliable
method to identify LBW babies. previous studies
reported correlation between birth weight to
several anthropometric measurements and their
predictive value. We aimed to evaluate the
correlation between birth length, head, chest,
and mid arm circumferences to birth weight.
Methods: A cross sectional study has been
conducted in SHARIATI Hospital in Tehran, from
September 2008 to February 2009. All Consecu-
tive full-term. Single ton, live born babies were
included and anthropometric measurements
carried out within 48 hours after birth by authors.
Birth weight was measured by digital scale
within the first 24 hours after delivery. Birth
length by somatometer and head, chest, mid
arm circumferences were measured 2 times by
using plastic measuring tape. Result: Out of 500
newborn studied. 52.2% were male and 47.8%
were female. The mean birth weight was 3195.4
± 399.9 gram and 3.8% of newborns were low
birth weight. It was evident a positive correlation
of birth weight to all such anthropometric mea-
surements with the highest correlation coeffi-
cient for chest circumference (r: 0.74). By ROC-
AUC analyses, chest circumference (AUC = 0.91,
95% CI 0.84 to 0.97) and arm circumference
(AUC = 0.87, 95% CI 0.79 to 0.95) were identified
as the optimal surrogate indicators of LBW
babies. The optimal cut-points for chest circum-
ference and arm circumference to identify LBW
newborns were ≥31.2 cm and ≥10.2 cm respec-
tively. Conclusions: Chest and mid arm circum-
ferences were the best anthropometric surrogates
of LBW among studied Iranian population. Further
studies are needed in the field to cross-validate
our results. anthropometric values are simple,
practicable, quick and reliable indicator for pre-
dicting LBW newborns in the community and can
be easily measured by paramedical workers in
developing nation.
Keywords: Low Birth Weight; Anthropometric
Measurements; Neonatal Mortality
1. INTRODUCTION
Of the approximately four million global neonatal
deaths that occur annually, 98% occur in developing
countries, where most newborns die at home while they
are being cared by mothers, relatives, and traditional
birth attendants [1]. About 38% of total under-five mor-
tality occurs during the neonatal period and nearly three
quarters of these deaths occur during the first week of
life [2]. Globally, about one-sixth of all newborns are
low birth weight (LBW, <2500 grams), which is single
most important underlying risk factor for neonatal deaths
[1,3]. Only about half of the newborns are weighed at
birth and for a smaller proportion of them gestational
age is known [4]. An estimated 18 million babies are
born with LBW [5]. They account for 60% - 80% of
neonatal deaths [6]. Moreover, LBW babies who survive
the critical neonatal period may suffer impaired physical
and mental growth. Therefore, an early identification and
prompt referral of LBW newborns is vital in preventing

N. Sajjadian et al. / Health 3 (2011) 752-756
Copyright © 2011 SciRes. Openly accessible at http:// www.scirp.org/journal/HEALTH/
753753
neonatal deaths. Available evidence from resource-poor
settings shows that extra essential newborn care for
LBW babies can reduce the number of neonatal deaths
by 20% - 40% [7]. Most neonatal deaths occur in the
community and some interventions, including vitamin A
supplementation, newborn skin cleansing with chlor-
hexidine and topical emollient therapy may be targeted
preferentially to LBW infants to reduce mortality risk.
Thus, continued efforts are required to describe optimal
methods for identifying these high-risk infants in the
community. In resource-poor settings, a large proportion
of deliveries take place at home and birth-weight is most
often not recorded. Therefore, there is a need to develop
simple, inexpensive and practical methods to identify
LBW newborns soon after birth [8]. One such method
may be the use of anthropometric surrogates to identify
LBW babies. A number of studies have focused on
measuring the circumference of the head, chest, mid
upper-arm, thigh or calf and observed the correlation
with continuous measurements on a gold standard
weighing scale (Bhargava et al., 1985; Singh et al., 1988;
WHO Collaborative study of birth weight surrogates,
1993; Dhar et al., 2002). In general, chest circumference
has performed better than other measures and has been
recommended for continued investigation, although in-
vestigators have demonstrated correlations between birth
weight and mid upper-arm circumference (Sauerborn et
al., 1990, calf (Gupta et al., 1996) (Samal and Swain,
2001 or thigh (Sharma et al., 1989) that are as strong as
with chest circumference.
Most suitable and reliable anthropometric surrogate to
identify LBW Iranian newborns and its cut-off point to
identify LBW newborns is not known. Therefore, we
carried out this study with following objectives:
1) to identify a suitable anthropometric surrogate to
identify LBW babies and
2) to determine its cut-off value to identify LBW ba-
bies.
2. MATERIALS AND METHODS
A cross sectional study was performed among all term
single tone neonate born at SHARIATI hospital (Tehran,
Iran), a reference center for high risk pregnancies, from
September 2008 to February 2009.
The study group consisted of all consecutive full
term―single tone newborn with gestational age of be-
tween 37 weeks and 41 weeks and 6 days as estimate by
maternal last menstrual period (LMP) date and first tri-
mester sonography when their differences are not more
than week. Preterms were excluded because they are
probably low birth weight.
These newborn were examined by the authors within
their first 48 hours of life. Newborns whose mother pre-
sented complications during pregnancy (preclampsia,
Diabetes, addiction and smoking) or newborns with ma-
jor congenital anomaly, hydropic feature or intrauterine
growth retardation (IUGR) were excluded.
Birth weight with naked neonate in supine position was
obtained soon after birth by digital scale with 10 gram
subdivision. All other anthropometric Variable including
chest, head, mid arm Circumferences were measured by
non extendable measuring tape, with a width of 1.0 cm
and subdivisions of 0.1 cm. and birth length was meas-
ured by somatometer
Head circumference was obtained by placing tape
along the largest occipitofrontal diameter along over the
occiput and eyebrow.
The chest circumference was measured by placing
measuring tape along the point of nipples. The mid arm
circumference was obtained from the left arm with el-
bow at the mid point between acromion and olecranon,
with the newborn was located in dorsal decubitus with
arm lying laterally to the trunk.
The length was measured with the newborn in supine
position with full extension of knee and distance between
top of head and heel when pressed against a vertical surface
and role on a stabilizing board was measured.
A total of two consecutive measurements were taken
for each variable and the mean values were recorded.
Continuous variables are reported as mean and stan-
dard deviation while between-gender comparisons of
continuous variables were performed using independent
sample t-test. Pearson’s product-moment correlation co-
efficient was used to assess the association between an-
thropometric measurements. Receiver operating charac-
teristic (ROC) curves were used to evaluate the accuracy
of different anthropometric measurements to predict
LBW. Non parametric receiver operating characteristic
analysis was done to compare the overall utility of an-
thropometric measurements for Identifying LBW infant.
Multivariate linear regression with backward stepwise
method was used for estimation of birth weight by an-
thropometric measurment.
Sensitivity, specificity were calculated at all cut-points
for any anthropometric measurement. We choose as “op-
timum” the cut-point with the highest [(sensitivity + speci-
ficity)/2] ratio. This criterion was chosen to allow compari-
son with previous studies available in the literature. The
data analysis was done by the spss version 11.5 and A
P-value <0.05 was considered statistically significant.
3. RESULTS
A total of 500 newborns (52.2% male and 47.8% fe-
male) were studied.
The mean birth weight was 3195.48 ± 399.92 gram.
3.8% of patients were LBW. Summary measures of

N. Sajjadian et al. / Health 3 (2011) 752-756
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754
weight, and anthropometric variable are presented in
Ta ble 1. In our study there were significant differences
in birth weight and anthropometric measurements be-
tween male and female newborns (P-value <0.05) the
males had higher birth weight and all anthropometric
variable except mid arm to head circumference ratio.
The anthropometric measurements were correlated
with birth weight with significant p value, the maximum
correlation with birth weight was observed for chest cir-
cumference (r = 0.74) and the mid arm circumference (r
= 0.70), head circumference (r = 0.65). Length (r = 0.61)
and a weak correlation was seen with mid arm circum-
ference to head circumference (r = 0.44) with the best
correlation coefficient observed for the weight-chest
circumference association.
Multivariate Linear regression analysis was conducted
for predicting birth weight by anthropometric measure-
ments (Table 2).
The best discrimination of LBW, as detected by ROC-
AUC, was obtained by chest circumference (AUC =
0.91, 95% CI 0.84 to 0.97) followed by lenght (AUC =
0.89, 95% CI 0.79 to 0.99), head circumference (AUC =
0.87, 95% CI 0.80 to 0.94), mid arm circumference
(AUC = 0.87, 95% CI 0.79 to 0.95) and mid arm to head
circumference ratio (AUC = 0.74, 95% CI 0.63 to 0.85)
The sensitivity, specificity, for classifying infants into
LBW status was shown in Ta ble 3. An optimum cut off
point identifying LBW were 31.2 cm for chest circum-
ference 10.2 cm for mid arm circumference, 33.2 cm for
head circumference, 48.5 cm for length and 0.3 for mid
head circumference, 48.5 cm for length and 0.3 for mid
arm to head circumference ratio (Table 3).
Table 1. Descriptive statistics of birth weight and anthropometric measurements.
Maximum Minimum Standard Deviation Mean Sex Va riab le
4550 2100 399.92 3195.48 Combined
4550 2200 408.20 3269.43 Male
4150 2100 375.18 3114.73 Female
Weight
13 9 0.89 10.79 Combined
13 9 0.87 10.88 Male
13 9 0.91 10.70 Female
Mid Arm Circumference
38 28 1.75 32.78 Combined
38 28 1.73 33.9 Male
37 28 1.72 32.43 Female
Chest Circumference
38.5 31 1.33 34.67 Combined
38.5 31 1.34 35.01 Male
38 31 1.21 34.29 Female
Head Circumference
0.37 0.25 0.02 0.31 Combined
0.37 0.26 0.02 0.31 Male
0.37 0.25 0.02 0.31 Female
MIC/HC Ratio
58 44 3.92 50.43 Combined
58 46 2.01 50.81 Male
56 44 1.85 50.01 Female
Length
Table 2. Linear regression equation for estimation of birth weight.
Adjusted R2 F (P-value) Regresion Equa t ion Variable
0.488 477.48 (0.00) BW = –162.58 + 311.19 (MAC) MAC
0.194 121.210 (0.00) BW = 839.45 + 7569.4 (MAC/HC) MAC/HC
0.548 606.38 (0.00) BW = –2329.13 + 168.55 (CC) CC
0.426 371.23 (0.00) BW = –3596.83 + 195.90 (HC) HC
0.374 298.8 (0.00) BW = 3041.77 + 123.67 (L) LE

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Ta b l e 3 . Sensitivity and specifity of optimum cutoff points of
anthropometrics.
Variable Cut off limit Sensitivity Specifity
Chest circumference 31.25 84% 81%
Head circumference 33.25 73% 85%
Mid arm circumference 10.25 94% 68%
Length 48.5 84% 88%
Mid arm circumference
Head circumference 0.303 73% 62%
4. DISCUSSION
The prime concern of the present study was to identify
the best suitable surrogate parameter, proxy, to birth
weight, which when used by the health personnel in do-
miciliary outreach will detect the maximum number of at
risk infants for providing them with timely and needed
intervention strategy.
The mean birth weight and anthropometrics in our
population is higher than some previous mentioned study.
A WHO multicenter study reported that the average birth
weight was 2630, 2780 and 3840 for newborns in India,
Nepal and Sri Lanka respectively [14]. Higher mean
birth weight may be because only the full term singleton
live births were included in our study. Previous studies
did not specify such criteria [11,16,19]. Birth weights of
the newborns born before completion of 37 weeks of
gestation (full term) may also have been included in the
studies cited above
Our data relieved that positive correlation between all
studied parameters and birth weight is present. In our
study there were significant differences in birth weight
and anthropometric measurements between male and
female newborns. Males had higher mean birth weight
and anthropometrics than females. This finding is similar
to Dhar study that strongest correlation was present be-
tween CHC and birth weight was observed (r = 0.84). It
may be due to large size of our population that make
these difference significant however they lack clinical
significance.
The percent of LBW in our population were lower
than the Nepal (8.5%) and Tanzania (18% - 8%) study
[8,9]. The reason of these finding may be related to dif-
ferent characteristics of population studied (genetic, nu-
tritional, environmental background) and because we
exclude all preterm neonates. In WHO collaborative
study of birth weight surrogates Clear differences were
seen between the centers in terms of the means and tenth
centiles of both birth weight and the anthropometric
measures. The values confirm the expected regional dif-
ferences, since centers in South Asia, such as Delhi and
Chandigarh, have on average the lowest values, whereas
those in Europe, such as St. Peters. Many researchers
have attempted to identify a suitable anthropometric
surrogate to identify LBW babies which is reliable, sim-
ple, and logistically feasible in field conditions. Some
studies have recommended that CHC, MUAC and HC
may be used as anthropometric surrogates to identify
LBW babies [11-15,17-20]. Therefore we considered all
these anthropometric measurement. In our study CHC
was identified as a suitable surrogate to identify LBW
babies.
In the present study, the maximum correlation with
birth weight was observed for chest circumference (r =
0.74) and the mid arm circumference (r = 0.70) so chest
and mid-arm circumference had the best correlation with
birth weight and are good predictors of LBW neonates.
According to other studies (mullany et al., 2007 WHO
Collaborative study of birth weight surrogates, 1993)
The correlations between birth weight, arm circumfer-
ence and chest circumference are high ranging from
0.60 to 0.95 and suggested that chest circumference is
the Optimal anthropometric measure for establishing
cutoffs for the identification of LBW infants [9,19].
The preset study shows that chest circumference at a
cut off limit of 31.2 cm is affective in detecting low birth
weight infant with a sensitivity of 84% and specifity of
81%. Cupta et al. showed cut off limit 30.1 cm with
specifity 69 and sensitivity of 83% and Virdi et al. study
cut off point of 30 with sensitivity 60 and specifity 0.3
[12,13]. A WHO collaborative study has recommended
that CHC of 29 centimeters and 30 centimeters may
identify “highly at risk” and “at risk” newborns respec-
tively [19]. In our study maximum sensitivity and speci-
ficity for CHC was at CHC of 30.8 centimeters. The
higher mean birth weight of newborns may be the reason
for a slightly higher cut-off point obtained in our study.
We considered only full-term deliveries, which was
unlike earlier studies [12,17,20].
Thus, it is evident from analysis of our data that chest
circumference is the best suitable and simple surrogate
parameter that could be used in the domiciliary outreach
when it is impossible to record weight of baby at birth.
For health personnel who are working in the community
can use color coded tapes indicting weight <2500 grams.
We recommend the use of chest rather than arm cir-
cumference as a surrogate for birth weight for two rea-
sons. First, it is simpler to measure identification of the
nipple line is easier, making measurement more opera-
tionally feasible than that of mid-arm circumference.
Second, our findings suggest that measurement of both
arm circumference and chest circumference is of little
additional value in predicting low-birth-weight babies.
We conclude that simple measurements such as chest
circumference and also other mentioned anthropometric
measure can simply and practicably identify infants with

N. Sajjadian et al. / Health 3 (2011) 752-756
Copyright © 2011 SciRes. Openly accessible at http:// www.scirp.org/journal/HEALTH/
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LBW when recording birth weight is not feasible. these
measurements are easy to learn and can conveniently be
introduced in to the existing system of health care to use
by paramedical workers to detect neonate who are LBW
and at risk. A color coded, measuring tape may be sug-
gested for use by health workers or family members to
identify LBW newborns in home setting.
REFERENCES
[1] The world health report. The newoborn health that went
unnoticed, perinatal mortality. A listing of available in-
formation. World Health Organization, Geneva, 1996.
[2] Lawn, J.E., Cousens, S. and Zupan, J. (2005) Lancet
neonatal survival steering team: 4 million neonatal deaths:
when? Where? Why? Lancet, 365, 891-900.
[3] Gogia, S. and Sachdev, H.S. (2010) Home visits by
community health workers to prevent neonatal deaths in
developing countries: A systematic review. Bulletin of the
World Health Organization, 88, 658
[4] Blanc, A.K. and Wardlaw, T. (2005) Monitoring low birth
weight: An evaluation of international estimates and an
updated estimation procedure. Bulletin of the World
Health Organization, 83, 178-185.
[5] United Nations Children’s Fund (UNICEF) (2005) The
state of the world’s children. New York.
[6] Bang, A., Reddy, M.H. and Deshmukh, M.D. (2002)
Child mortality in Maharashtra. Economic Political
Weekly, 37, 4947-4965.
[7] Darmstadt, G.L., Bhutta, Z.A., Cousens, S., Adam, T.,
Walker, N. and de Bernis, L. (2005) Lancet neonatal sur-
vival steering team: Evidence-based, cost-effective in-
terventions: How many newborn babies can we save?
Lancet, 365, 977-998.
doi:10.1016/S0140-6736(05)71088-6
[8] Mullany, L.C., Darmstadt, G.L., Coffey, P., Khatry, S.K.,
LeClerq, S.C. and Tielsch, J.M. (2006) A low cost, colour
coded, hand held spring scale accurately categorises birth
weight in low resource settings. Archives of Disease in
Childhood, 91, 410-413. doi:10.1136/adc.2005.088781
[9] Ramaiya, C., Msamanga, G., Massawe, S., Mpanju, W.
and Nywalle, E. (1994) Newborn’s arm circumference as
screening tool of low birth weight in temeke pistric,
peres salaam, Tunzania. Tropical and Geographical
Medicine, 46, 318-321.
[10] Naik, D.B., Kulkarni, A.P. and Aswar, N.R. (2003) Birth
weight and anthropometry of newborns. Indian Journal
of Pediatrics, 2003, 70, 145-146.
doi:10.1007/BF02723742
[11] Samal, G.C. and Swain, A.K. (2001) Calf circumference
as an alternative to birth weight to predict low birth
weight babies. Indian Pediatrics, 38, 275-277.
[12] Gupta, V., Hatwal, S.K., Mathur, S., Tripathi, V.N.,
Sharma, S.N., Saxena, S.C. and Khadwal, A. (1996) Calf
circumference as a predictor of low birth weight babies.
Indian Pediatrics, 33, 119-121.
[13] Virdi, U.S., Jain, B.K. and Singh, H. (2001) Calf cir-
cumference for identification of low birth weight babies.
Indian Pediatrics, 38, 934-935.
[14] World Health Organization (1994) Multi-centre study on
low birth weight and infant mortality in India, Nepal and
Sri Lanka. Southeast Asia Regional Office, World Health
Organization, New Delhi.
[15] Ahmed, F.U., Karim, E. and Bhuiyan, S.N. (2000)
Mid-arm circumference at birth as predictor of low birth
weight and neonatal mortality. Journal of Biosocial Sci-
ence, 32, 487-493. doi:10.1017/S0021932000004879
[16] Das, J.C., Afroze, A., Khanam, S.T. and Paul, N. (2005)
Mid-arm circumference: an alternative measure for scree-
ning low birth weight babies. Bangladesh Medical Re-
search Council Bulletin, 31, 1-6.
[17] Ezeaka, V.C., Egri-Okwaji, M.T., Renner, J.K. and
Grange, A.O. (2003) Anthropometric measurements in
the detection of low birth weight infants in Lagos. The
Nigerian Postgraduate Medical Journal, 10, 168-172.
[18] Hossain, M.M., Habib, M. and DuPont, H.L. (1994) As-
sociation between birth weight and birth arm circumfer-
ence of neonates in rural Egypt. Indian Journal of Pedi-
atrics, 61, 81-87. doi:10.1007/BF02753565
[19] (1993) Use of a simple anthropometric measurement to
predict birth weight. WHO collaborative study of birth
weight surrogates. Bulletin of the World Health Organi-
zation, 71, 157-163.
[20] Mullany, L.C., Darmstadt, G.L., Jhatry, S.K. et. al. (2007)
Relationship between the surrogate anthropometric
measures, foot length and chest circumference and birth
weight among newborn of sarlahi, Nepal. European
Journal of Clinical Nutrition, 61, 40-46.
doi:10.1038/sj.ejcn.1602504
[21] Hanimi, R.M. and Abhay T. (2005) How to identify neo-
nate at risk of death in rural India: clinical criteria for the
risk approach. Journal of Perinatology, 25, s44-s50.
doi:10.1038/sj.jp.7211272
[22] Kliegman, R.M., Jenson, H.B., Marcdanle, K.J. and Be-
harman, R.E. (2006) Nelson essentials of pediatrics. 5th
Edition, Elsevier Saunders Press, Amsterdam.
[23] Eghba, L.F. (2007) Evaluation of etiology of low birth
weight. Iranian Pediatric Journal, 17, 27-33.
[24] Bindu, N.R., Elizabeth, K.E., Varghese, G. and Varghese,
S. (2006) Mid arm circumference (MAC) and body mass
index (BMJ)―The tow important auxologic parameters
in neonates. Journal of tropical pediatrics, 52, 341-345.
[25] Seeramarddy, C.T., Chuni, N., Patil, R., Singh, D. and
Shakya, B. (2008) Anthropometric surrogates to identify
low birth weight Nepalese newborn: A hospital-based
study. BMC Pediatrics, 8, 16.
doi:10.1186/1471-2431-8-16
[26] (1993) WHO Collaborative study of birth weight surro-
gates―Use of a simple anthropometric measurement to
predict birth weight. Bulletin of the World Health Or-
ganization, 71, 157-163.
[27] Gupta, V., Hatwal, S.K., Mathur, S., et al. (1996) Calf
circumference as a predictor of low birth babies. Indian
Pediatrics, 33, 119-121.