scholarly journals Maternal Resources, Pregnancy Concerns, and Biological Factors Associated to Birth Weight and Psychological Health

2021 ◽  
Vol 10 (4) ◽  
pp. 695 ◽  
Author(s):  
David Ramiro-Cortijo ◽  
María de la Calle ◽  
Andrea Gila-Díaz ◽  
Bernardo Moreno-Jiménez ◽  
Maria A. Martin-Cabrejas ◽  
...  
Keyword(s):  
Life Satisfaction ◽  
Birth Weight ◽  
Pregnant Women ◽  
Maternal Depression ◽  
Psychological Health ◽  
Neonatal Outcome ◽  
P Value ◽  
Linear Regression Models ◽  
Psychological Outcome ◽  
Biological Variables

Cognitive maternal adaptation during pregnancy may influence biological variables, maternal psychological, and neonatal health. We hypothesized that pregnant women with numerous general resources and less negative emotions would have a better coping with a positive influence on neonatal birth weight and maternal psychological health. The study included 131 healthy pregnant women. A blood sample was obtained in the first trimester to assess biological variables (polyphenols, hematological and biochemical parameters). Psychological variables (negative affect, anxiety, optimism, resilience, family–work conflicts, pregnancy concerns, general resources, and life satisfaction) were evaluated at several time points along gestation, and birth weight was recorded. Hierarchical linear regression models were used to associate the above parameters with maternal psychological outcome at the end of gestation (depression, resilience, and optimism) and neonatal outcome (birth weight). Maternal depression was associated with leukocytes (β = 0.08 ± 0.03, p-value = 0.003), cholesterol (β = 0.01 ± 0.002, p-value = 0.026), and pregnancy concerns (β = 0.31 ± 0.09, p-value = 0.001). Maternal resilience was associated with leukocytes (β = −0.14 ± 0.09, p-value = 0.010) and life satisfaction (β = 0.82 ± 0.08, p-value = 0.001), and maternal optimism was associated with polyphenol levels (β = 0.002 ± 0.001, p-value = 0.018) and life satisfaction (β = 0.49 ± 0.04, p-value = 0.001). Birth weight was associated with maternal resilience (β = 370.2 ± 97.0, p-value = 0.001), red blood cells (β = 480.3 ± 144.4, p-value = 0.001), and life satisfaction (β = 423.3 ± 32.6, p-value = 0.001). We found associations between maternal psychological, blood variables, and birth weight and maternal depression. This study reveals the relevance of psychological health during pregnancy for maternal and neonatal outcome, and it emphasizes the need to consider it in preventive policies in the obstetric field.

AN EPIDEMIOLOGICAL STUDY ON THE PREVALENCE OF HYPOTHYROIDISM IN PREGNANT WOMEN AND ITS OUTCOME

2021 ◽  
pp. 48-50
Author(s):  
Vinita singh ◽  
Sneha kumari
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Pregnant Women ◽  
Neonatal Outcome ◽  
Reproductive Age ◽  
P Value ◽  
Overt Hypothyroidism ◽  
Thyroid Disorder ◽  
Neonatal Complications ◽  
In Pregnancy

Thyroid disorders are the most common endocrine disorders affecting women of reproductive age group Hypothyroidism is common in pregnancy with an estimated prevalence of 2-3% Maternal hypothyroidism leads to many maternal and perinatal complications like miscarriage, gestational diabetes mellitus, pre-eclampsia, pre-term labor, placental abruption, and fetal death. AIMS AND OBJECTIVE: To nd out the effect of hypothyroidism on the course of pregnancy, to study the neonatal outcome, to know the prevalence of subclinical and overt hypothyroidism in pregnant women. MATERIALS AND METHODS: This prospective study was conducted in the department of Obstetrics and Gynecology, Nalanda medical college and hospital, Patna. All pregnant women attending the obstetric unit during this period were included in the study after informed consent 10 ml of blood sample of pregnant women was drawn at the rst visit in the rst trimester; then it was centrifuged and stored at -70 degree Celsius until assays, which were done after delivery, TFT was assessed by quantitative analysis of serum TSH and FT4 (ELISA). The pregnancy outcome variables like miscarriages, preterm deliveries, IUGR, preeclampsia, anemia, low birth weight, intrauterine fetal demise, antepartum hemorrhage, stillbirth, postpartum hemorrhage, birth asphyxia were studied. The neonatal outcome was also studied. The statistical analysis was done using the odds ratio. P-value <0.05 was considered signicant. RESULTS: Out of the 250 pregnant women 25 had hypothyroidism (9.5%). The prevalence of subclinical hypothyroidism was more as compared to the overtone (Table 2). Abortions were seen in 12.5% of subclinical and 11.1% of overt hypothyroid women. PIH and abruptions were signicantly higher in subclinical cases (P<0.05) while in the overt group both complications were higher as compared to the normal women but the p-value was not signicant for abruption. More of the hypothyroid women had preterm delivery (37.5% in subclinical and 44.4% in the overt group), Regarding neonatal complications, IUD and Early neonatal deaths were signicantly higher in overt hypothyroidism (P<0.01) Hypothyroid women had more low birth weight babies (31.25% in subclinical and 35.5% in overt) and IUGR babies (18.70% in subclinical and 22.21% in overt), CONCLUSION: The present study shows that, though the occurrence of hypothyroidism in pregnancy is less yet it causes many maternal and neonatal complications therefore universal screening of thyroid disorder should be done in pregnancy.

HPV Prevalence and its Association with Perinatal Outcomes among Singleton Mothers: Analysis of Pregnancy Risk Assessment and Monitoring System (PRAMS) Data, 2004-2011

2019 ◽  
Vol 15 (2) ◽  
pp. 143-149 ◽  
Author(s):  
Harpriya Kaur ◽  
Delf Schmidt-Grimminger ◽  
Baojiang Chen ◽  
K.M. Monirul Islam ◽  
Steven W. Remmenga ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Pregnant Women ◽  
Monitoring System ◽  
Large Population ◽  
Perinatal Outcomes ◽  
Hpv Infection ◽  
Adverse Outcomes ◽  
P Value ◽  
Pregnancy Risk

Background: Pregnancy may increase the risk of Human Papillomavirus (HPV) infection because of pregnancy induced immune suppression. The objective of this study was to use a large population-based dataset to estimate the prevalence of HPV infection and its association with adverse outcomes among pregnant women. Methods: We analyzed Pregnancy Risk Monitoring System data from 2004-2011 (N=26,085) to estimate the self-reported HPV infection. Survey logistic procedures were used to examine the relationship between HPV infection and adverse perinatal outcomes. Results: Approximately 1.4% of women were estimated to have HPV infection during their pregnancy. The prevalence of adverse outcomes in this sample was preterm birth (8.4%), preeclampsia (7.5%), low birth weight (6.3%) and premature rupture of membranes (2.8%). Compared to women without HPV infection, HPV infection positive women were much more likely to have had other infections such as chlamydia (9.23% vs. 2.12%, p-value <.0001), Group B Strep (21.7% vs. 10.04%, p-value <.0001), and herpes (7.17% vs. 1.07%, p-value <.0001). After adjusting for other risk factors including other infections, HPV infection was significantly associated with low birth weight (OR: 1.94, 95% CI: 1.14-3.30). Conclusion: The study indicated a potential association between HPV infection and low birth weight. Because pregnant women with HPV infection are at higher risk of other infections, future research may focus on the roles of co-infection in the development of adverse perinatal effects.

scholarly journals Neonatal Outcome Among Adolescent and Adult Pregnancy in a Tertiary Care Center of Nepal

2018 ◽  
Vol 14 (2) ◽  
pp. 56-59
Author(s):  
Jyoti Adhikari ◽  
Shristi Kharel ◽  
Lalita Bahl ◽  
Deepal Poudel ◽  
Rajesh K.C.
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Preterm Delivery ◽  
Adolescent Mothers ◽  
Neonatal Outcome ◽  
Birth Asphyxia ◽  
Adolescent Mother ◽  
P Value ◽  
The Common ◽  
Mother Group

Background: Teenage pregnancy is a common public health problem worldwide which is detrimental to the health of mother and child and has long been considered a high-risk situation. The risk of low birth weight (LBW) and preterm delivery is particularly high among teenagers.Methods: A comparative study was conducted in Nepalgunj Medical College Teaching Hospital, Kohalpur during the period of July 2015 to June 2016. The study was carried out to compare the immediate neonatal outcome and morbidity pattern in neonates of 50 adolescent and 50 adult mothers.Results: In the present study, 84% belonged to adolescent mother group (17-19 years) whereas 50% belonged to adult mother group (20-23 years). Illiteracy was seen more in adolescent mothers (62%) and most were from rural areas (68%). The common immediate neonatal outcome found in adolescent and adult mothers were preterm delivery (96% vs. 52%; p value 0.001), low birth weight (LBW) (70% vs. 38%; p value 0.001). The common neonatal morbidities seen significantly high in neonates of adolescent mothers, viz: Neonatal sepsis (NNS)(54% vs. 20% p value <0.02), apnea (30% vs. 14% P value <0.02), neonatal jaundice(NNJ)(44% vs. 30% p value <0.01) while the other morbidities found were birth asphyxia (20% vs. 14%; p value <0.1), Respiratory distress syndrome (RDS) (36% vs. 24% p value<0.1), anemia (16% vs. 8%; p value <0.1), seizure (10% vs. 8%; p value <0.1), meconium aspiration syndrome (MAS) (6% vs. 18%; p value<0.1) and intrauterine growth retardation(IUGR)(22% vs. 20%; p value <0.5). Similarly mortality was found to be more in neonates of adolescent mothers (14% vs. 8%; p value <0.1).Conclusion: Adolescent pregnant mothers are at risk of having poor neonatal outcome and morbidities like NNS, NNJ, RDS, apnea, IUGR, birth asphyxia, anemia and seizure. JNGMC,  Vol. 14 No. 2 December 2016, Page: 56-59

scholarly journals Faktor Risiko Bayi Berat Lahir Rendah di Rumah Sakit Umum Daerah Haji Makassar

2020 ◽  
Vol 1 (1) ◽  
pp. 16
Author(s):  
Hatijar Hatijar
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Nutritional Status ◽  
Pregnant Women ◽  
Maternal Age ◽  
Health Workers ◽  
Sampling Technique ◽  
P Value ◽  
Cross Sectional ◽  
Low Birth Weight Babies

Low birth weight babies are babies born with a weight less than 2500 grams. LBW (low birth weight) affects the high mortality rate in infants and is at risk of experiencing obstacles in growth and development. LBW is generally caused due to lack of nutrition and nutritional needs from mother to fetus while pregnant women aged less than 20 years and more than 35 years have the risk of giving birth to LBW. The purpose of this study is to determine the risk factors that cause LBW based on maternal age and nutritional status. The research method used was observational with a cross sectional study approach. The sampling technique was random sampling at the Regional Haji Makassar General Hospital in the January to July 2015 period with a total sample of 65 people. Analysis using the Chi Square Test. The results showed that there was a relationship between maternal age, nutritional status of LBW with a value (p value = 0.00 <α = 0.05). Maternal age and nutritional status are factors that influence low birth weight where the results of the study indicate that there is a relationship between maternal age and nutritional status on the incidence of low birth weight. To reduce the incidence of low birth weight, it is necessary to increase counseling about the causes of low birth weight babies by health workers, especially midwives to pregnant women to prevent the risk of low birth weight birth.

scholarly journals Food habits and Pregnancy outcomes

2021 ◽  
Author(s):  
Devdatt Pitale
Keyword(s):  
Socioeconomic Status ◽  
Birth Weight ◽  
Nutritional Status ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Food Habits ◽  
P Value ◽  
Age Group ◽  
Maternal Nutritional Status ◽  
Nicu Admission

Abstract Introduction: Nutrition during pregnancy plays an important role for an optimum outcome of pregnancy. Women may be malnourished even before they become pregnant and this may further adversely affect the pregnancy. Maternal undernutrition can lead to poor intrauterine growth and low weight of the baby at birth. Moreover, the leading causes for maternal deaths like hemorrhage and infection are related directly or indirectly to nutrition. Aim of the Study: To study the impact of existing food habits on pregnancy outcome in a south Indian population. Materials and Methods: This prospective study was conducted at a tertiary health care and research institute in India. From the antenatal clinic, 350 women who satisfied the following inclusion and exclusion criteria were admitted to the study. Results: The majority of pregnant women belonged to the age group of 21-25 yrs (47%) followed by the 26-30 yrs age group (40%).The number of teenage pregnancies was 30 (8%) whereas 5% of pregnant women belong the age group of 31-35 yrs.83% of the study population belonged to the low socioeconomic class. Majority of the babies (66%) had the birth weight in the range of 2.5-2.9 kgs. 29 % of babies had birth weight in the range of 3-3.5 kgs. There was a significant association (p value < 0.05) between the socioeconomic status of the mother, parity and her calorie intake. The present study found a statistically significant association between the maternal nutritional status, the birth weight of the baby and the need for NICU admission (p value < 0.05). Conclusion: Maternal food habits have an impact on the pregnancy outcome. Maternal food habits are influenced by many factors like socioeconomic status, parity, social food taboos and pregnancy itself. The pregnancy outcomes like birth weight, need for NICU admission and postnatal complications are influenced by maternal nutritional status.

scholarly journals PENINGKATAN BERAT BADAN IBU SAAT HAMIL BERHUBUNGAN DENGAN BERAT BADAN LAHIR BAYI

2021 ◽  
Vol 7 (4) ◽  
pp. 818-823
Author(s):  
Muhammad Subaim ◽  
Lidya Ariyanti
Keyword(s):  
Weight Gain ◽  
Birth Weight ◽  
Pregnant Women ◽  
Statistical Tests ◽  
P Value ◽  
Normal Infant ◽  
Maternal Weight ◽  
Chi Square ◽  
Weight Category ◽  
Infant Birth

Background : Infant mortality occurs in perinatal insanction (0 - 6 days), followed by death in neonatal indancy (7 – 28 days) and infant time (>28 days-<1year). The cause of death of perinatal babies in Lampung Province in 2013 was caused by asphyxia by 37.14% and the largest neonatal death was caused by BBLR by 28.18%.Purpose : Known correlation of weight gain of mothers while pregnant with the results of baby birth weight in Ambon Market Bandar Lampung Year 2019Methods: Quantitative research type, analytical survey research design with cross sectional approach. The population of 108 pregnant women based on the slovin formula was obtained by a sample of 85 respondents, sampling techniques using simple random sampling.Analyze univariate data and bivariate statistical tests using chi squaretest.Result : From 85 respondents obtained 51 respondents (60.0%) experienced normal weight gain, 34 respondents (40.0%) abnormal weight gain, 58 respondents (68.2%) with normal infant birth weight category, 27 respondents (31.8%) with the weight category of babies born abnormally. Conclusion : Statistical test results using chi square test are obtained p-value = 0.001 (< 0.05) which means there is a correlation of increase in maternal weight while pregnant with the results of baby birth weight in Ambon Market Bandar Lampung City Year 2019. Suggestion Pregnant women can maintain nutritional status from the beginning of the trimester to the end of the trimester through regular consumption of nutrients and energy according to the needs of the condition of the pregnant woman. Keywords : BB Enhancement, Pregnant Women, Baby Birth Weight ABSTRAK Pendahuluan: Kematian bayi terjadi pada masa bayi perinatal (0 - 6 hari), diikuti kematian pada masa bayi neonatal (7 – 28 hari) dan masa bayi (>28 hari-<1tahun). Penyebab kematian bayi perinatal Provinsi Lampung tahun  2013 disebabkan  karena  asfiksia  sebesar 37,14% dan kematian neonatal terbesar disebabkan BBLR sebesar28,18%.Tujuan:Diketahui korelasi peningkatan berat badan ibu saat hamil dengan hasil berat badan lahir bayi di Pasar Ambon Kota Bandar Lampung Tahun 2019.Metode: Jenis penelitian kuantitatif, rancangan penelitian Survei Analitik dengan pendekatan crosssectional. Populasi 108 ibu hamil berdasarkan rumus slovin didapat sampel sebanyak 85 responden, teknik sampling menggunakan simple random sampling. Analisa data univariat dan bivariat, uji statistik menggunakan uji chisquare.Hasil: Dari 85 responden didapat 51 responden (60,0%) mengalami peningkatan berat badan normal, 34 responden (40,0%) mengalami peningkatan berat badan tidak normal, 58 responden (68,2%) dengan kategori berat lahir bayi normal, 27 responden (31,8%) dengan kategori berat bayi lahir tidak normal.Kesimpulan: Hasil uji statistik menggunakan uji chi square didapat nilai p-value = 0,001 (<0.05) yang artinya terdapat korelasi peningkatan berat badan ibu saat hamil dengan hasil berat badan lahir bayi di Pasar Ambon Kota Bandar Lampung Tahun 2019.Saran ibu hamil dapat menjaga status gizi mulai dari awal trimester hingga akhir trimester melalui konsumsi zat gizi dan energi yang teratur sesuai dengan kebutuhan kondisi ibuhamil. Kata Kunci :Peningkatan BB, Ibu Hamil, Berat Badan Lahir Bayi 

scholarly journals Hubungan Anemia Pada Ibu Hamil Terhadap Kejadian BBLR di RSIA Sitti Khadijah 1 Makassar

2021 ◽  
Vol 2 (1) ◽  
pp. 27-35
Author(s):  
KHartina Burhan ◽  
Dahliah Dahliah ◽  
Nevi Sulvita Karsa
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Pregnant Women ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional ◽  
Mild Anemia ◽  
Mother And Child ◽  
Moderate Anemia ◽  
Child Hospital

In 2011, there were 32.4 million pregnant women aged 15-49 years in the world experiencing anemia. Data (WHO 2011) shows that around (30%) pregnant women in Indonesia experience anemia. This figure is higher compared to some other countries in Southeast Asia such as Malaysia (27%), Singapore (28%), and Vietnam (23%). This study aims to determine the relationship of anemia in pregnant women with the incidence of low birth weight babies (LBW) in the Mother and Child Hospital Sitti Khadijah 1 Makassar in 2018. Research conducted is descriptive analytic using cross sectional method in which a study, variables including risk factors and variables including effects are observed at once at the same time. Based on data from 70 pregnant women who have anemia, there are 66 pregnant women classified as mild anemia (94.3%) and 4 pregnant women with moderate anemia category (5.7%). Of the 23 pregnant women who gave birth to LBW babies were categorized into mild anemia as many as 22 (31.4%) and moderate anemia as much as 1 (1.42%). Based on the chi-square statistical test results obtained p value> 0.05 (p = 0.601) which means there is no significant relationship between anemia in pregnant women with the incidence of low birth weight in the Mother and Child Hospital Sitti Khadijah 1 Makassar in 2018.

scholarly journals Pregnancy outcome in isolated oligohydramnios diagnosed in third trimester

2021 ◽  
Vol 10 (5) ◽  
pp. 1914
Author(s):  
Pratibha Singh ◽  
Vibha Rani Pipal ◽  
Dharmendra Kumar Pipal ◽  
Navdeep Kaur Ghuman ◽  
Garima Yadav ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Amniotic Fluid ◽  
Pregnancy Outcome ◽  
Preterm Delivery ◽  
Neonatal Outcome ◽  
Low Risk ◽  
Control Group ◽  
P Value ◽  
Third Trimester

Background: The aim of this study was to compare the outcomes of pregnancies complicated by isolated oligohydramnios with the low risk pregnancies with normal amniotic fluid volume.Methods: The present study is a retrospective cohort study of singleton pregnancies diagnosed with Isolated oligohydramnios (AFI≤5) in their third trimester (N=35). Pregnancy outcome was compared with a matched control group of low risk pregnancies with amniotic fluid volume >5 (N=30).Results: The overall incidence of Isolated oligohydramnios was 0.7-0.8%. In oligohydramnios group, significant association were found in null-parity (60% vs 23.33%, p-value<0.005), Fetal growth retardation (25.71% vs 0% p-value<0.02), preterm delivery (22.85% vs 3.33%, p-value 0.025), rate of Induction of labor (40% vs 10%) and cesarean rate for non-reassuring fetal heart rate (20% vs 3.33%, p-value<0.001). Likewise, the incidence of low birth weight was (54.28% vs 13.33%, p-value<0.001) and NICU admissions was (20% vs 0%, p-value<0.01), but there was no difference in Apgar score finding. NICU stay was of short duration and all babies discharged in stable condition, there were no stillbirth or early neonatal death in both groups.Conclusions: Isolated oligohydramnios has an adverse influence on pregnancy and neonatal outcome in the form of FGR, preterm delivery, increased rate of Induction and cesarean section. Despite the high incidence of low birth weight and NICU admissions, the overall early neonatal outcome was similar to the other low risk pregnancies.

Relationship between the nutritional status of pregnant women and the incident of Low Birth Weight infant

2020 ◽  
Vol 1 (3) ◽  
pp. 58-62
Author(s):  
Mardiaturrahmah Mardiaturrahmah ◽  
Anjarwati Anjarwati
Keyword(s):  
Birth Weight ◽  
Mortality Rate ◽  
Infant Mortality ◽  
Low Birth Weight ◽  
Nutritional Status ◽  
Pregnant Women ◽  
Infant Mortality Rate ◽  
P Value ◽  
Case Group ◽  
Control Approach

The maternal mortality rate is 19,500 to 20,000 people every year or occurs every 26-27 minutes. The caus of maternal death is bleeding 30.5%, infection 22,5%, gestosis 17,5 and anesthesia 2%.  The infant mortality rate is around 10,000 to 280,000 per 18-20 minutes. The cause of infant mortality is due to Low Birth Weight (LBW) of 15/1000%.  The infant mortality rate in Indonesia is still the highest problem in other ASEAN countries. The infant mortality rate in Indonesia from 2008 was around 248 per 100,000 live births. Basic Health Research (RISKESDA) 2013 shows there are still 10,2% of babies with LBW, which is less than 2,500 grams. Neonatal death because LBW is basically affected by the nutritional status of pregnant women. This study aims to determine the relationship between the nutritional status of pregnant women and the  incidence  of  LBW. This  quantitative  research  uses  a  case  control  approach  using  a  retrospective approach. The population in this study were mothers who had given birth to babies during the last two years (2016-2017). The sampling technique uses total sampling for control cases by using a ratio of 1: 1 for the case group of 40: 40 samples. Analysis using Chi Square with p value 0,000 (OR=3,500, CI 95%=2,313-5,296). There is a relationship between nutritional status of pregnant women and the incidence of LBW. Health Technology Assessment (HTA) which can seek 1000 first day of life can be a breakthrough in assessing and providing interventions of nutrition in families, especially in pregnant women.

scholarly journals Post-Natal Gestational Age Assessment Using Sonographic Measurement of Femoral Length

2017 ◽  
Vol 36 (3) ◽  
pp. 268-272
Author(s):  
Anupama Deka ◽  
G.M. Manoj ◽  
B.J. Prabhu
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Statistical Difference ◽  
Neonatal Outcome ◽  
P Value ◽  
Long Bones ◽  
Age Assessment ◽  
Femoral Length

Introduction: An accurate Gestational Age (GA) is a better predictor of neonatal outcome than birth weight. GA assessment has many diagnostic and therapeutic importance. The methods available for GA estimations are LMP, new Ballard score and each methods has its own drawback which makes them either over estimate or under estimate GA. Antenatal 2nd trimester ultrasound measured femoral length gives more accurate GA estimation. Using similar principles we hypothesized that biometry of long bones with sonography imaging is feasible after birth and may be used to assess GA. The objectives of this study were to assess Post-natal gestational age using sonographic measurement of femoral length and then compare values with antenatal standards and further comparison of validity of each value with gestational age assessment by new Ballard score and the GA by LMP.Material and Methods: Ninety neonates from 32 weeks to 40 weeks of GA according to accurate LMP were subjected ultrasonographic measurement of femoral length.Results: GA calculated using accurate LMP as standard and compared with GA calculated from New Ballard score over estimated the GA. Post natal femoral length measured using sonographic method showed increase in femoral length with increasing GA similar to antenatal femoral standard and showed no statistical difference (p-value 0.375).Conclusions: post natal femoral length measured by ultrasonographicaly is a safe, feasible, objective and fastest method of GA estimation.  J Nepal Paediatr Soc 2016;36(3):268-272

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