CAN score to difference bewteen iugr and sga baby
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CAN Score — Differentiating IUGR from SGA
The CAN (Clinical Assessment of Nutritional status) Score is used to clinically distinguish IUGR (Intrauterine Growth Restriction) — a pathologically growth-restricted fetus — from SGA (Small for Gestational Age) — a constitutionally small but otherwise healthy infant.
Why the Distinction Matters
| Feature | SGA | IUGR |
|---|---|---|
| Definition | Birth weight <10th percentile for gestational age | Fetus failing to reach its growth potential due to pathology |
| Cause | Constitutional (genetic, ethnic) | Placental insufficiency, infection, maternal disease |
| Nutritional status | Normal | Depleted (wasted) |
| Risk | Low | High (perinatal asphyxia, hypoglycemia, polycythemia) |
| Management | Routine | Intensive monitoring/intervention |
CAN Score (Metcoff, 1994)
Assesses signs of nutritional depletion in the newborn. A low score = significant wasting = likely IUGR rather than constitutionally small.
9 physical parameters are assessed, each scored 0, 1, or 2:
| Parameter | 0 (Severely depleted) | 1 (Moderately depleted) | 2 (Normal) |
|---|---|---|---|
| 1. Hair | Thin, sparse, easily pluckable, dull | Intermediate | Thick, shiny, not pluckable |
| 2. Cheeks | Very flat (no buccal fat pad) | Flat | Rounded (good buccal fat pads) |
| 3. Chin/neck | Very loose skin, deep folds | Some skin folds | Full, no folds |
| 4. Arm | Very loose skin, thin muscle | Moderate looseness | Full, well-muscled |
| 5. Back | Loose skin, ribs prominent | Moderate | No loose skin, no ribs visible |
| 6. Chest | Ribs very prominent, little subcutaneous fat | Ribs visible | Ribs not visible, good fat |
| 7. Abdomen | Scaphoid/sunken, skin loose | Slightly flat | Rounded, good fat |
| 8. Leg (thigh + calf) | Very loose skin, muscle wasting | Moderate | Plump, well-muscled |
| 9. Genitalia | Reduced fat pad | Intermediate | Normal fat pad |
Scoring Interpretation
| Total Score (out of 18) | Interpretation |
|---|---|
| ≥ 25 | Normal nutrition → likely SGA (constitutional) |
| < 25 | Nutritional depletion → likely IUGR |
Some references use a cutoff of ≤ 24 to define significant wasting consistent with IUGR.
Key Points
- The CAN score is a bedside clinical tool — no laboratory tests needed.
- It specifically detects subcutaneous fat loss and muscle wasting, which are hallmarks of chronic placental insufficiency (asymmetric IUGR).
- It is most useful in asymmetric IUGR, where the head is relatively spared but the body is wasted (brain-sparing effect).
- In symmetric IUGR (early insult — infections, chromosomal), wasting may be less prominent and the score less discriminating.
- A low CAN score should prompt investigation for hypoglycemia, polycythemia, hypothermia, and close neonatal surveillance.
Bottom line: CAN score < 25 out of 18 (i.e., the baby shows physical signs of malnutrition/wasting) = IUGR; score ≥ 25 = SGA (constitutionally small, nutritionally intact).
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