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Anterior Fontanel Size Among Term Newborns: A Systematic Review and Meta-Analysis
Mohammed Oumer1,2, Ashenafi Tazebew3, Mekuriaw Alemayehu4
1Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Insights
This systematic review found the average anterior fontanel size in newborns is 2.58 cm. Male newborns have a statistically larger anterior fontanel size compared to female newborns.
Area of Science:
- Pediatrics
- Anatomy
- Craniometry
Background:
- The anterior fontanel is a crucial component of the infant craniofacial system.
- It is the largest of the six fontanels in a newborn skull and vital for clinical assessment.
- Factors like sex, race, genetics, gestational age, and region influence its size, with existing data showing inconsistencies.
Purpose of the Study:
- To determine the pooled mean size of the anterior fontanel in term newborns.
- To identify the pooled mean difference in anterior fontanel size between male and female newborns.
Main Methods:
- A systematic literature search was conducted across multiple databases (PubMed/Medline, Google Scholar, Science Direct, JBI Library, Embase, Cochrane Library).
- Data extraction was standardized, and heterogeneity was assessed using Cochrane Q and I² statistics.
- Fixed-effect and random-effect models were employed for meta-analysis, with subgroup, meta-regression, and sensitivity analyses to address heterogeneity.
Main Results:
- The meta-analysis included 8,661 newborns from 26 studies across Asia, Africa, America, and Europe.
- The pooled mean anterior fontanel size was 2.58 cm (95% CI: 2.31, 2.85 cm).
- A statistically significant difference was observed between sexes, with male newborns exhibiting a larger mean anterior fontanel size (pooled MD = 0.15 cm, 95% CI: 0.02, 0.29 cm).
Conclusions:
- This review provides a reliable pooled estimate for anterior fontanel size in newborns.
- A significant sex-based difference in anterior fontanel size was confirmed, with males having larger fontanels.
- These findings contribute valuable data for clinical evaluation and understanding craniofacial development.
Abstract:
Background: Anterior fontanel is an integral element of an infant craniofacial system. There are six fontanels in the newborn skull, namely anterior, posterior, two mastoid, and two sphenoid fontanels. The anterior fontanel is the largest, prominent, and most important for clinical evaluation. Sex, race, genetics, gestational age, and region are the principal factors that influence anterior fontanel size. There exist inconclusive findings on the size of anterior fontanel in newborns. Therefore, this systematic review and meta-analysis aimed to determine the pooled mean size of anterior fontanel among term newborns and to identify the pooled mean difference of anterior fontanel size between males and females. Methods: PubMed/Medline, Google Scholar, Science Direct, JBI Library, embase, and Cochrane Library databases were systematically searched. All essential data were extracted using a standardized data extraction format. The heterogeneity across studies was assessed using the Cochrane Q test statistic, I2 test statistic, and p-values. A fixed-effect model and random effect model were used to estimate the pooled mean size of anterior fontanel and the pooled mean difference between male newborns and female newborns, respectively. To deal with heterogeneity, sub-group analysis, meta-regression analysis, and sensitivity analysis were considered. JBI quality appraisal checklist was used to evaluate the quality of studies. Results: In this meta-analysis, 8, 661 newborns were involved in twenty-six studies. Among studies, 13 conducted in Asia, 7 in Africa, 5 in America, and 1 in Europe. The pooled mean size of anterior fontanel was 2.58 cm (95% CI: 2.31, 2.85 cm). The pooled mean size of anterior fontanel for Asia, Africa, America, and Europe region was 2.49, 3.15, 2.35, and 2.01 cm, respectively. A statistically significant mean difference was detected between male and female newborns (D + L pooled MD = 0.15 cm, 95% CI: 0.02, 0.29 cm). Conclusion: The pooled estimate of this review does provide the mean value of the anterior fontanel size in the newborns. There was a statistically significant mean fontanel size difference between male and female newborns. Therefore, male newborns had a significantly larger mean size than female newborns.
