Sonographic Assessment Of Normal Spleen Size In Indian Neonates

Sonographic Assessment Of Normal Spleen Size In Indian Neonates | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Sonographic Assessment Of Normal Spleen Size In Indian Neonates Devesh Bafna, Uma Chillalshetti, Veena Kalmath, Kanan Vadodariya, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8252637/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Several pathological abnormalities can affect spleen size, which can be difficult to diagnose via routine palpation in neonates. Knowledge of normal spleen size, and its relation with age and biometric parameters (length and weight) of physical growth, is important in determining mild splenomegaly. Objective The purpose of this study is to measure splenic size in Indian neonates, establish fresh parameters of normal splenic size, and establish correlation with age, body length and weight. Material and methods The study was conducted in the Radiology department of Chhatrapati Shivaji Maharaj Hospital, Thane. We conducted a prospective study of 51 normal neonates visiting our hospital; the majority of whom were either born at the hospital or came for reasons other than those with splenic pathology. The child’s length, weight, and gestational history of the mother were noted. A thorough history was elicited to rule out past/current pathologies affecting the spleen. Routine ultrasonography of the abdomen and pelvis was performed and the child’s spleen was measured in two dimensions. Results The mean splenic length is 3.54 ± 0.19 cm, with a range of 3.2–3.92 cm. The splenic longitudinal dimension showed better correlation with body parameters, with neonatal length showing highest correlation coefficient. Conclusion Knowledge of the normal dimensions of a neonatal normal spleen will aid radiologists and pediatricians in identifying splenomegaly at an earlier stage. We believe to have provided reference values to assist in the early identification of splenic disorders. Nuclear Medicine & Medical Imaging Sonography Neonates Splenic size Splenomegaly Figures Figure 1 Figure 2 Introduction The spleen is a vascular abdominal organ that arises from mesenchyme and is a site of red blood cell production in the fetus. Splenic hematopoiesis peaks at approximately 20 weeks of gestation. While the normal spleen of a child or an adult does not produce red blood cells, the spleen may be a site of extramedullary hematopoiesis, as in thalassemia or osteopetrosis. The postnatal function of the spleen is the removal of old and damaged red blood cells from circulation. Splenomegaly in children can be associated with pathologies like infections, neoplasms, thalassemia major, hemolytic anemia, portal hypertension, Sickle cell anemia, Gaucher’s Disease, etc. [ 1 , 2 ] Before the advent of Ultrasonography, palpation and percussion were the two bedside methods to assess the splenic size. These are considered crude and unreliable, [ 3 ] as the organ had to be enlarged 2–3 times for it to be palpable. [ 4 ] Furthermore, the spleen is normally palpable in about 15–17% of healthy neonates. [ 4 , 5 ] Normal splenic size estimation studies have been done frequently in children, yet it’s rarely been done in newborns. With the advent of ultrasonography, splenic size estimation has become more accurate and reproducible. [ 6 ] It is a safe, quick, low-cost and reliable method with no ionising radiation or anaesthesia required. [ 3 ] It is also a very sensitive method to detect mild splenomegaly, as clinical examination is inaccurate in detecting mild enlargement. In children, knowledge of normal splenic size (splenic length) in relation to age and other biometric parameters (body length and weight) of physical growth is of great importance for the determination of mild splenomegaly. [ 3 ] In the study, we opted to examine splenic size in normal neonates, who came to the Radiology department for evaluation of abdominal/pelvic issues unrelated to splenic pathology or those who were delivered in the hospital premises. Aims and Objectives The main objective of this study was to estimate normal range of splenic size in neonates and establish its correlation with age, birth weight, body length and sex of the neonate. Materials and methods The study procedures were carried out in accordance with the Declaration of Helsinki. The study was approved by the Institutional Clinical Ethics Committee (ICEC) of Rajiv Gandhi Medical College (RGMC) and Chhatrapati Shivaji Maharaj Hospital, Kalwa, with Approval No: RGMC/ICEC/65/2018 dated 06/04/2018. The study evaluated 51 neonates who came to the department of Radiology for reasons other than splenic pathology like undescended testes, suspected congenital diaphragmatic hernia, or sonography of the skull as well as normal newborns delivered (by both vaginal and by Caesarean section) in the same institute. Neonates with fever of any origin, or under evaluation for conditions affecting spleen e.g. thalassaemia, hemolytic anemia, malaria, enteric fever, malnutrition (Grade III and IV, Indian Academy of Paediatrics IAP guideline), and congestive heart failure were excluded from the study. Baseline data like age, body length and weight of the neonate were noted and recorded. Body length was measured using an infantometer and weight with an electronic weighing scale, using standard methods. [ 7 ] After obtaining written consent from parents, sonography of the neonate was performed. Parents were informed about the nature of the study, and informed consent was obtained for the publication of data while maintaining anonymity. Caution was taken that the child was well fed and calm during the scan. Ultrasonographic evaluation The scan was performed with a 5 MHz curvilinear probe using Sonoscape (Sonoscape Medical Corp., Shenzhen, China) and Mindray Consona (Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China) ultrasound machines. All procedures were carried out according to standard protocols to ensure reproducibility. The convex probes used and settings were adjusted based on patient characteristics and examination requirements. Images were obtained and interpreted by radiologists. The spleen was measured by the optically maximal distance (ideally at the hilum) on the longitudinal coronal view (between the most superomedial and the most inferolateral points). [ 8 ] The measurements were made during quiet breathing, neither preparation nor sedation was used. In all the scans, spleens showed a uniform homogenous echo pattern. Statistical Analysis All statistical analyses were performed using Microsoft Excel (Microsoft 365, Version 2019). In addition, the on-site biostatistician was approached for advice on statistical methodology and analytical techniques. Results We approached parents of 110 children for enrollment into the study, out of which 32 refused to participate and 27 were excluded for reasons mentioned above. Thus, 51 neonates were included (29[56.86%] boys). The age of the neonates ranged from 1 day old (33[64.71%]), 2 days old (9[17.65%]), 3 days old (5[9.80%]), 4 days old (2[3.92%]), and 5 days old (2[3.92%]). The mean splenic length in male neonates was 3.55 ± 0.21 cm, while in female neonates it was 3.50 ± 0.16 cm. An independent samples t-test showed that this difference was not statistically significant ( t (49) = 0.81, p = .41). Therefore, all data was rearranged without being separated according to sex. [Table 1 ] shows the measured ultrasonographic and anthropometric data from the 51 neonates. Table 1 Splenic Dimensions and Anthropometric Data Analysis Parameter Mean SD (Standard Deviation) Min Max 5th centile 95th centile Spleen Length(cm) 3.54 0.19 3.1 4 3.2 3.92 Spleen width(cm) 1.57 0.17 1.2 2.07 1.35 1.97 Neonatal Weight(kg) 2.85 0.23 2.5 3.5 2.5 3.5 Length(cm) 49.96 1.36 47 53 47.5 52.62 The mean splenic length is 3.54 ± 0.19 cm, with a range of 3.2–3.92 cm (taking the 5th and 95th centiles as the uppermost and lowermost limits). The correlation between splenic size and neonatal anthropometric parameters was assessed and is presented as a scatter plot with regression analysis in [Table 2 ], [ Figure 1 ] and [Figure 2]. Table 2 Correlation Coefficients of Splenic Dimensions vs Length and Weight Parameter Length Weight Splenic Size Longitudinal 0.88 0.42 Splenic Size Transverse 0.27 0.48 Since the age group selected for the study was narrow, age as a factor was not considered for correlation with splenic length. A strong positive correlation was observed between splenic length and neonatal length, with an R 2 value of 0.77. In contrast, the correlation between splenic length and weight was weak, with an R 2 value of 0.17. Discussion Spleen is a large, vascular, predominantly lymphoid encapsulated organ, serving two main functions in adults: production of antibodies and removing of particulate material, aged and defective blood cells. In the fetus, it serves as an important site for hematopoiesis. Splenomegaly in neonates could be due to sepsis, disseminated intravascular coagulation, congenital toxoplasmosis, viral infections, genetic disorders like chromosomal bone marrow defects, familial thrombocytopenia, maternal pregnancy-induced hypertension, autoimmune disorders, etc. [2,4,9] It is hence essential for the sonologist to be aware of the normal splenic dimensions, particularly in neonates, wherein minor changes could be significant. Ultrasonography provides the most dependable information for assessing the splenic length, especially since it is established as a safe, quick, and reliable method. [10] While conducting a review of the studies published so far, we found several on normal splenic size for the pediatric population, [1,8,11,12] but parameters for the neonatal population lack sufficient coverage. Knowledge of normal splenic size in neonates is essential as cases of mild splenomegaly are easily overlooked if not well aware of the size in correlation to body length, weight, and age of the neonate. Waelti et al [12] performed ultrasonography on 22 neonates and provided a range of 4.1-6 cm (5 th to 95 th centile), along with a linear relation between splenic size with body length and a non-linear relationship between splenic size and weight or age. Konus et al [13] and Rosenberg et al [14] included full-term neonates in their study. While both of their findings showed good correlation between length and splenic size, neither provided a size range specific to neonates, and included them in the 0 to 3-month bracket. We find this to be highly variable and unreliable, as growth parameters of an infant show logarithmic progression in the earlier months making it difficult to diagnose splenomegaly in neonates. Our study examined 51 healthy neonates and neonates with pathologies unrelated to the spleen. Although male neonates had a slightly higher mean splenic size than females, the difference did not reach statistical significance. This suggests that gender may not be a strong determinant of splenic length in the neonatal period. These findings align with other studies [8,13,14] who found no significant sex-based differences. However, Waelti et al [12] found a statistically significant difference in splenic size between genders, even after taking body length and weight into consideration. The Pearson correlation coefficient of our study reflects a strong correlation between longitudinal splenic dimension and length of the newborn, and a moderate correlation with weight of the neonate. Also inferred from the study was that the longitudinal splenic dimension was more reliable, reproducible and showed better correlation than the transverse measurement. On evaluation of studies conducted in Central Europe and the United States of America, we discovered that Indian neonates have shown to have smaller mean organ sizes. [1, 8, 11, 15] This finding was consistent with our study, where the splenic size range showed a 5 th centile of 3.2cm and a mean of 3.54cm, whereas Waelti et al [12] reported a 5 th centile of 4.1cm in neonates and a mean of 4.8cm. We believe our study to be the first to provide a reference range for splenic size in healthy Indian neonates. It also shows a positive correlation of splenic size with the length(strong) and weight(weak) of the neonate. Limitations: This study has a few limitations that should be considered when interpreting the results. First, the sample size was relatively small (n = 51), which may limit the generalizability of the findings to the broader neonatal population. Second, the study could only include neonates aged 0–5 days, which also limits the applicability of the splenic size norms across different postnatal age ranges. Future studies with larger, more diverse cohorts and extended neonatal age groups are recommended to validate and expand upon these findings. Declarations Ethics approval: This study was approved by the Institutional Clinical Ethics Committee (ICEC) of Rajiv Gandhi Medical College & Chhatrapati Shivaji Maharaj Hospital, Kalwa. Approval Number: RGMC/ICEC/65/2018. Date of Approval: 06/04/2018. All participating individuals in this study were informed of the same, and a written and informed consent was taken. Consent: Informed consent to participate in the study was obtained from all participants. Data availability : The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Conflict of Interest : The authors declare no competing interests. Funding : No external funding to declare. Authors’ contribution: DB: Manuscript editing, Literature search, Data Analysis; UC: Concept, Definition of Intellectual content; VK: Design, Data Acquisition; KV: Concept, Data Analysis; AB: Manuscript preparation, Literature search; BV: Design, Manuscript review; DM: Statistical analysis, Data Acquisition Acknowledgements : NA References Tanna NA, Ambiye MV, Tanna VA, Joshi HA. Ultrasonic Measurement of Normal Splenic Size in Infants and Children in Pediatric Indian Population. National Journal of Community Medicine . 2012;3(03):529-533. Hilmes MA, Strouse PJ. The pediatric spleen. Semin Ultrasound CT MR . 2007;28(1):3-11. doi:10.1053/j.sult.2006.10.003 Rumack CM. Diagnostic Ultrasound . 3rd ed. Elsevier; 2005:3-34,147. Kliegman RM, St Geme JW. Nelson Textbook of Pediatrics . 19th ed. Vol 2. Elsevier; 2011:1723. Mimouni F, Merlob P, Ashkenazi S, Litmanovitz I, Reisner SH. Palpable spleens in newborn term infants. Clin Pediatr (Phila). 1985;24(4):197-198. doi:10.1177/000992288502400403 Sutton D. Textbook of Radiodiagnosis . 7th ed. Vol 1. Elsevier; 2003:746-747. Swash M. Hutchison's Clinical Methods . 20th ed. WB Saunders; 1995 Megremis SD, Vlachonikolis IG, Tsilimigaki AM. Spleen length in childhood with US: normal values based on age, sex, and somatometric parameters. Radiology . 2004;231(1):129-134. doi:10.1148/radiol.2311020963 Moreira M, Brás R, Gonçalves D, et al. Fetal Splenomegaly: A Review. Ultrasound Q . 2018;34(1):32-33. doi:10.1097/RUQ.0000000000000335 Palmer PES. Manual of Diagnostic Ultrasound . 2nd ed. WHO; 1995:287. Dhingra B, Sharma S, Mishra D, Kumari R, Pandey RM, Aggarwal S. Normal values of liver and spleen size by ultrasonography in Indian children. Indian Pediatr. 2010;47(6):487-492. doi:10.1007/s13312-010-0090-6 Waelti, S., Fischer, T., Wildermuth, S. et al. Normal sonographic liver and spleen dimensions in a central European pediatric population. BMC Pediatr 21, 276 (2021). https://doi.org/10.1186/s12887-021-02756-3 Konuş OL, Ozdemir A, Akkaya A, Erbaş G, Celik H, Işik S. Normal liver, spleen, and kidney dimensions in neonates, infants, and children: evaluation with sonography. American Journal of Roentgenology . 1998;171(6):1693-1698. doi:10.2214/ajr.171.6.9843315 Rosenberg HK, Markowitz RI, Kolberg H, Park C, Hubbard A, Bellah RD. Normal splenic size in infants and children: sonographic measurements. AJR Am J Roentgenol. 1991;157(1):119-121. doi:10.2214/ajr.157.1.2048509 Calle-Toro JS, Back SJ, Viteri B, Andronikou S, Kaplan SL. Liver, Spleen, and Kidney Size in Children as Measured by Ultrasound: A Systematic Review. Journal of Ultrasound in Medicine. 2020;39(2):223-230. doi:10.1002/jum.15114 Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8252637","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":553575103,"identity":"8ce5d41c-75e5-4ae4-9c88-236ea5b03c15","order_by":0,"name":"Devesh Bafna","email":"","orcid":"https://orcid.org/0009-0007-2658-3952","institution":"Formerly at Department of Obstetrics \u0026 Gynecology, Rajiv Gandhi Medical College (RGMC) \u0026 Chhatrapati Shivaji Maharaj Hospital (CSMH), Kalwa, Maharashtra, India. 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15:09:21","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":57809,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8252637/v1/f9f1929806c3d85ece61eff3.html"},{"id":97367806,"identity":"89838351-837d-4871-8ecf-0e84ba81adbb","added_by":"auto","created_at":"2025-12-03 16:20:48","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":37529,"visible":true,"origin":"","legend":"\u003cp\u003eScatter plot shows Splenic Size Longitudinal plotted against Neonatal Length. It has an R2 value of 0.78, showing strong linear correlation.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8252637/v1/1a905de7a9ff11143f1a4b67.jpg"},{"id":97273139,"identity":"6cfd0cd0-e782-4651-b2b1-56e5bfb54745","added_by":"auto","created_at":"2025-12-02 15:09:21","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":34705,"visible":true,"origin":"","legend":"\u003cp\u003eScatter plot shows Splenic Size Longitudinal plotted against Neonatal Weight. It has an R2 value of 0.17, showing weak linear correlation.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8252637/v1/5100dd62b87facc32dc0700f.jpg"},{"id":97665828,"identity":"513af1b4-bcf0-489c-8fe2-cd1dad646d33","added_by":"auto","created_at":"2025-12-08 09:19:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":553428,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8252637/v1/8574c4b1-8d95-4693-b72c-d5ea1f38b342.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eSonographic Assessment Of Normal Spleen Size In Indian Neonates\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe spleen is a vascular abdominal organ that arises from mesenchyme and is a site of red blood cell production in the fetus. Splenic hematopoiesis peaks at approximately 20 weeks of gestation. While the normal spleen of a child or an adult does not produce red blood cells, the spleen may be a site of extramedullary hematopoiesis, as in thalassemia or osteopetrosis. The postnatal function of the spleen is the removal of old and damaged red blood cells from circulation.\u003c/p\u003e\u003cp\u003eSplenomegaly in children can be associated with pathologies like infections, neoplasms, thalassemia major, hemolytic anemia, portal hypertension, Sickle cell anemia, Gaucher\u0026rsquo;s Disease, etc.\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eBefore the advent of Ultrasonography, palpation and percussion were the two bedside methods to assess the splenic size. These are considered crude and unreliable,\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e as the organ had to be enlarged 2\u0026ndash;3 times for it to be palpable.\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e Furthermore, the spleen is normally palpable in about 15\u0026ndash;17% of healthy neonates.\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eNormal splenic size estimation studies have been done frequently in children, yet it\u0026rsquo;s rarely been done in newborns. With the advent of ultrasonography, splenic size estimation has become more accurate and reproducible.\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e It is a safe, quick, low-cost and reliable method with no ionising radiation or anaesthesia required.\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e It is also a very sensitive method to detect mild splenomegaly, as clinical examination is inaccurate in detecting mild enlargement.\u003c/p\u003e\u003cp\u003eIn children, knowledge of normal splenic size (splenic length) in relation to age and other biometric parameters (body length and weight) of physical growth is of great importance for the determination of mild splenomegaly.\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn the study, we opted to examine splenic size in normal neonates, who came to the Radiology department for evaluation of abdominal/pelvic issues unrelated to splenic pathology or those who were delivered in the hospital premises.\u003c/p\u003e"},{"header":"Aims and Objectives","content":"\u003cp\u003eThe main objective of this study was to estimate normal range of splenic size in neonates and establish its correlation with age, birth weight, body length and sex of the neonate.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e The study procedures were carried out in accordance with the Declaration of Helsinki. The study was approved by the Institutional Clinical Ethics Committee (ICEC) of Rajiv Gandhi Medical College (RGMC) and Chhatrapati Shivaji Maharaj Hospital, Kalwa, with Approval No: RGMC/ICEC/65/2018 dated 06/04/2018. The study evaluated 51 neonates who came to the department of Radiology for reasons other than splenic pathology like undescended testes, suspected congenital diaphragmatic hernia, or sonography of the skull as well as normal newborns delivered (by both vaginal and by Caesarean section) in the same institute.\u003c/p\u003e\u003cp\u003eNeonates with fever of any origin, or under evaluation for conditions affecting spleen e.g. thalassaemia, hemolytic anemia, malaria, enteric fever, malnutrition (Grade III and IV, Indian Academy of Paediatrics IAP guideline), and congestive heart failure were excluded from the study.\u003c/p\u003e\u003cp\u003eBaseline data like age, body length and weight of the neonate were noted and recorded. Body length was measured using an infantometer and weight with an electronic weighing scale, using standard methods.\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e After obtaining written consent from parents, sonography of the neonate was performed. Parents were informed about the nature of the study, and informed consent was obtained for the publication of data while maintaining anonymity. Caution was taken that the child was well fed and calm during the scan.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eUltrasonographic evaluation\u003c/strong\u003e\u003cp\u003eThe scan was performed with a 5 MHz curvilinear probe using Sonoscape (Sonoscape Medical Corp., Shenzhen, China) and Mindray Consona (Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China) ultrasound machines. All procedures were carried out according to standard protocols to ensure reproducibility. The convex probes used and settings were adjusted based on patient characteristics and examination requirements. Images were obtained and interpreted by radiologists.\u003c/p\u003e\u003c/p\u003e\u003cp\u003eThe spleen was measured by the optically maximal distance (ideally at the hilum) on the longitudinal coronal view (between the most superomedial and the most inferolateral points).\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e The measurements were made during quiet breathing, neither preparation nor sedation was used. In all the scans, spleens showed a uniform homogenous echo pattern.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003cp\u003eAll statistical analyses were performed using Microsoft Excel (Microsoft 365, Version 2019). In addition, the on-site biostatistician was approached for advice on statistical methodology and analytical techniques.\u003c/p\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eWe approached parents of 110 children for enrollment into the study, out of which 32 refused to participate and 27 were excluded for reasons mentioned above. Thus, 51 neonates were included (29[56.86%] boys). The age of the neonates ranged from 1 day old (33[64.71%]), 2 days old (9[17.65%]), 3 days old (5[9.80%]), 4 days old (2[3.92%]), and 5 days old (2[3.92%]).\u003c/p\u003e\n\u003cp\u003eThe mean splenic length in male neonates was 3.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21 cm, while in female neonates it was 3.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16 cm. An independent samples t-test showed that this difference was not statistically significant (\u003cem\u003et\u003c/em\u003e(49)\u0026thinsp;=\u0026thinsp;0.81, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.41). Therefore, all data was rearranged without being separated according to sex.\u003c/p\u003e\n\u003cp\u003e[Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e] shows the measured ultrasonographic and anthropometric data from the 51 neonates.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSplenic Dimensions and Anthropometric Data Analysis\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParameter\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSD (Standard Deviation)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMin\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMax\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e5th centile\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95th centile\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpleen Length(cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpleen width(cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeonatal Weight(kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLength(cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e49.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e47.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e52.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe mean splenic length is 3.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19 cm, with a range of 3.2\u0026ndash;3.92 cm (taking the 5th and 95th centiles as the uppermost and lowermost limits).\u003c/p\u003e\n\u003cp\u003eThe correlation between splenic size and neonatal anthropometric parameters was assessed and is presented as a scatter plot with regression analysis in [Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e], \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e[\u003c/span\u003eFigure \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e]\u003c/span\u003e and \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e[Figure 2].\u003c/span\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCorrelation Coefficients of Splenic Dimensions vs Length and Weight\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eParameter\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLength\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWeight\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSplenic Size Longitudinal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSplenic Size Transverse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eSince the age group selected for the study was narrow, age as a factor was not considered for correlation with splenic length.\u003c/p\u003e\n\u003cp\u003eA strong positive correlation was observed between splenic length and neonatal length, with an R\u003csup\u003e2\u003c/sup\u003e value of 0.77. In contrast, the correlation between splenic length and weight was weak, with an R\u003csup\u003e2\u003c/sup\u003e value of 0.17.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSpleen is a large, vascular, predominantly lymphoid encapsulated organ, serving two main functions in adults: production of antibodies and removing of particulate material, aged and defective blood cells. In the fetus, it serves as an important site for hematopoiesis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSplenomegaly in neonates could be due to sepsis, disseminated intravascular coagulation, congenital toxoplasmosis, viral infections, genetic disorders like chromosomal bone marrow defects, familial thrombocytopenia, maternal pregnancy-induced hypertension, autoimmune disorders, etc.\u003csup\u003e[2,4,9]\u003c/sup\u003e It is hence essential for the sonologist to be aware of the normal splenic dimensions, particularly in neonates, wherein minor changes could be significant.\u003c/p\u003e\n\u003cp\u003eUltrasonography provides the most dependable information for assessing the splenic length, especially since it is established as a safe, quick, and reliable method.\u003csup\u003e[10]\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eWhile conducting a review of the studies published so far, we found several on normal splenic size for the pediatric population,\u003csup\u003e[1,8,11,12]\u003c/sup\u003e but parameters for the neonatal population lack sufficient coverage. Knowledge of normal splenic size in neonates is essential as cases of mild splenomegaly are easily overlooked if not well aware of the size in correlation to body length, weight, and age of the neonate.\u003c/p\u003e\n\u003cp\u003eWaelti et al\u003csup\u003e[12]\u003c/sup\u003e performed ultrasonography on 22 neonates and provided a range of 4.1-6 cm (5\u003csup\u003eth\u003c/sup\u003e to 95\u003csup\u003eth\u003c/sup\u003e centile), along with a linear relation between splenic size with body length and a non-linear relationship between splenic size and weight or age. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eKonus et al\u003csup\u003e[13]\u003c/sup\u003e and Rosenberg et al\u003csup\u003e[14]\u003c/sup\u003e included full-term neonates in their study. While both of their findings showed good correlation between length and splenic size, neither provided a size range specific to neonates, and included them in the 0 to 3-month bracket. We find this to be highly variable and unreliable, as growth parameters of an infant show logarithmic progression in the earlier months making it difficult to diagnose splenomegaly in neonates.\u003c/p\u003e\n\u003cp\u003eOur study examined 51 healthy neonates and neonates with pathologies unrelated to the spleen. Although male neonates had a slightly higher mean splenic size than females, the difference did not reach statistical significance. This suggests that gender may not be a strong determinant of splenic length in the neonatal period. These findings align with other studies\u003csup\u003e[8,13,14]\u003c/sup\u003e who found no significant sex-based differences. However, Waelti et al\u003csup\u003e[12]\u003c/sup\u003e found a statistically significant difference in splenic size between genders, even after taking body length and weight into consideration.\u003c/p\u003e\n\u003cp\u003eThe Pearson correlation coefficient of our study reflects a strong correlation between longitudinal splenic dimension and length of the newborn, and a moderate correlation with weight of the neonate. Also inferred from the study was that the longitudinal splenic dimension was more reliable, reproducible and showed better correlation than the transverse measurement. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOn evaluation of studies conducted in Central Europe and the United States of America, we discovered that Indian neonates have shown to have smaller mean organ sizes.\u003csup\u003e[1, 8, 11, 15]\u003c/sup\u003e This finding was consistent with our study, where the splenic size range showed a 5\u003csup\u003eth\u003c/sup\u003e centile of 3.2cm and a mean of 3.54cm, whereas Waelti et al\u003csup\u003e[12]\u003c/sup\u003e reported a 5\u003csup\u003eth\u003c/sup\u003e centile of 4.1cm in neonates and a mean of 4.8cm.\u003c/p\u003e\n\u003cp\u003eWe believe our study to be the first to provide a reference range for splenic size in healthy Indian neonates. It also shows a positive correlation of splenic size with the length(strong) and weight(weak) of the neonate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLimitations: This study has a few limitations that should be considered when interpreting the results.\u003c/p\u003e\n\u003cp\u003eFirst, the sample size was relatively small (n = 51), which may limit the generalizability of the findings to the broader neonatal population.\u003c/p\u003e\n\u003cp\u003eSecond, the study could only include neonates aged 0–5 days, which also limits the applicability of the splenic size norms across different postnatal age ranges.\u003c/p\u003e\n\u003cp\u003eFuture studies with larger, more diverse cohorts and extended neonatal age groups are recommended to validate and expand upon these findings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval:\u003c/strong\u003e This study was approved by the Institutional Clinical Ethics Committee (ICEC) of Rajiv Gandhi Medical College \u0026amp; Chhatrapati Shivaji Maharaj Hospital, Kalwa. Approval Number: RGMC/ICEC/65/2018. Date of Approval: 06/04/2018. All participating individuals in this study were informed of the same, and a written and informed consent was taken.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent:\u0026nbsp;\u003c/strong\u003eInformed consent to participate in the study was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e: The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: No external funding to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contribution:\u003c/strong\u003e DB: Manuscript editing, Literature search, Data Analysis; UC: Concept, Definition of Intellectual content; VK: Design, Data Acquisition; KV: Concept, Data Analysis; AB: Manuscript preparation, Literature search; BV: Design, Manuscript review; DM: Statistical analysis, Data Acquisition\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e: NA\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTanna NA, Ambiye MV, Tanna VA, Joshi HA. Ultrasonic Measurement of Normal Splenic Size in Infants and Children in Pediatric Indian Population. \u003cem\u003eNational Journal of Community Medicine\u003c/em\u003e. 2012;3(03):529-533.\u003c/li\u003e\n\u003cli\u003eHilmes MA, Strouse PJ. The pediatric spleen. \u003cem\u003eSemin Ultrasound CT MR\u003c/em\u003e. 2007;28(1):3-11. doi:10.1053/j.sult.2006.10.003\u003c/li\u003e\n\u003cli\u003eRumack CM. \u003cem\u003eDiagnostic Ultrasound\u003c/em\u003e. 3rd ed. Elsevier; 2005:3-34,147.\u003c/li\u003e\n\u003cli\u003eKliegman RM, St Geme JW. \u003cem\u003eNelson Textbook of Pediatrics\u003c/em\u003e. 19th ed. Vol 2. Elsevier; 2011:1723.\u003c/li\u003e\n\u003cli\u003eMimouni F, Merlob P, Ashkenazi S, Litmanovitz I, Reisner SH. Palpable spleens in newborn term infants. Clin Pediatr (Phila). 1985;24(4):197-198. doi:10.1177/000992288502400403\u003c/li\u003e\n\u003cli\u003eSutton D. \u003cem\u003eTextbook of Radiodiagnosis\u003c/em\u003e. 7th ed. Vol 1. Elsevier; 2003:746-747.\u003c/li\u003e\n\u003cli\u003eSwash M. \u003cem\u003eHutchison\u0026apos;s Clinical Methods\u003c/em\u003e. 20th ed. WB Saunders; 1995\u003c/li\u003e\n\u003cli\u003eMegremis SD, Vlachonikolis IG, Tsilimigaki AM. Spleen length in childhood with US: normal values based on age, sex, and somatometric parameters. \u003cem\u003eRadiology\u003c/em\u003e. 2004;231(1):129-134. doi:10.1148/radiol.2311020963\u003c/li\u003e\n\u003cli\u003eMoreira M, Br\u0026aacute;s R, Gon\u0026ccedil;alves D, et al. Fetal Splenomegaly: A Review. \u003cem\u003eUltrasound Q\u003c/em\u003e. 2018;34(1):32-33. doi:10.1097/RUQ.0000000000000335\u003c/li\u003e\n\u003cli\u003ePalmer PES. \u003cem\u003eManual of Diagnostic Ultrasound\u003c/em\u003e. 2nd ed. WHO; 1995:287.\u003c/li\u003e\n\u003cli\u003eDhingra B, Sharma S, Mishra D, Kumari R, Pandey RM, Aggarwal S. Normal values of liver and spleen size by ultrasonography in Indian children. Indian Pediatr. 2010;47(6):487-492. doi:10.1007/s13312-010-0090-6\u003c/li\u003e\n\u003cli\u003eWaelti, S., Fischer, T., Wildermuth, S. \u003cem\u003eet al.\u003c/em\u003e Normal sonographic liver and spleen dimensions in a central European pediatric population. \u003cem\u003eBMC Pediatr\u003c/em\u003e 21, 276 (2021). https://doi.org/10.1186/s12887-021-02756-3\u003c/li\u003e\n\u003cli\u003eKonuş OL, Ozdemir A, Akkaya A, Erbaş G, Celik H, Işik S. Normal liver, spleen, and kidney dimensions in neonates, infants, and children: evaluation with sonography. \u003cem\u003eAmerican Journal of Roentgenology\u003c/em\u003e. 1998;171(6):1693-1698. doi:10.2214/ajr.171.6.9843315\u003c/li\u003e\n\u003cli\u003eRosenberg HK, Markowitz RI, Kolberg H, Park C, Hubbard A, Bellah RD. Normal splenic size in infants and children: sonographic measurements. AJR Am J Roentgenol. 1991;157(1):119-121. doi:10.2214/ajr.157.1.2048509\u003c/li\u003e\n\u003cli\u003eCalle-Toro JS, Back SJ, Viteri B, Andronikou S, Kaplan SL. Liver, Spleen, and Kidney Size in Children as Measured by Ultrasound: A Systematic Review. Journal of Ultrasound in Medicine. 2020;39(2):223-230. doi:10.1002/jum.15114\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Maharashtra University of Health Sciences","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Sonography, Neonates, Splenic size, Splenomegaly","lastPublishedDoi":"10.21203/rs.3.rs-8252637/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8252637/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eSeveral pathological abnormalities can affect spleen size, which can be difficult to diagnose via routine palpation in neonates. Knowledge of normal spleen size, and its relation with age and biometric parameters (length and weight) of physical growth, is important in determining mild splenomegaly.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThe purpose of this study is to measure splenic size in Indian neonates, establish fresh parameters of normal splenic size, and establish correlation with age, body length and weight.\u003c/p\u003e\u003ch2\u003eMaterial and methods\u003c/h2\u003e\u003cp\u003eThe study was conducted in the Radiology department of Chhatrapati Shivaji Maharaj Hospital, Thane. We conducted a prospective study of 51 normal neonates visiting our hospital; the majority of whom were either born at the hospital or came for reasons other than those with splenic pathology. The child\u0026rsquo;s length, weight, and gestational history of the mother were noted. A thorough history was elicited to rule out past/current pathologies affecting the spleen. Routine ultrasonography of the abdomen and pelvis was performed and the child\u0026rsquo;s spleen was measured in two dimensions.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe mean splenic length is 3.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19 cm, with a range of 3.2\u0026ndash;3.92 cm. The splenic longitudinal dimension showed better correlation with body parameters, with neonatal length showing highest correlation coefficient.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eKnowledge of the normal dimensions of a neonatal normal spleen will aid radiologists and pediatricians in identifying splenomegaly at an earlier stage. We believe to have provided reference values to assist in the early identification of splenic disorders.\u003c/p\u003e","manuscriptTitle":"Sonographic Assessment Of Normal Spleen Size In Indian Neonates","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-02 15:09:16","doi":"10.21203/rs.3.rs-8252637/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8013094f-069c-4bec-a638-1c31dfe15997","owner":[],"postedDate":"December 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":58905677,"name":"Nuclear Medicine \u0026 Medical Imaging"}],"tags":[],"updatedAt":"2025-12-02T15:09:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-02 15:09:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8252637","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8252637","identity":"rs-8252637","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}