Neurodevelopmental Outcome of Extremely Low Birth Weight Children at Corrected Age of Two Years.

Objective: To assess the neurodevelopmental, cognitive and behavioral function of extremely low birth weight babies (ELBW) till corrected age of two years. Methods: 79 ELBW babies were enrolled and followed at 1 year (n=50), 18 months (n=47) and 2 years (n=36). Adverse composite outcome was defined as death or moderate-to- severe neurodevelopmental impairment (defined as either cerebral palsy or DQ score <70 or deafness or blindness). Results: At 1 year, 24% were neurologically abnormal. At 18 months, average score (>85) was seen in 25 (54%) children in motor and 8 (17%) in mental development. Abnormal behavioral score (³12) was seen in 89% children. Adverse composite outcome was present in 28 (35.4 %) babies. Conclusion: ELBW neonates are at a high risk of neurodevelopmental and behavioral impairment.

Stress in Fathers of Premature Newborns Admitted in a Neonatal Intensive Care Unit.

Objective: To study stress in fathers of preterm infants admitted in a neonatal intensive care unit. Methods: Questionnaire-based study. Questionnaire included domains on infant’s health, maternal illness, staff behavior, parental role, home affairs and finances. Eligible fathers were repeatedly interviewed on day 7 (n=80), day 17 (n=59) and day 27 (n=28). Raw and standardized stress scores were calculated. Results: Financial burden was the main stressor at all times. Stress related to staff behavior and altered parental role reduced with time. Birthweight and father’s age, occupation and education independently predicted stress. Conclusions: Fathers of preterm infants admitted in hospital are stressed, primarily due to financial burden.

Longitudinal Growth and Post-discharge Mortality and Morbidity Among Extremely Low Birth Weight Neonates.

Objectives: To study post-discharge growth, mortality and morbidity of extremely low birth weight neonates at corrected age of 2 years. Methods: Weight, length and head circumference were compared on WHO growth charts at corrected ages 3 (n=54), 6, 9, 12 (n=51) and 24 months (n=37); rates of underweight, stunting, microcephaly and wasting were calculated. Results: The mean Z-score for weight, length, head circumference and weightfor- length significantly improved from 3 to 24 months (P<0.001); a significant proportion remained malnourished at 2 years. Nine infants (11%) died and 35 (44%) required readmission during first year of age. Conclusion: Extremely low birth weight neonates remain significantly growth retarded at corrected age of 2 years.

Predictors of Mortality and Major Morbidities in Extremely Low Birth Weight Neonates.

Objectives: To determine predictors of mortality and morbidity in extremely low birth weight neonates (ELBW) from a developing country Study design: Prospective observational study. Setting: Level III neonatal unit in Northern India. Subjects: Neonates <1000g born and admitted to intensive care during study period were enrolled. They were analyzed based on survival and development of major morbidity. Multivariable logistic regression model was used to determine independent risk factors. Outcome: Mortality and major morbidity (one or more of the following: Bronchopulmonary dysplasia (BPD), Retinopathy of Prematurity (ROP) requiring laser, grade III or IV intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL) and necrotizing enterocolitis (NEC) stage III) during hospital stay. Results: Of 255 ELBW neonates born, 149 received optimal care, of which 78 (52%) survived and 57 (39%) developed morbidities. Mean birth weight and gestational age were 29.1±2.6 weeks and 843±108g. Major causes of mortality were sepsis (46%), birth asphyxia (20%) and pulmonary hemorrhage (19%). Birth weight ≤800g [OR (95% CI)-3.51 (1.39-8.89), P=0.008], mechanical ventilation [4.10 (1.64-10.28), P=0.003] and hypotensive shock [10.75 (4.00-28.89), P<0.001] predicted mortality while birth weight ≤800g [3.75 (1.47-9.50), P=0.006], lack of antenatal steroids [2.62 (1.00-6.69), P=0.048), asphyxia [4.11 (1.45-11.69), P=0.008], ventilation [4.38 (1.29-14.79), P=0.017] and duration of oxygen therapy [0.004 (1.001-1.006), P=0.002] were the predictors of major morbidities. Conclusions: Low birth weight, mechanical ventilation and hypotensive shock predicted mortality in ELBW neonates while low birth weight, lack of antenatal steroids, birth asphyxia, ventilation and duration of oxygen therapy were predictors for major morbidity.

Survival and Morbidity Among Two Cohorts of Extremely Low Birth Weight Neonates from a Tertiary Hospital in Northern India.

This study was conducted to compare the survival and morbidity of extremely low birth weight neonates born during two different time periods (2009-10 and 2001-02) at a Level III referral neonatal unit in Northern India. All consecutive intramural extremely low birth weight neonates (<1000g), irrespective of gestation, and admitted to Intensive Care were enrolled. 149 and 123 neonates were enrolled during 2009-10 and 2001-02, respectively. The baseline characteristics were comparable except for mean birth weight, which was lower during 2009-10 (843±108g vs 885±126g, P=0.003). Surfactant therapy (54% vs 18%, P<0.001), non-invasive ventilation (28% vs 6%, P<0.001), high frequency ventilation (24% vs 4%, P=0.001), IVH (52% vs 25%, P<0.001) and PDA (34% vs 18%, P=0.004) were significantly more during 2009-10. Culture positive sepsis (33% vs 51%, P=0.003) and ROP rates (7% vs 23%, P=0.042) were significantly higher during 2001-02. Overall survival was similar; however, neonates between 28-30 weeks gestation had better survival (63%) during 2009-10 compared to 2001-02 (38%), P=0.009. Survival in neonates 28-30 weeks improved during this period while overall survival remained the same.

Neurodevelopmental and behavioral outcome of very low birth weight babies at corrected age of 2 years.

Objective Neurodevelopmental and behavioral assessment of very low birth weight babies (VLBW) at corrected age (CA) of 2 years. Methods 127, 110, 99 and 101 babies ≤34 weeks and ≤1500 g were followed at CA of 3, 6, 9, 12 months respectively for developmental and neurological assessment. DASII (Developmental assessment scale for Indian infants) was used at CA of 18 months and preschool behavioural checklist (PBCL) at CA 2 years. Results Of 101 VLBW babies available for follow up at CA 1 year, 3 (3%) babies had Cerebral Palsy (CP) and 3% (n=3) had suspect abnormality (mild hypotonia), 11% (n= 11) had gross motor and 8% (n=8) had language abnormality. Their mean mental (MeDQ) and motor (MoDQ) quotients were 80.4±10.7 and 77.2±13.3 and a score of<70 was found in 17% (MeDQ) and 25.7% (MoDQ) VLBW babies. High PBCL score (mean 16.8± 5.4) was seen in 84%VLBW babies. On subgroup analysis, 2 babies (5%) in subgroup1 ( n=54, ≤1200 g,) and 1 (1.6%) in subgroup 2 (n=78, 1201–1500 g) had CP. Twelve (29%) in subgroup 1 had significant language delay (p=0.004) as compared to 4 (15%) in subgroup 2 at 1 year. BSID and PBCL scores were comparable. Amongst ELBW babies (<1000 g), 6.6% (n=1) had CP, 25% (n=3) and 42% (n=5) had low MeDQ and MoDQ respectively and all of them had high PBCL score. AGA and SGA had similar outcome. Conclusion VLBW babies need close and longer follow up due to high risk of neurodevelopmental and behavioral abnormality.

Effect of human milk fortification in appropriate for gestation and small for gestation preterm babies: a randomized controlled trial.

OBJECTIVE: To study the effects of human milk fortification on short term growth and biochemical parameters in preterm very low birth weight (VLBW) appropriate for gestation (AGA) and small for gestation (SGA) babies. DESIGN: Prospective, randomized controlled trial. SETTING: Level III neonatal unit. SUBJECTS: Preterm infants weighing < or = 1500 grams and < or = 34 weeks of gestation born between March 2001 to June 2002. METHODS: Babies (n =166) were randomized in two groups either to get fortified human milk or exclusive human milk along with mineral and vitamin supplementation when feed volume reached 150 mL/Kg/day. Fortification was done with a powdered fortifier added in expressed breast milk and continued till the baby reached 2 Kg or full breast feeds. Primary outcome measures were Short-term growth (daily weight, length and head circumference (HC) weekly) till discharge or 2 Kg. RESULTS: Fortification (n = 85, birth weight 1202 g, gestation 30.8 wk) resulted in better growth in preterm VLBW babies as compared to control group (n=81, birth weight 1259 g, gestation 31.3 wk). Weight gain (15.1 and 12.9 g/kg/d, P <0.001), length (1.04 and 0.86 cm/week, P = 0.017) and HC (0.83 and 0.75 cm/week, P<0.001) increased significantly in fortified group. SGA babies showed significant improvements in weight (16 g/Kg/d and 12.9 g/kg/d, P = 0.002) and length (1.09 cm/week and 0.92 cm/week, P = 0.042) in fortified group (n = 38) as compared to control group (n = 29). In AGA subgroup, there was significant increase (P = 0.006) in length (1 cm vs 0.82 cm) in fortified group but no difference in weight (P = 0.12) or HC (P=0.054) in fortified (n=47) vs control (n=52) group. Biochemical parameters were comparable, however feed intolerance was more in control group. CONCLUSION: Preterm VLBW babies showed better growth with human milk fortification. The effect is significant in SGA (weight and length)rather than AGA (only length) babies.