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correspondence

Indian Pediatr 2011;48: 569-570

Growth of VLBW Infants


Venkataseshan Sundaram and Vandana Negi

Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh; and Army Hospital
(Research & Referral), New Delhi, India.
Email: [email protected]
 
 


Few issues need clarification, with reference to the recent article by Saluja, et al. [1].

First, the authors have observed maternal hypertension in 52 subjects (54%). A subgroup analysis of growth in these infants would have made the study more interesting. Similarly, maternal characteristics like socioeconomic status, parity, level of antenatal care, maternal weight gain/nutrition etc did not find a place in the report. These epidemiological factors are important as they could have modified the in-utero growth and hence the resultant postnatal growth assessment.

Secondly, the authors have not reported the type of SGA in the study subjects (whether symmetric or asymmetric) as the postnatal growth pattern would have been different in each of this group. Moreover, it’s unclear how gestation was assessed in subjects where the estimates of last menstrual period were unreliable and early ultrasonography was not available. Situations like these are very common in our country and this needs clarification.

Thirdly, even though the authors have mentioned that calories were targeted at 80 kcal/100mL with an additional protein intake of 0.6 g/kg/day, they have not mentioned in how many they were able to achieve this target; how long it took for them to achieve full enteral feeds; and what were their target total calorie and protein requirements. Moreover, information regarding total parenteral nutrition (TPN) like how many received TPN and growth patterns in those infants who received TPN before they were transitioned to enteral feeds needs more elaboration.

Fourthly, only 9 out of the 97 (9%) were extremely low birth weight (ELBW) infants. Hence, a growth trajectory for ELBW infants with such small number is prone to be erroneous. The authors have observed a decrease of 1Z score in all parameters from birth to discharge. Surprisingly, this decrease has been observed with head growth too which may not be really good information. However, this reinforces the need for an aggressive postnatal nutrition policy which includes utilization of TPN to tide over the transition period from intravenous fluids to enteral feeds [2].

Finally, the authors have not mentioned how many subjects had major morbidities like necrotizing enterocolitis and bronchopulmonary dysplasia, as these morbidities can significantly compromise the postnatal growth [3].

References

1. Saluja S, Modi M, Kaur A, Batra A, Soni A, Garg P, et al. Growth of very low birth-weight Indian infants during hospital stay. Indian Pediatr. 2010;47:851-6.

2. Embleton NE, Pang N, Cooke RJ. Postnatal malnutrition and growth retardation: An inevitable consequence of current recommendations in preterm infants? Pediatrics. 2001;107:270-3.

3. Ehrenkranz RA, Younes N, Lemons JA, Fanaroff AA, Donovan EF, Wright LL. Longitudinal growth of hospitalized very low birth weight infants. Pediatrics. 1999;104: 280-9.
 

 

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