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.