We appreciate the readers’ keen interest in our article and their critical comments.  It has been rightly pointed out that epidemiological and maternal characteristics have an impact on fetal and post natal growth. However, our primary objective was to evaluate postnatal growth pattern of VLBW infants, rather than impact of demographic predictors on their growth per se. Further, relatively small sample size of our study precluded statistical analysis of these predictors on postnatal growth with adequate power.

Even though we did not report type of SGA in our manuscript, majority of SGA infants in our cohort were asymmetric and in most of them the reason for growth restriction was gestational hypertension or placental dysfunction. More than half (53.6%) of pregnancies with VLBW infants were associated with hypertension. Assessment of gestational age was done (in that order) by 1st trimester USG, LMP, if reliable, or by new Ballard score. In the settings where this study was performed, majority of pregnancies are booked and more than 80% pregnancy had first trimester ultrasound available for gestational age assessment.

We followed an aggressive policy on enteral feeds. Infants were initiated on enteral feeds at a mean age of 2.81 ± 2.33 days and time taken to reach full feeds was 10.99 ± 7.67 days. Infants who were not likely to be on full enteral feeds or developed feed intolerance were initiated on parenteral nutrition (PN) on first day with 1g/kg of amino acids and lipids and gradually increased to a total of 3g/kg/day. Forty four (45.4%) of infants in our cohort received PN during NICU stay and the target for calorie intake were 90 cal/kg/d on PN and 120-130 cal/kg/d on enteral nutrition. We achieved calorie density of enteral formula to 80 cal/100 mL by adding human milk fortifier once infant reached 100mL/kg/day. If human milk was not available, preterm/LBW milk formula with a calorie and protein content of 80 cal/100 mL and 1.83g/100mL, respectively.

As the readers have commented, growth pattern of ELBW infants in our study might not be truly representative due to small number of infants and a large data is needed to demonstrate growth pattern of this subgroup with reasonable confidence. Only 3 of the survivors in this cohort had BPD and one developed NEC. Differential analysis of growth pattern in these infants could not have been inferential due to very small number. We observed a lag in head growth despite management based on current nutrition guidelines and aggressive PN. Similar lag in head growth in VLBW infants during hospital stay has been reported in other studies [1,2]. This fact emphasizes the need for finding predictors of poor head growth and optimizing postnatal care of VLBW infants.