Indian Pediatr 2014;51: 238-239
Outcome of ELBW Neonates: A Raveling Picture
We appreciate the efforts of the authors for presenting the
comparison of the two cohorts of extremely-low-birth-weight
(ELBW) babies, and to appraise the care of these babies with
many modern and available modalities . However, we wish
to make a few comments:
1. It was concluded that survival of
E2LBW neonates has improved whereas authors have stated
many was of times that the overall survival was similar
in two cohorts.
2. It was also observed that some
important factors for mortality and morbidity were
significantly higher, namely respiratory distress
syndrome (RDS) and sepsis, in 2001-02 cohort .
3. Authors state that there was a
significant decrease in mortality in 28 to 30 weeks
neonates in 2009-10 cohort without comparing the
baseline characteristics and interventions in two
4. As both the groups had a similar
rate (64%) of mechanical ventilation, it may not be
appropriate to associate this to intraventricular
hemorrhage (IVH) without any supporting data on
determinants like hypoxemia, hypercarbia, peak inflation
pressure and duration of ventilation [3,4]. However,
higher use of high frequency ventilation may be related
to IVH .
5. It is evident from the data that
2009-10 cohort had significantly more cases with
maternal and obstetric complications, low Apgar scores
and lesser birth weight. The absence of comparison of
severity of illness at the time of admission is a major
limitation to reflect a reliable image of optimization
or improvement in newborn care.
A Gupta and S Srivastava
Department of Pediatrics and Neonatology,
Fortis Hospital and Research Centre, Faridabad,
1. Mukhopadhyay K, Louis D, Murki S,
Mahajan R, Dogra MR, Kumar P. Survival and morbidity among
two cohorts of extremely low birth weight neonates from a
tertiary hospital in Northern India. Indian Pediatr.
2. Sehgal A, Telang S, Passah SM, Jyothi
MC. Maternal and neonatal profile and immediate outcome in
ELBW babies. Indian Pediatr. 2003;40:991-5.
3. Dykes FD, Lazzara A, Ahmann P,
Blumenstein B, Schwartz J, Brann AW. Intraventricular
hemorrhage: a prospective evaluation of etiopathogenesis.
Pediatr. 1980; 66:42-9.
4. Aly H, Hammad TA, Essers J, Wung JT.
Is mechanical ventilation associated with intraventricular
hemorrhage in preterm infants? Brain Dev. 2012;34:201-5.
5. Cools F, Offringa M. Meta-analysis of
elective high frequency ventilation in preterm infants with
respiratory distress syndrome. Arch Dis Fetal Neonatal
We thank authors for their comments on
our article. We would like to clarify some of their queries:
1. The overall survival in this
cohort of ELBW neonates did not change between the two
epochs as clearly highlighted in the abstract; however,
among neonates between 28 to 30 weeks, survival had
significantly improved from 2001-02 to 2009-10.
2. The rate of sepsis and RDS were
higher in the 2001-02 cohort but several other adverse
factors including PDA and IVH were more common in the
2009-10 cohort. Hence it is difficult to attribute any
of these factors as isolated or independent causes for
mortality and morbidity in either cohort.
3. The two cohorts did not differ
significantly in the baseline characteristics.
Gestational age, birth weight (except for a 40g
difference), gender, SGA, obstetric complications, Apgar
scores at 1 and 5 minutes were comparable between the
two groups. The only two factors that might have had an
impact is the use of antenatal steroids and surfactant
4. We agree that the rates of
mechanical ventilation were similar between the two
groups. We actually meant high frequency ventilation
when we referred mechanical ventilation. We thank you
for pointing this out.
5. We agree with the authors that we
did not compare the severity of illness score among the
two cohorts. Using such a score could have improved the
comparability between the two cohorts. This has already
been mentioned as one of the drawbacks of our study.
Department of Pediatrics, PGIMER,