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Letters to the Editor Indian Pediatrics 2002; 39:1063-1064 |
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Low Birth Weight and Maturity: A Future Marriage of Convenience? |
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Low birth weight (LBW) babies are those born with less than 2500 grams. In 1978, the then World Health Assembly defined a goal to reduce LBW rate to less than 10% by 2000 AD. Unfortunately, the goal set was a utopian dream for most of the countries till date. In India, for instance, the rate is hovering around 25% over the last decade. Global trends also show that LBW rates have not changed substantially over time. Interestingly, Sub-Saharan African countries have a lower average LBW rate (12%) as against 25% in South-Asian countries, although the child survival rates are remarkably different! LBW is linked to the mother’s poor health and nutrition, but there is an upward trend in the percentage of ante-natal visits as well as an improvement in maternal anemia over the last decade(1). These observations indicte that there are wide regional variations in LBW rates with persistently high rates, despite a downturn in the prevalence of the known risk factors, calling into question the ‘adequacy’ of this indicator in the present context. There is a growing debate about LBW and maturity status of a newborn being independently used as important tools for assessing ‘high risk’ babies when risk factors are reported to be similar for both ‘preterm’ and ‘term’ LBW babies(2). Although a higher percentage of live-birth are LBW (28%) compared to preterm babies (14%), their individual contributions to neonatal deaths are similar(3). There is a decline in ‘preterm’ LBW babies both in rural and urban regions(4). These observations suggest that maturity status offers a more realistic picture of not only the mortality but also the morbidity experience of newborns and their subsequent survival. I think LBW levels and maturity status in terms of gestational age may be mathematically correlated to arrive at a more specific as well as a sensitive level for utilising this new paradigm as a ‘risk’ assessment tool in the future. A regional-specific level with a lower cut-off line for LBW may also help identify the ‘high risk’ babies not only more accurately but also timely(5). This approach is more likely to preferentially channellize the limited health resources to those most in need in resource-poor countries, such as India. Zubair Kabir Researh Fellow, CResT Directorate, St. James’s Hospital, University of Dublin (Trinity College), Dublin-8, Ireland. E-mail: [email protected] |
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