We read with much interest the research paper on growth and neurodevelopmental outcomes of VLBW infants at 1 year corrected age by Modi, et al. [1]. There are indeed, not many follow-up studies from India featuring long term outcomes of preterm infants. The present study, although a step in this direction, does not add substantially to the existing knowledge considering the modest sample size and follow-up timeline of 1 year. Following points need to be highlighted.

The sample size calculation is not mentioned and the blinding of the developmental paediatrician is not specified.

Almost half the infants (46%) in the cohort are small for gestational age (SGA). These babies are well known to have different outcomes than their AGA counterparts (whether term or preterm) in both short and long term [2-4]. Segregating SGA from AGA and analyzing the results separately would have given more credibility to the results, especially in this scenario wherein, there is an almost 3 week difference between mean gestational age of AGA and SGA infants, thereby complicating the results further! Also, comparing VLBW-SGA babies with NBW-SGA babies would be more meaningful as also comparing VLBW-AGA babies with NBW-AGA babies. The authors mention that there was growth catch-up shown by all babies in all anthropometric parameters. The difference in catch-up growth, between AGA and SGA babies if any, needs to be highlighted.

The authors have drawn conclusions that the developmental indices are significantly lower in VLBW babies than NBW counterparts at 1 year corrected age. Firstly, the sample size seems too small to draw any such conclusions. Secondly, the assessment was made at 1 year of age when some of the components of DASII scale which can only be performed for example at 18-24 months, cannot be applied (which the author also points out). Therefore, the significance cannot be judged appropriately. Thirdly, the statistical significance found in the study is unlikely to be of any clinical relevance as all the babies who were assessed scored above 90 on DASII scale. Similarly, the head size of – 1 SD although on the smaller side, but is within normal limits. Developmental indices of > 90 are also within normal limits. Therefore it’s very difficult to draw the conclusion of poor neurological outcome from the available data.

1. Modi M, Saluja S, Kler N, Batra A, Kaur A, Garg P, et al. Growth and neurodevelopmental outcome of VLBW infants at 1 year corrected age. Indian Pediatr. 2013;50:573-7.

2. Arcangeli T, Thilaganathan B, Hooper R, Khan KS, Bhide A. Neurodevelopmental delay in small babies at term: a systematic review. Ultrasound Obstet Gynecol. 2012;40: 267-75.

3. Qiu X, Lodha A, Shah PS, Sankaran K, Seshia MM, Yee W, et al. Neonatal outcomes of small for gestational age preterm infants in Canada. Am J Perinatol. 2012;29:87-94.