Interpretation of Physical Growth among Healthy Late Preterm Neonates

Correspondence

Indian Pediatr 2018;55: 170

	Interpretation of Physical Growth among Healthy Late Preterm Neonates
Jogender *Kumar¹ and Amitabh Singh²** Departments of Pediatrics; ¹PGIMER, Chandigarh, and ²VMMC and Safdarjung Hospital, New Delhi; India. Email: [email protected] Editor’s Notes: Authors of the manuscript entitled "Physical growth, morbidity and mortality among late-preterm neonates" did not respond to the above queries despite reminders.
We read with interest the recent research paper on Physical growth, morbidity and mortality among late-preterm neonates [1]. There are certain methodological issues, clarification to which would help in better interpretation of these results: 1. In this study, the authors have compared physical growth parameters of healthy term and late preterm neonates and concluded that late preterms have higher odds of being underweight, stunted and wasted at the chronological age of one year. However, authors did not use corrected age. CDC as well as WHO multicenter growth reference study (MGRS) has endorsed that corrected age should be used for preterms (<37 weeks) till two years of corrected age [2]. Babies born at 34+1 weeks of gestation cannot be compared with those born at 41+6 weeks, and infants having normal growth potential for their corrected age may be misclassified as having growth faltering. 2. The authors have mentioned that feeding problems and bottle feeding were more in late preterms but it is not clear that these problems were more in the first two months (till corrected age of 40 weeks) or at the end of one year. As their feeding skills may be immature till corrected age of 40 weeks, persistence of feeding problems beyond this age carries more significance. 3. There were 1333 late preterm neonates out of which only 37 (2.8%) were small for gestational age (SGA), which is very less considering SGA prevalence in India as 46.9% [3]. 4. Authors rightly state that the obstetrician colleagues should not perform elective caesarean sections before full-term gestation, but according to The American College of Obstetricians and Gynaecologists (ACOG) latest definitions, full term is 390/7 weeks through 406/7 weeks, not 37 weeks as stated by the author [4]. ACOG endorsed in its recommendation that because of potential medical complications, elective cesarean delivery should not be performed before a gestational age of 39 weeks [5]. References 1. Gupta P, Mital R, Kumar B, Yadav A, Jain M, Upadhyay A. Physical growth, morbidity profile and mortality among healthy late preterm neonates. Indian Pediatr. 2017;54: 629-34. 2. Rao SC, Tompkins J, World Health Organization. Growth curves for preterm infants. Early Hum Dev. 2007;83: 643-51. 3. Lee ACC, Katz J, Blencowe H, Cousens S, Kozuki N, Vogel JP, et al. National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010. Lancet Glob Health. 2013;1:e26-36. 4. American College of Obstetricians and Gynecologists. Definition of Term Pregnancy. Available from: http://www.acog.org/-/media/Committee-Opinions/Committee-on-ObstetricPractice/co579.pdf. Accessed June 6, 2017. 5. American College of Obstetricians and Gynecologists. Cesarean Delivery on Maternal Request. Available from: http://www.acog.org/-/media/Committee-Opinions/Committee-on-Obstetric-Practice/co559.pdf. Accessed June 6, 2017.