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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 [1]. 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 [2].

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 cohorts.

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].

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,
Haryana, India.
Email: dramitgupta2001@gmail.com


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. 2013;50:1047-50.

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 Ed.1999; 80:F15-F20.


Authorís Reply

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 therapy.

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.   

Kanya Mukhopadhyay
Department of Pediatrics, PGIMER,
Chandigarh, India.
Email: kanyapupul@yahoo.com


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