Survival and morbidity among two cohorts of extremely low birth weight neonates from a tertiary hospital in northern India

Survival and Neurodevelopmental Outcome of Extremely-Low-Birth-Weight Infants at One Year of Age-A Prospective, Descriptive Study

OBJECTIVES

To study the survival rates at discharge and neurodevelopmental outcome at 1 y of corrected age (CA) of extremely-low-birth-weight ELBW neonates.

METHODS

This prospective, descriptive study was conducted in a tertiary care level III extramural NICU of a teaching hospital. Forty-nine extremely-low-birth-weight (ELBW) neonates were enrolled in the study from July 2017 to June 2018. Baseline demographic data, morbidities during NICU stay, and survival at discharge for the enrolled neonates were recorded. The enrolled infants were followed up to 1 y of CA at three-monthly intervals. During the follow-up, anthropometry, developmental screening by Denver Developmental Screening Test (DDST), and tone assessment by Amiel-Tison scale were done. Developmental Assessment Scale for Indian Infants (DASII) was administered at CA of 12 mo.

RESULTS

Thirty-seven (75.5%) neonates survived to discharge. Survival rate of neonates with birth weight > 750 g and with gestational age ≥ 26 wk was 90.2% and 85.7%, respectively. Amongst those < 750 g or < 26 wk (n = 8), none survived. Abnormal developmental quotient (DQ < 70%) was seen in 6 infants out of 33 infants (18.1%) followed at 1 y of CA.

CONCLUSION

Overall, 3/4^th of ELBW infants survived to discharge and 80% of those who were followed up at 1 y of CA had normal neurodevelopmental outcome. However, survival rates of neonates born at < 26 wk and/or with birth weight < 750 g  were less and needs to be improved.

Longitudinal Growth of Extremely Low Birth Weight Infants at 5 years

This prospective cohort study assessed longitudinal growth of Extremely low birth weight (ELBW) infants at 5 y of age. ELBW infants discharged alive during 2009-2011 were prospectively followed till 5 y of age. Forty-five matched controls were enrolled. The weight, length, and occipitofrontal circumference were recorded and Z-scores were calculated using the WHO software. The primary outcome was the comparison of growth parameters of the ELBW cohort with controls. Forty-seven ELBW and 45 controls were assessed at 5 y. In ELBW cohort, 17 (36.2%) were underweight, 13 (27.7%) were stunted, 11 (23.4%) were wasted, and 6 (15.7%) had microcephaly at 5 y. As compared to controls, the proportion of underweight and stunting was significantly higher among ELBW infants (p < 0.001). There was no significant difference in Z-scores at 2 and 5 y. ELBW infants have significant undernutrition at 5 y of age and there is no catch-up growth beyond 2 y.

Current status of NICUs in India: a nationwide survey and the way forward

The number of Neonatal Intensive Care Units (NICUs) and Special Care Newborn Units (SCNUs) in the country has increased exponentially. However, their current status of functioning is not known. A structured questionnaire survey of 70 NICUs spread across the country was conducted to assess their infrastructure, staffing, equipment, patient profile and their involvement in research and training. Majority of the units were well staffed and led by neonatologists trained in India and abroad. All had facilities for mechanical ventilation and were equipped with sophisticated imported equipment. Yet, availability of in-house blood gas and X-ray, microbiology facility, invasive blood pressure monitoring and support of ophthalmologist was not universal. More than half had published papers in scientific journals and were having recognized training programs in neonatology. Though tremendous progress is visible since the last surveys, the number of NICUs is still grossly insufficient. The current and future gap in trained manpower is however daunting, and intensive efforts for expanding the in-service training programs and innovative approaches to training are required. There is an urgent need to improve the quality of care by launching collaborative quality improvement programs and mandatory periodic accreditation managed by independent empowered organizations. The focus has to move forward from simply 'survival till discharge' to 'intact complete life survival'. Simultaneously, the NICU care has to stay available and affordable for the masses.