EXTREMELY LOW BIRTH WEIGHT BABIES

Dear Editor,

This is in reference to the article ’Extremely low birth weight babies’ [1]. The author needs to be congratulated on an excellent effort in saving two neonates born as extremely low birth weight babies in a level 1 NICU with no ventilator facility. The point proven by the article is that preterm neonates need constant attention with minimum handling, prevent sepsis with strict aseptic protocols and dedicated 24 hours nursing. And the most important message for all involved in the care of preterm is that breast milk remains the best for even these tiny neonates with no need for formula feeds. In the context of baby friendly hospital initiative program, this message is relevant. As a recognized baby friendly hospital, our protocol has been similar i.e. exclusive breast-feeding for all neonates including all preterms and participation of mother in the day to day care.

Rational scientific evidence together with the gold standard of the randomized, controlled trial have taught us the benefits of some of our current basic neonatal feeding practices while demonstrating a paucity of adverse effects. For example, early hydration with intravenous glucose was demonstrated three decades ago to improve survival while reducing the incidence of azotemia, oliguria, hyperbilirubinemia, hypoglycaemia and hypothermia [2]. One strong conclusion is that gastrointestinal priming must become the standard of care for very low birth weight infants. Also known as minimal feeds, gut stimulation, or hypocaloric feedings, this practice attempts to prepare the premature infant's intestine for later advancement of full enteral feedings while preventing the known mucosal atrophy and unphysiological gut hormone status noted in animals and human kept NPO [3]. Further human milk feeding has been shown to reduce the incidence of necrotizing enterocolitis and to improve cognitive function in very low birth weight infants [4].

A job well done needs kudos! However a proper follow up of these high risk neonates is equally important to identify certain expected deviations in such extremely low birth weight neonates and take corrective action. It is mandatory to follow up low birth weight babies for auditory function, visual including retinopathy of prematurity, developmental milestones and later on cognitive functions, since both children must be around five years now, it would be worthwhile screening them for minor learning disorders. In a cohort study at two tertiary care centers, singleton infants (n=127) with fetal growth retardation due to placental insufficiency at a gestational age of 26 to 32 weeks during the years 1984–1989 were studied. Main outcome measures were special education, mainstream education below the appropriate age level and behaviour according to attention deficit hyperactivity criteria at school age (4 1/2–10 1/2 years). 114(90%) had a complete follow-up. Special education was found in 14% of the assessed children. More children in the older age group than in the younger age group were placed in special school (20% versus 10%). Behavioral problems were scored in 39% of the assessed children attending mainstream education. The authors conclude that this specific group of growth-retarded children is at serious disadvantage for adequate performance in school, although the incidence of special education and behavioral problems was comparable to other preterm infants [5].