Objectives: To study the immediate outcome of VLBW babies. Setting- Level II care Nursery, Period of study- 1 year. Methods: All babies weighing less than 1500 grams other than those in the exclusion criteria. Study design: A retrospective case study done over a period of one year where based on the antenatal events, perinatal events & neonatal course the outcome was evaluated. Results: Sixty four per cent of the VLBW babies survived until discharged to home. Male babies & the one with lower gestational age had increased mortality rate. Conclusion: Mortality & major morbidity is higher in smaller infants.
VLBW babies are those weighing less than 1500 grams account for 3.3% of all live born infants in India according to National Neonatology forum (NNF-2002 data)  and the incidence is almost same throughout the world. They belong to high risk group, demanding close monitoring & highly skilled service along with advanced therapeutic measures for their care. The mortality rate is 29.7% in this group and hence, it is an accurate contributor of the infant mortality rate. Very low birth weight (VLBW) infants are at higher risk of poor growth and neurodevelopmental outcomes, due to associated adverse perinatal risk factors and postnatal morbidities. Several studies have reported high incidence of growth failure and poor neurological outcome during infancy and childhood . At our center which is a Level II care nursery  in an industrial hospital with moderate resources, the outcome of these VLBW babies needs a vivid analysis. Although to compare the study in terms of survival with the other centers of excellence having sophisticated facilities will be meaningless, this work is an effort to know where we stand and the aspects needed to be looked into for improvement.
|Characteristics||Survivors (n=81)||Deaths (n=45)||Odds ratio (95% CI)||P value|
|Maternal age ≤ 20 years||24(29.6%)||9(20%)||1.68(0.7-4.3)||0.29|
|PROM >18 hrs||10(12.3%)||7(15.6%)||0.76(0.26-2.17)||0.59|
|GA < 30 wks||17(21%)||14(31.1%)||0.58(0.26-1.3)||0.28|
|APGAR score at 5 min ≤5||6(7.4%)||2(4.4%)||1.72(0.33-8.90)||0.71|
A retrospective study was conducted to include VLBW babies admitted in TMH in nursery ward during October’12 to September’13 irrespective of place of delivery, mode of delivery & sex of the baby. However, admission after 72 hours of delivery, those born with congenital malformations, suspected IEM & intrauterine infections were excluded.
All the babies admitted were first categorized into study group based on the above mentioned criteria and then subjected to thorough clinical examination, physical and neurological assessment and findings were recorded in the prescribed format. Those babies > 72 hours old were excluded because of increased chances of community acquired infections, more number of sub-optimally managed cases & greater incidence of acquired metabolic abnormalities like hypoglycemia, hypocalcaemia and hypothermia.
|Disease profile||Incidence||Deaths||Mortality in disease||Contribution to total mortality|
Statistical analysis: All the relevant data were recorded in a systematic and tabular form was analyzed statistically and observations were compared with different study groups. All the data was analyzed statistically by using with software “GraphPad InStat” downloaded from site www.graphpad.com. Significance of risk factors under study associated with the neonatal outcome was compared and its statistical significance was determined by using Odds ratio. Probability value (‘p’ value) and confidence interval at 95% was calculated from software mentioned earlier and ‘p’ value considered to be significant when it was less than 0.05.
|Birth weight group (average LOS)||Average LOS* of VLBW babies discharged||Average LOS of VLBW babies who were DAMA#||Average LOS of VLBW babies who died|
|< 750 gms (2.12 days)||-||-||2.12|
|751-1000 gms (8.13 days)||15.8||4.67||3.92|
|1001-1500 gms (6.6 days)||9.12||5.47||5.21|
|Total (7.42 days)||10.19||5.24||4.29|
Out of the 126 VLBW babies, one baby was home delivered, 38 were out-born deliveries & the rest 87 were TMH born deliveries. 27 % of the babies were delivered by Caeserian section. Details of all relevant observations are presented in tabular form and figures.
|Birth weight||Admission||Total admissions||Deaths||Total deaths|
|TMH born||Outside born||TMH born||Outside born|
Out of the total 1827 newborn admitted to the NICU during the study period, VLBW babies constituted 7.5% of the total neonatal admission which is more than twice as compared to NNF-2002 data  (3.3% of live births). The number of deaths among the VLBW babies was 35.7%. Female sex and higher gestational age of the babies were associated with increased survival. The most common clinical condition leading to deaths in VLBW babies are RDS (64.4%), apnea (62.2%) and septicemia (37.8%) followed by pneumonia, hypoglycemia, neonatal jaundice and NEC. The incidence of septicemia in the present study is 44 (34.9%). Majority of VLBW deaths were within 72 hours of life (46.7%). The mean duration of hospital stay was 7.42 days. The median duration of hospital stay was 6 days.
|Disease condition||Roy et al (4)||Our study|
|Neonatal jaundice||17 (24.2%)||40 (31.7%)|
|RDS||12 (17.1%)||48 (38%)|
|Culture proven sepsis||10 (14.2%)||44 (34.9%)|
|Birth asphyxia (APGAR at 5 mins <3)||9 (12.8%)||10 (7.9%)|
|Mean duration of hospital stay||24 days||7.42 days|
The overall mortality of VLBW babies is 35.7% and the mortality was higher for lower birth weight group as compared to higher birth weight groups. The mortality was 48.1% and 26.4% for birth weight group between 751-1000 grams and 1001-1500 grams respectively. None of the babies less than or equal to 750 grams survived.
Comparative study on clinical profile in VLBW babies with Roy et al  is described in table 5.
The survival advantage of female VLBW babies was comparable to Avery ME et al, 1987 , Horbar et al, 1988 , Fanaroff et al, 1995  and Tyson JE et al, 1996 . The weight wise distribution of mortality rates among babies weighing 751-1000 grams and 1001-1500 gms of 48.1% and 26.4 % respectively was comparable to Lemons JA et al , 2001 & Horbar JD et al, 2002 .
|Birth weight group||Survival rates of TMH study, ‘12-‘13||Survival rates of Atasay et al, 2003 (11)||Survival rates of Canada Study,2000 (12)||Survival rates of NICHD,1998 (13)|
|≤ 750 gms||0%||9.3%||62%||54%|
Weight wise survival rates of different study groups is compared in tabular form in table 6.
There are several limitations to our study, including improved neonatal care practices and trained personnel conversant with these interventions. A large multicentric longitudinal study is required to arrive at a conclusion regarding the facts and figures observed in the present study.
Acknowledgements: We are thankful to Lt. Gen. (Retd.) Dr. G. Ramdas, General Manager, Medical services, Tata Steel Limited, for permitting to send this article for publication. We would also like to thank the parents of the babies for their consent.
SKM: Concept, design, Data collection, Statistical analysis; AM: Drafting, critical review of manuscript
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