Abstract

Background: Advances in perinatal care and improved neonatal services have improved the survival rates of very low birth weight (VLBW) babies. The risk of neurodevelopmental deficit increases as gestational age decreases, which includes high risk of cerebral palsy, developmental delay, hearing and vision impairment and subnormal academic achievement. So these infants require periodic follow up for assessment of growth, sensory function and neurodevelopment for early detection and management of deficits.

Materials & Methods: This is a prospective hospital based study to study the growth and neurodevelopmental outcome of very low birth weight (VLBW) babies, ≤1500 g, in the 1^st  year of life. 50 consecutive VLBW babies discharged from NICU of a tertiary level centre in the Government sector were followed for 1 year. Babies with major congenital anomalies, those with of intrauterine infections and hypoplastic babies were excluded. Detailed antenatal history and events during neonatal period were noted. Gestational age of babies was determined by 1^st trimester Ultrasound scan, New Ballard score and date of Last Menstrual Period. Assessment of growth was done by 3 monthly measurements of weight, length, Head circumference and interpreted using IAP charts. Development was assessed using DDST II and severe developmental delay was defined as DQ<75. ROP screening started at 1 month by indirect ophthalmoscopy and hearing assessment was done by BERA/OAE. Assessment for intermittent illnesses/ rehospitalisations was also done.

Results: Mean gestational age of study group was 31.5 weeks and mean birth weight was 1.297 kg. At 1 year of age, 59.6% of babies had weight less than 3^rd centile, 38.2% had length under 3^rd centile and 6.3% had head circumference less than 3^rd centile. 18% had severe developmental delay, of which 4% had cerebral palsy.16% developed ROP, of which 14% underwent laser therapy. Myopia was detected in 62.5% and strabismus in 58% at 1 year follow up.  None had hearing impairment. Two babies expired on followed up due to probable meningitis. 19% were readmitted in hospital. Bronchiolitis was the major morbidity.

Conclusion: The incidence of post natal growth failure, weight less than 3^rd percentile, in the study group was high. Interventions like early aggressive parenteral nutrition may be required to improve this. The incidence of cerebral palsy was comparable to other studies. Follow up for visual morbidities and developmental delay is necessary for all VLBW babies. Drawback of the study was the small sample size.

Keywords: Very low birth weight, growth, neurodevelopmental outcome.

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