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To the Editor: We accolade the authors for their study on very-low-birth-weight (VLBW) mortality from tertiary care Indian setup [1]. However, a few concerns for the present study are summarized. Firstly, nearly 18% neonates of the enrolled neonates were treated with surfactant replacement therapy (SRT) for respiratory distress syndrome (RDS) and 60% of the SRT-treated RDS neonates were associated with mortality [1]. The present study aptly points out the ailments which contribute to high fatality rates amongst VLBW neonates. The burden of RDS mortality in developing countries is significant. From a public health point of view, the authors have suggested monitoring RDS-specific mortality in developing countries and evaluate causes of higher case fatality associated with RDS [2]. In line with these, monitoring the cause-specific neonatal mortality (e.g., RDS in preterm neonates) is one of the dashboard indicators of India Newborn Action Plan [3]. Since the present study enrolled only the inborn neonates, a physician-certified cause of deaths could have provided valuable data. Secondly, the study cohort’s fatality rate of the VLBW neonates is lower than published literature; an overall care improvement in India is possibly the most important reason [4]. It has been speculated that nearly 95% of the neonates with RDS can be managed with combined use of continuous positive airway pressure (CPAP), SRT, and invasive ventilation [2]. However, bridging the huge gap in neonatal survival with RDS between developing and developed nations remains a challenge. From an intensivist point of view, the literature suggests an improved diagnosis of persistent pulmonary hypertension of newborn (PPHN) in preterm neonates in the present era [5]. We believe PPHN is under-reported in the study and is possibly a hidden culprit contributing to higher fatality rates.
References
Gupta S, Adhisivam B, Bhat BV, Plakkal N, Amala R. Short term outcome and predictors of mortality among very low birth weight infants—a descriptive study. Indian J Pediatr. 2021;88:351–7.
Kamath BD, Macguire ER, McClure EM, Goldenberg RL, Jobe AH. Neonatal mortality from respiratory distress syndrome: lessons for low-resource countries. Pediatrics. 2011;127:1139–46.
India Newborn Action Plan (INAP) National Health Mission. In: MOHFW, GOI Publication. 2014. Available at: https://nhm.gov.in/images/pdf/programmes/inap-final.pdf. Accessed on 1 July 2021.
Ramanathan R, Bhatia JJ, Sekar K, Ernst FR. Mortality in preterm infants with respiratory distress syndrome treated with poractant alfa, calfactant or beractant: a retrospective study. J Perinatol. 2013;33:119–25.
Nakanishi H, Suenaga H, Uchiyama A, Kusuda S; Neonatal Research Network, Japan. Persistent pulmonary hypertension of the newborn in extremely preterm infants: a Japanese cohort study. Arch Dis Child Fetal Neonatal Ed. 2018;103:F554–F61.
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Khare, C., Jain, M. Short Term Outcome and Predictors of Mortality Among Very Low Birth Weight Infants—A Descriptive Study: Correspondence. Indian J Pediatr 88, 1155 (2021). https://doi.org/10.1007/s12098-021-03906-2
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DOI: https://doi.org/10.1007/s12098-021-03906-2