Perinatal risk stratification of preterm neonates ≤ 34 Weeks and their Neurodevelopmental Outcomes at One Year.

There has been an exponential progress in the field of neonatology. In 1963, the son of US President John F. Kennedy died of respiratory distress syndrome two days after his premature birth at 34 weeks gestation. 50 years down the lane, we are now in a situation where such events are a rarity even in level 2 care newborn nurseries. The number of surviving preterm babies are increasing. These preterm babies contribute to a significant cause of long-term loss of human potential amongst survivors. An estimated 150 lakh babies are born too soon every year. India ranks first amongst the number of preterm births with 35.19 lakh in 2010. Establishing a standardized follow up program with provision for early intervention is advised for all newborn nurseries who care for preterm babies <34 weeks of gestation. The follow up of preterm babies is not structured / standardized in most neonatal units. Stratification of preterm babies based on intra-uterine, perinatal and neonatal risks could possibly identify a group of babies at higher risk. Babies at lowest risk could be referred back to primary care and require less frequent assessment. Given the proven benefits of early stimulation, the risk approach will allow optimal utilization of limited, labour intensive, follow up services and optimize the early stimulation therapy to those babies at highest risk. Gestational age ≤30 weeks, 5 minute APGAR <6, presence of sepsis and shock are independent risk factors for poor composite outcome of death or major neurodevelopmental delay at 1 year of corrected age. Gestational age ≤30 weeks, acute hypoxic events (air leaks, apnea requiring resuscitation, hypocapnia), growth delay, abnormal neurosonogram at 40 weeks and shock are associated with an odds ratio >10 for a poor composite outcome of death or major neurodevelopmental delay at 1 year of corrected age. Catch-up growth of preterm babies