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  • Correspondence
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Response to Jogender Kumar DM

Journal of Perinatology volume 39, page 344 (2019)Cite this article

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Dear editor,

We read the letter from Dr. Kumar with interest and would like to respond to the issues raised by him.

  1. 1.

    He has raised the possibility of the high seizure burden contributing to abnormal neurodevelopment in both groups in our study [1]. The diagnosis of neonatal seizures without conventional or amplitude-integrated EEG is a clinical challenge in resource-limited settings [2]. Although clinical seizures were noted in most infants, 70% were seizure-free after one episode, and only 14% were on antiepileptic drugs at discharge. Abnormal neurological outcome in hypoxic ischemic encephalopathy may be associated more with the duration of seizures rather than the occurrence of seizures per se [3]. Hence it is possible, but unlikely, that these transient seizures contributed to the neurological outcome.

  2. 2.

    Dr. Kumar contends that this pilot study was underpowered to detect a 17% reduction in the primary outcome. This was clearly acknowledged in the article.

  3. 3.

    The author has sought clarification on the definition of retinopathy of prematurity (ROP) used. Any stage of ROP was defined as abnormal in this trial. Apart from mechanical ventilation, low birth weight, sepsis, hypoxia, apnea, shock, and need for resuscitation are known risk factors for developing ROP [4]. The presence of multiple risk factors in many infants may have contributed to the abnormal screen. None of the infants had progression of ROP or required treatment.

  4. 4.

    We accept the author’s suggestion that an MRI would have been ideal, but it was not feasible in the setting of this study due to the long waiting times.

  5. 5.

    As mentioned by the author, intrauterine growth restriction (IUGR) can affect the outcomes. However, small for gestational age (SGA) status is easier to ascertain in our population than IUGR. Since the randomization was stratified based on SGA status, we expect that any effect of IUGR on the groups would have been minimal.

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References

  1. Tanigasalam V, Plakkal N, Vishnu Bhat B, Chinnakali P. Does fluid restriction improve outcomes in infants with hypoxic ischemic encephalopathy? A pilot randomized controlled trial. J Perinatol. 2018;38:1512–7.

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  2. Shah DK, Boylan GB, Rennie JM. Monitoring of seizures in the newborn. Arch Dis Child - Fetal Neonatal Ed. 2012;97:F65–F69.

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  3. Kharoshankaya L, Stevenson NJ, Livingstone V, Murray DM, Murphy BP, Ahearne CE, et al. Seizure burden and neurodevelopmental outcome in neonates with hypoxic-ischemic encephalopathy. Dev Med Child Neurol. 2016;58:1242–8.

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  4. Azami M, Jaafari Z, Rahmati S, Farahani AD, Badfar G. Prevalence and risk factors of retinopathy of prematurity in Iran: a systematic review and meta-analysis. BMC Ophthalmol. 2018;18:83.

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Author contribution:

VT drafted the initial manuscript. NP edited and approved the final manuscript. All authors approved the final manuscript.

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No sponsors were involved in any stage of the study design, manuscript preparation, and publication.

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Authors and Affiliations

  1. Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India

    Vasanthan Tanigasalam & Nishad Plakkal

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  1. Vasanthan Tanigasalam
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  2. Nishad Plakkal
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Correspondence to Nishad Plakkal.

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Tanigasalam, V., Plakkal, N. Response to Jogender Kumar DM. J Perinatol 39, 344 (2019). https://doi.org/10.1038/s41372-018-0290-9

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  • DOI: https://doi.org/10.1038/s41372-018-0290-9

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