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Very low birth weight infant outcomes in a resource-limited setting: a five-year follow-up study

Windhi Kresnawati¹, Peter John Pandie², Rinawati Rohsiswatmo³

¹Department of Child Health, Gatot Soebroto Military Hospital, Jakarta, Indonesia.

Frontiers in Pediatrics

|May 16, 2025

Insights

Very low birth weight (VLBW) infants in Indonesia face high rates of growth and developmental issues by age five. Improved survival necessitates focus on long-term care for these vulnerable children.

Area of Science:

Neonatalogy
Pediatric Development
Public Health in Low-Income Settings

Background:

Preterm birth and very low birth weight (VLBW) contribute significantly to neonatal mortality in resource-limited areas like Indonesia.
National interventions improved survival rates for low birth weight (LBW) infants but challenges in growth and development persist.
This study investigates the 5-year growth and developmental outcomes of VLBW infants in a remote Indonesian region.

Purpose of the Study:

To assess the long-term growth and developmental status of very low birth weight infants at five years of age.
To identify the prevalence of specific impairments including stunting, wasting, cerebral palsy, and blindness in this cohort.
To inform future strategies for comprehensive care of VLBW infants in resource-constrained environments.

Main Methods:

Retrospective data collection from September 2021 to May 2022.
Inclusion of infants born with VLBW (<1,500 grams) at Biak Regional Hospital between 2016 and 2017.
Assessment of growth parameters (stunting, wasting) and developmental outcomes (cerebral palsy, blindness, developmental delays) at 5-year follow-up.

Main Results:

A 5-year survival rate of 68.5% was observed among 54 discharged VLBW infants (born 2016-2017).
High incidences of stunting (32.1%), wasting (46.4%), cerebral palsy (21.4%), and blindness (10.7%) were recorded by age five.
Infants had a mean gestational age of <34 weeks and birth weights between 625-1,400 grams.

Conclusions:

The study underscores a high burden of growth and developmental impairments in Indonesian VLBW survivors.
Sustained, multidisciplinary interventions are crucial to enhance long-term outcomes beyond mere survival.
Future healthcare strategies must prioritize comprehensive development support for VLBW infants in low-resource settings.

Read full analysis

Abstract

Background:

Preterm birth and very low birth weight (VLBW) remain major contributors to neonatal morbidity and mortality, particularly in low-income settings such as Indonesia, where healthcare resources are limited. In response, the Ministry of Health introduced mentoring programs in 2014, followed by intensive neonatal training initiatives in 2015. These interventions substantially improved survival rates for LBW infants however, they face significant growth and developmental challenges. This study aims to investigate the growth and development of VLBW infants in remote area at five years of age.

Method:

Data were collected retrospectively between September 2021 and May 2022 from children born between 2016 and 2017 with VLBW (<1,500 grams) at Biak Regional Hospital, Indonesia. Growth parameters, including stunting and wasting and developmental outcomes such as cerebral palsy, blindness, and developmental impairment or delays were assessed after 5 years of age for follow up assessment.

Results:

Among 78 identified infants with VLBW, 54 infants (69.2%) with a gestational age of <34 weeks were discharged alive between 2016 and 2017. Their gestational ages ranged from 27 to 33 weeks, with birth weights between 625 and 1,400 grams. Overall, 12 infants died before reaching one year of age while five died after one year. The 1-year survival rate was 77.8%, while 5-year survival rate was 68.5%. The incidences of stunting, wasting, cerebral palsy, and blindness were 32.1%, 46.4%, 21.4%, and 10.7%, respectively.

Conclusion:

The high prevalence of growth and developmental impairments highlights the need for sustained multidisciplinary efforts to improve long-term outcomes for VLBW infants. In resource-limited settings, the focus should extend beyond survival to ensure optimal growth and development of the children.

Keywords:

developmental impairment growth low birth weight preterm neonates survival rate

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