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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurodevelopment assessment of small for gestational age children in a community-based cohort from Pakistan
Sabahat Naz1, Zahra Hoodbhoy2, Ali Jaffar1
1Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Sindh, Pakistan.
Insights
Children born small for gestational age (SGA) show poorer neurodevelopment, particularly in fine motor skills, compared to appropriate for gestational age (AGA) peers. This highlights potential long-term impacts on development and school performance.
Area of Science:
- Pediatric Neurodevelopment
- Developmental Pediatrics
- Global Child Health
Background:
- Children born small for gestational age (SGA) may face long-term neurodevelopmental challenges.
- Existing research indicates potential disparities in developmental outcomes between SGA and appropriate for gestational age (AGA) infants.
Purpose of the Study:
- To investigate and compare the neurodevelopmental outcomes of children born SGA versus AGA in a Pakistani periurban setting.
- To identify specific domains of neurodevelopment affected by SGA status in early childhood.
Main Methods:
- A prospective cohort study followed newborns from a 2018 pilot Doppler study.
- 180 children (90 SGA, 90 AGA) aged 2-4 years were assessed using the Malawi Developmental Assessment Tool (MDAT).
- Statistical analyses included multivariable linear and logistic regression to compare neurodevelopmental scores.
Main Results:
- SGA children exhibited significantly lower fine motor scores compared to AGA children.
- SGA children had a threefold increased odds of overall neurodevelopmental z-scores ≤-2.
- While other domains showed lower scores in SGAs, only fine motor skills reached statistical significance.
Conclusions:
- SGA is linked to poorer overall neurodevelopment in young children, primarily driven by deficits in fine motor skills.
- Further longitudinal studies are warranted to track the neurodevelopmental trajectory and academic performance of SGA children.
- Early identification and intervention may be crucial for mitigating the long-term effects of SGA on child development.
Background:
Children born small for gestational age (SGA) may experience more long-term neurodevelopmental issues than those born appropriate for gestational age (AGA). This study aimed to assess differences in the neurodevelopment of children born SGA or AGA within a periurban community in Pakistan.
Methods:
This was a prospective cohort study in which study participants were followed from the pilot Doppler cohort study conducted in 2018. This pilot study aimed to develop a pregnancy risk stratification model using machine learning on fetal Dopplers. This project identified 119 newborns who were born SGA (2.4±0.4 kg) based on International Fetal and Newborn Growth Consortium standards. We assessed 180 children (90 SGA and 90 AGA) between 2 and 4 years of age (76% of follow-up rate) using the Malawi Developmental Assessment Tool (MDAT).
Findings:
Multivariable linear regression analysis comparing the absolute scores of MDAT showed significantly lower fine motor scores (β: -0.98; 95% CI -1.90 to -0.06) among SGAs, whereas comparing the z-scores using multivariable logistic regression, SGA children had three times higher odds of overall z-scores ≤-2 (OR: 3.78; 95% CI 1.20 to 11.89) as compared with AGA children.
Interpretation:
SGA exposure is associated with poor performance on overall MDAT, mainly due to changes in the fine motor domain in young children. The scores on the other domains (gross motor, language and social) were also lower among SGAs; however, none of these reached statistical significance. There is a need to design follow-up studies to assess the impact of SGA on child's neurodevelopmental trajectory and school performance.
