UCSF

As neonatal and under-five mortality rates decrease in low- and middle-income countries (LMIC), an increased number of children may be at risk of not meeting their full developmental potential. Children born preterm and with LBW are at high risk for suboptimal neurological development. However, due to lack of accurate and available gestational dating methods, it is difficult to accurately assess prematurity in LMIC settings. The present secondary analysis examined the neurodevelopmental outcomes of a sample (n=362) of preterm and low birth weight babies cross-sectionally sampled at 6, 12 and 18 months of adjusted age in Migori County, Kenya. Data were obtained from a large facility-based cluster randomized control trial (cRCT). The sample consisted of a majority of moderately low birth weight and late preterm babies. Of particular interest was whether birth weight was independently associated with adverse neurodevelopmental outcomes within each age category and whether neurodevelopmental outcomes were significantly different between the age categories. Neurodevelopment was evaluated using Z-scores on the Malawi Developmental Assessment Tool. Birth weight was significantly associated with gross motor development at the 18-month stage after adjusting for gestational age, length for age and five-minute Apgar score. A significant association between neurodevelopmental outcomes and age category was also detected after controlling for birth weight, gestational age, length for age and five-minute Apgar. To conclude, the results of this analysis found associations between birth weight and neurodevelopment, and subtle developmental deviations in the12-month age category from the population mean, based on the Z-score reference population. The implications of these findings are: 1) birth weight may be a key criterion for the allocation of resources to early child development programs, and 2) more longitudinal, long-term follow up research is needed to understand the impact of moderately low birth weight and late prematurity on the developmental trajectory and burden of developmental disability in low- and middle-income countries.