Assessment of growth and neurodevelopmental outcomes in preterm infants at 2 years corrected age in a resource-limited setting

Project Abstract

This study assesses growth trajectories and neurodevelopmental outcomes of preterm infants at 2 years corrected age in a resource-limited setting, aiming to identify determinants, prevalence of impairments, and opportunities for targeted interventions. A prospective cohort design was employed, enrolling neonates born before 37 weeks gestation over a 24-month period from three tertiary hospitals and two district facilities. Data collection integrated baseline perinatal factors, neonatal morbidities, growth measurements, and standardized neurodevelopmental assessments at 24 months corrected age. Growth was monitored using weight, length, and head circumference z-scores aligned with WHO Child Growth Standards, while neurodevelopment was evaluated with a culturally adapted version of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III), supplemented by the Hammersmith Infant Neurological Examination and caregiver-reported functional outcomes. Preliminary analyses indicate a high burden of growth faltering, with stunting and wasting prevalences exceeding regional norms. Head circumference growth lag correlated strongly with neurodevelopmental outcomes, particularly cognitive and language domains, after adjusting for sociodemographic variables, sex, and late neonatal morbidities such as intraventricular hemorrhage and sepsis. The study identifies prematurity-related complications—bronchopulmonary dysplasia, retinopathy of prematurity, and necrotizing enterocolitis—as significant predictors of adverse motor and cognitive outcomes. Socioeconomic status, maternal education, access to post-discharge follow-up, and home environment quality emerged as important modifiers of developmental trajectories, underscoring the influence of environmental enrichment even in the presence of medical risk. Multivariate models reveal that while corrected age at assessment is essential, intrinsic neonatal factors have persistent effects on neurodevelopment independent of post-discharge care, though frequent follow-up visits and caregiver engagement mitigate some adverse outcomes. The internal consistency of the adapted Bayley-III battery demonstrated acceptable reliability in this setting, with modest sensitivity in detecting mild delays, suggesting a need for locally validated cutoffs or supplementary functional measures. Notably, a substantial proportion of infants exhibited domain-specific impairments, with language delays more prevalent than motor deficits, aligning with patterns reported in low-resource environments and underscoring the importance of early language-enriched interventions. The findings have implications for policy and practice, highlighting the necessity of integrated care models that combine neonatal intensive support with structured, family-centered follow-up programs, community health worker engagement, and scalable early intervention services. Recommendations include developing context-specific screening protocols at 6, 12, and 24 months corrected ages, enhancing nutrition and growth monitoring, and facilitating access to developmental therapies in resource-limited settings. Limitations include potential selection bias due to referral patterns, loss to follow-up, and reliance on caregiver-reported data. Overall, the study provides critical insights into the interplay between medical severity, growth trajectories, and environmental factors shaping neurodevelopmental outcomes in preterm children within resource-constrained environments.

Project Overview

What This Project Is About

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A straightforward look at how babies born prematurely develop by the time they reach two years corrected age, especially when care resources are limited. It examines growth (height, weight, and body mass) and neurodevelopment (movement, learning, and behavior) to understand long-term outcomes and what influences them.

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The Problem It Addresses

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Preterm infants often face higher risks of slow growth and developmental delays, and resources in some settings are not enough to track or support them effectively. This project identifies what outcomes look like at two years corrected age and what factors in a resource-limited setting predict better or worse results.

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Objectives of the Project

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1. Describe growth and neurodevelopmental status of preterm infants at two years corrected age.
2. Identify factors in the care environment that are linked to better outcomes.
3. Evaluate the feasibility of simple, low-cost screening methods for follow-up in resource-limited settings.
4. Provide evidence to guide local guidelines for post-discharge care.

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What You Will Do Step by Step

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1. Review existing literature on preterm outcomes and common assessment tools.
2. Define inclusion criteria and enroll eligible preterm infants followed up to two years corrected age.
3. Collect data on growth metrics (weight, length, head circumference) and basic neurodevelopmental milestones.
4. Administer simple, culturally appropriate developmental screening tools.
5. Analyze relationships between growth measures and developmental outcomes.
6. Identify key factors in care practices and environment that associate with outcomes.
7. Assess practical implications for follow-up programs in limited-resource settings.
8. Prepare a concise report with recommendations for stakeholders.

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Expected Outcome

Expected findings include a profile of growth and developmental status at two years corrected age, identification of modifiable factors linked to better outcomes, and practical, low-cost recommendations to improve follow-up care in resource-limited settings.