Published online July 3, 2006
PEDIATRICS Vol. 118 No. 1 July 2006, pp. 280-289 (doi:10.1542/peds.2005-2014)
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Neurodevelopmental Outcomes of Preterm Infants in Bangladesh

Naila Z. Khan, MBBS, FCPS, PhDa, Humaira Muslima, MBBS, DCMa, Monowara Parveen, MSca, Mallika Bhattacharya, MSca, Nasreen Begum, MBBS, MPHa, Selim Chowdhury, MSca, Moshrat Jahan, MBBSa and Gary L. Darmstadt, MD, MSb,c

a Child Development Centre, Child Development and Neurology Unit, Dhaka Shishu (Children's) Hospital, Sher-e-Bangla Nagar, Dhaka, Bangladesh
b Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
c Saving Newborn Lives Initiative, Save the Children-US, Washington, DC

OBJECTIVES. The purpose of this work was to determine neurodevelopmental outcomes of preterm infants followed by a multidisciplinary team in a tertiary hospital in Bangladesh.

METHODS. Infants <33 weeks' gestational age were serially assessed for neurodevelopment by physicians and developmental psychologists. An estimate of "low," "moderate," or "high" risk for neurodevelopmental impairments was made at the first visit. At later assessments, neurodevelopmental impairments were graded by severity as "none," "mild," or "serious."

RESULTS. Of the 159 enrolled children, 65% survived, 16% died, and 19% were lost to follow-up. Family income was lowest among those who died, and maternal and paternal literacy was highest among the survivors. At a mean age of 31 months, developmental status of the 85 children followed-up for ≥12 months was normal in 32%; 45% had mild and 23% had serious neurodevelopmental impairments. Cognitive impairment was the most common deficit (60%). Final outcome was significantly better than estimated initially. Most serious (85%) but fewer mild (37%) problems were identified independently by both child health physicians and psychologists.

CONCLUSIONS. Parental education and family income had significant influence on postdischarge mortality. Two thirds of infants demonstrated neurodevelopmental impairments. Most mild cognitive impairments would have been missed had either physicians or psychologists alone done the assessments. Preterm infants in this low-resource setting are at high risk for neurodevelopmental impairments, which need to be identified early, preferably by a multidisciplinary team of professionals.

Key Words: disability • follow-up • impairment • low birth weight • mortality • neurodevelopment • preterm

Abbreviations: LBW—low birth weight • SGA—small for gestational age • CDC—Child Development Centre • DSH—Dhaka Shishu Hospital • NDI—neurodevelopmental impairment • NDA—neurodevelopmental assessment • EEG—electroencephalogram • BSID II—Bayley Scales for Infant Development • MDI—Mental Development Index • PDI—Psychomotor Development Index • ROP—retinopathy of prematurity

Accepted Feb 6, 2006.


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