Developmental Outcomes of Preterm and Low Birth Weight Toddlers and Term Peers in Rwanda

Abstract

Background:As neonatal care improves in low-resource settings, more preterm or low birth weight (LBW) babies are surviving, but little is known about their long-term outcomes. Globally, preterm and/or LBW babies are at increased risk of mortality, malnutrition, and developmental delay.Objectives:We aim to describe the differences in development in rural Rwandan children at 24–36 months of age born preterm and/or LBW compared to their peers born term or normal birth weight (term/NBW), and to assess factors associated with poor development.Methods:We conducted a cross-sectional study using secondary data analysis from two combined datasets from 2014, using Ages and Stages Questionnaire (ASQ-3) for developmental assessment and anthropometrics for nutritional status (stunting and wasting). Demographic and clinical factors associated with poor developmental outcomes in univariate regression at α = 0.20 were included in a full model; we used backward stepwise penalized multivariable logistic regression to identify a final model at α = 0.05.Findings:In total, 445 children were included; 405 term/NBW, and 40 preterm and/or LBW. Half of them (n = 234; 52.6%) had developmental delay, including 207 (51.1%) among term/NBW and 27 (67.5%) among preterm and/or LBW (p = 0.048). In the final model, term/NBW children with stunting alone had a significant increase in the odds of developmental delay (OR 2.05, 95% CI 1.37–3.07), and children with wasting had a borderline statistically significant increased odds of developmental delay (OR 5.79, 95% CI 0.98-34.39). Being preterm and/or LBW and not stunted completely predicted delay.Conclusion:Half of the children had developmental delay in our sample from rural Rwanda. Preterm and/or LBW infants were more likely to have developmental delay, and the main predictor of developmental delay was stunting, with high rates of stunting observed also in term/NBW infants. Interventions to reduce undernutrition and prevent prematurity and LBW, alongside investments to promote early stimulation for optimal development, are needed if gains in addressing developmental delay are to be made.

Prevalence and risk factors for low birth weight in Jordan and its association with under-five mortality: a population-based analysis

“…LBW is one of the most important predictors of nutrition, health and survival of infants (2). LBW is also an important biomarker of adverse health and development problems in early and later life, including delays in cognitive and behavioural development, growth retardation, neurological problems in childhood, and many chronic diseases (2,(4)(5)(6)(7). Babies with LBW have a 5-30 times higher risk of dying during infancy than normal birth weight (≥ 2500 g) babies (2).…”

“…LBW can be a consequence of preterm birth (i.e. birth before 37 completed weeks of pregnancy), or intrauterine growth restriction, each of which is influenced by many factors related to the mother, the infant, the physical environment or genetics (2,4,5,7). However, the pattern of risk factors for LBW and their relative contribution vary from one setting to another.…”

Prevalence of and socioeconomic gradient in low birth weight in Ethiopia: further analysis of the 2016 demographic and health survey data

“…Globally, prematurity related complications remain the leading cause of under-five mortality [2]. Not only does prematurity lead to mortality, but it has also been shown to be a driver of many health problems such as developmental delay and Low Birth Weight (LBW) [3,4].…”

Growth and neurodevelopment in low birth weight versus normal birth weight infants from birth to 24 months, born in an obstetric emergency hospital in Haiti, a prospective cohort study

“…Even so, the important stunting (WHZ scores lower than − 2) observed in both the LBW and NBW group at birth and up to 12 months of age suggests that nutrition and feeding practices are a challenge in Haiti. This was described previously in Haiti and was thought to be due to a breakdown in the parent-child relationship [30]. Stunting has been repeatedly shown to be a risk factor for delayed neurodevelopment.…”