Neurodevelopmental outcomes of preterm babies during infancy in Eastern Uganda: a prospective cohort study

Abstract

Background Complications due to prematurity are a threat to child survival and full developmental potential particularly in low-income settings. Objective The aim of the study was to determine the neurodevelopmental outcomes among preterm infants and identify any modifiable factors associated with neurodevelopmental disability (NDD) Methods We recruited 454 babies (242 preterms with birth weight <2.5 kg, and 212 term babies) in a cohort study at birth from Iganga hospital between May and July 2018. We followed up the babies at an average age of 7 months (adjusted for prematurity) and assessed 211 preterm and 187 term infants for neurodevelopmental outcomes using the Malawi Developmental Assessment tool. Mothers were interviewed on care practices for the infants. Data were analyzed using STATA version 14. Results The study revealed a high incidence of NDD of 20.4% (43/211) among preterm infants compared to 7.5% (14/187) among the term babies, p < 0.001, of the same age. The most affected domain was fine motor (11.8%), followed by language (9.0%). At multivariate analysis, malnutrition and Kangaroo Mother Care (KMC) at home after discharge were the key factors that were significantly associated with NDD among preterm babies. The prevalence of malnutrition among preterm infants was 20% and this significantly increased the odds of developing NDD, OR = 2.92 (95% CI: 1.27–6.71). KMC practice at home reduced the odds of developing NDD, OR = 0.46, (95% CI: 0.21–1.00). Re-admission of preterm infants after discharge (a sign of severe illness) increased the odds of developing NDD but this was not statistically significant, OR = 2.33 (95% CI: 0.91–5.94). Conclusion Our study has shown that preterm infants are at a high risk of developing NDD, especially those with malnutrition. Health system readiness should be improved to provide follow-up care with emphasis on improving nutrition and continuity of KMC at home.

Impact of respiratory distress syndrome and birth asphyxia exposure on the survival of preterm neonates in East Africa continent: systematic review and meta-analysis

“…In this systematic review and meta-analysis, the pooled mortality rate among preterm in East Africa was found to be 19.2%. This is consistent with the studies conducted in Asia, India, and Nigeria [ 48 , 49 , 51 ]. However, The mortality rate reported in this study is higher than studies reported from Germany [ 59 ], Iran [ 60 ], Australian [ 61 ], China [ 62 ], Libya [ 63 ], Mexico [ 64 ], Spain [ 65 ], and France 4.9% [ 66 ].…”

“…The studies were conducted from 2012 to 2020 among more than 11 Eastern Africa countries including 12 from Ethiopia represented by 14 studies [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. Tanzania [ 14 , 45 , 46 , 47 ] and Uganda [ 12 , 48 , 49 , 50 ] represented by 04 studies, Besides, Burundi [ 51 , 52 ] and Eretria [ 53 , 54 ] represented by 02 studies. While Malawi [ 55 ], Kenya [ 56 ], Zambia [ 24 ], Sudan [ 25 ], Mozambique [ 57 ], and Zimbabwe [ 58 ] are represented by 01 studies.…”

“…While Malawi [ 55 ], Kenya [ 56 ], Zambia [ 24 ], Sudan [ 25 ], Mozambique [ 57 ], and Zimbabwe [ 58 ] are represented by 01 studies. Regarding study design, 13 studies employed retrospective cohort [ 12 , 14 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 56 , 57 ], whereas 07 prospective cohort studies [ 31 , 32 , 46 , 47 , 48 , 49 , 50 ], 01 case-control type [ 36 ], and 11 cross-sectional design [ 24 , 25 , 33 , 34 , 35 , 51 , 52 , 53 , 54 , 55 , 58 ]. All studies included in this review were observational studies which were conducted in the hospital with sample sizes ranging from 100 participants reported from a study in Ethiopia and Sudan [ 25 , 36 ], and 29811 from Uganda [ 12 ] respectively ( Table 1 ).…”

Father involvement in the care of children born small and sick in Rwanda: Association with children's nutrition and development

“…Children born small and sick are at higher risk of impaired growth and development and thus need more support to achieve their optimum developmental potential (World Health Organization, 2019). Studies on developmental delay and disability in the region amongst children born small and sick have shown anywhere from 20%–67% of children born small and sick surviving with developmental delay or disability (Boogaard et al, 2017; Kirk et al, 2017; Namazzi et al, 2020).…”

The effect of influenza virus infection on pregnancy outcomes: A systematic review and meta-analysis of cohort studies

“…Data in recent years have shown that adverse pregnancy outcomes such as preterm birth and LBW are the leading causes of under-5 mortality and neonatal death (Liu et al, 2015;Koffi et al, 2020;Dhaded et al, 2020). Additionally, premature and LBW infants are more likely to have complications such as neonatal jaundice (Platt, 2014), neonatal pneumonia (Shennan et al, 1988), neurodevelopmental disabilities (Namazzi et al, 2020) and other diseases. The increasing literature has demonstrated that preterm birth is associated with an increased risk for various diseases, including hypertension and kidney disease in adult life (Carmody and Charlton, 2013;de Jong et al, 2012;Reichetzeder et al, 2016).…”