Project Details

Validation of Neurodevelopmental Assessments for Early Identification of High Risk Infants in LMIC

Susanne Martin Herz, MD, PhD

Summary

BACKGROUND: Globally, an estimated 53 million children under 5 years have developmental disability, with approximately 95% living in low- and middle-income countries (LMICs). Appropriate neurodevelopmental impairment (NDI) assessment tools are often unavailable in these settings, due to lack of validation, cost, and cultural-linguistic challenges. GAP: The Prechtl General Movement Assessment (GMA) and the Hammersmith Infant Neurologic Examination (HINE) have shown high sensitivity and specificity for cerebral palsy and cognitive delays, but have limited validation in LMICs. The Global Scales for Early Development (GSED) show promise, but have not been validated beyond 6 months, in high-risk cohorts, or at an individual-level. HYPOTHESIS: (1) Both the GMA and HINE will be feasible to administer and show strong predictive ability for NDI at 24 months; (2) The GSED will show construct validity, discriminate between known risk groups, and have predictive ability over multiple ages from 3 to 18 months for children with and without NDI at 24 months. METHODS: This prospective cohort study will recruit at least 600 infants across the NDI risk spectrum related to perinatal asphyxia/neonatal encephalopathy. In addition to demographic, antenatal and perinatal data collected at enrollment, NDI assessments will occur at 3, 6, 12, 18 and 24 months. Study activities will take place at the Children’s Rehabilitation Unit at Sally Mugabe Central Hospital in Harare, Zimbabwe. RESULTS: Pending. IMPACT: If valid, the GMA, HINE and GSED could provide much earlier, feasible and low-cost identification of children at elevated risk for NDI in LMICs. This would allow appropriate early intervention to be initiated by 6 months.