Prevalence and Risk Factors of Developmental Delay among High-risk Preterm NICU Graduates – A Cross-Sectional Study
Authors: ArvindKrishna Dhakshinamurthy , Naaraayan Sridevi A. , Devi Meenakshi Krishnaswami 
Published: January 2025

Objectives:
Preterm and low birth weight neonates are vulnerable to developing neurodevelopmental handicaps more frequently compared to their term counterparts. Neurodevelopmental delay is multifactorial and is likely a consequence of an immature brain, perinatal risk factors, and environmental exposures. The study objective was to determine the prevalence of developmental delay in high-risk preterm infants and also to determine the risk factors for delay in development.

Material and Methods:
The study was an analytical cross-sectional study conducted in the Department of Pediatrics of a tertiary care medical college hospital from October 2021 to October 2022. Infants born as high-risk preterm neonates who required neonatal intensive care unit (NICU) stay in the early neonatal period were included in the study at the corrected age of 1 year after informed parental consent. Infants whose parents did not consent to the study were excluded from the study. Details of maternal, neonatal, and perinatal risk factors were noted in a pro forma. All infants included in the study were part of the follow-up program in the high risk newborn follow-up clinic and were assessed for growth and development periodically. A detailed neurological examination was done. During the follow-up of high-risk neonates, clinical assessment tools like Amiel-Tison angles were used. Details regarding the passive tone and active tone were documented in the follow-up card and reviewed. Early intervention was planned if tone abnormalities were identified. Developmental screening was done using the Trivandrum developmental screening test. Only trivandrum developmental screening test (TDSC) was used in screening, and confirmatory tests such as Bayley and developmental assessment scale for Indian infants (DASII) were not used in the study center. Although TDSC is not a confirmatory test, in a resource-limited setting, it may help to identify infants with delays in development early and refer them to a higher center. The prevalence of developmental delay was expressed in proportion with a 95% confidence interval (CI). Risk factors were determined by bivariate, followed by multivariate logistic regression analysis. P < 0.05 was considered significant.

Results:
The present study included infants who were high-risk preterm NICU graduates, of whom 57.2% were male. 22.7% of neonates had birth weight <1750 g. The prevalence (95% CI) of developmental delay was 18 % (12.2–27.6%). There were 18% neonates with gross motor delay, 13% with delay in fine motor development, 18% with delayed language development, and 14% with delay in social and adaptive milestones. By multivariate analysis, it was found that among the neonatal risk factors, apnea and birth weight <1.75 kg were independent risk factors for developmental delay.

Conclusion:
High-risk preterm NICU graduates are at risk of neurodevelopmental delay, and we observed an 18% prevalence of delay. Periodic follow-up and early intervention of babies with risk factors such as apnea and birth weight <1.75 kg is necessary.