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Developmental problems linked with birth complications

Friday January 13th, 2012

More than one third of babies who are born with a variety of complications go on to suffer long-term developmental consequences, experts warned today.

Preterm birth, obstetric complications, jaundice or infections are all risk factors, according to a study published Online First by The Lancet.

The report’s authors say that although neonatal care is improving, some nations, especially those with intensive care but poor monitoring and little follow up data, could already be experiencing an epidemic of disability similar to that seen in high-income countries in the middle of the last century.

Dr Michael Mwaniki, of the Centre for Geographic Medicine Research, Kenya Medical Research Institute, Kilifi, Kenya, and Dr Joy Lawn of Saving Newborn Lives/Save the Children, Cape Town, South Africa, and colleagues said many babies who survive these serious illnesses do go on to develop normally.

But in some, the injuries can cause varying degrees of long-term brain and nervous system impairment.

This systematic review included 153 studies from 1966 to 2011, which reported consequences after neonatal complications.

The pooled risk estimate of at least one impairment associated with one or more of the injuries – or insults – studied was 37 per cent. This excluded HIV.

Because most of the high quality studies were from Europe and North America, the authors believe this may have given an incomplete assessment of the global picture. Data is most lacking from the regions with the most births.

The authors found a risk of at least one severe impairment of 18 per cent, of at least one moderate impairment of five per cent, and of at least one mild impairment of 10 per cent.

The most common impairments were learning difficulties, cognition, or developmental delay (59 per cent of impaired children), cerebral palsy (21 per cent); hearing impairment (20 per cent); and visual impairment (18 per cent).

Only 40 studies included data for multidomain impairments. These studies included 2815 individuals, of whom 1048 (37 per cent) had impairments, with 334 (32 per cent) having multiple impairments.

The authors highlight the role of neonatal sepsis and infections. Because median impairment after preterm birth was 28 per cent, and that of septic premature neonates was 49 per cent, they say: “sepsis probably increases the likelihood of neurological impairment in preterm neonates. Moreover, the degree of impairment was more likely to be severe for septic preterm neonates than in nonseptic neonates.”

They hope their study will lead to a greater focus on the quality of neonatal care, as well as more resources for short and long-term follow-up and rehabilitation services.

“Rehabilitation and supportive care might improve quality of life,” they say.

“However, changes to policy and programmes are unlikely without a more cohesive, interagency, proactive approach to improving data … As neonatal care is improving in middle-income and low-income countries, are we recreating the epidemics of impairment because of prematurity, such as retinopathy, seen in the mid-20th century in Europe and North America? We need better data to clarify this issue.”

In a linked Comment, Dr Lucy Thompson, Mental Health and Wellbeing, University of Glasgow, UK and Professor Christopher Gillberg, Gillberg Neuropsychiatry Centre, Gothenburg, Sweden, point out the importance of behavioural problems.

“Behavioural problems are often the first sign for parents and caregivers that a child is not developing along the desired trajectory,” they say. “There is a need to understand and identify these signs better.”

The Lancet January 13 2012

Tags: Africa | Child Health | Childbirth and Pregnancy | Women’s Health & Gynaecology | World Health

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