Early neurological and developmental trajectories of infants at high risk of cerebral palsy in Bangladesh: a prospective longitudinal cohort study
Tasneem Karim, Anna te Velde, Annabel Webb, Catherine Morgan, Nadia Badawi, Iona Novak, Saifuddin Ahmed, Shafiul Islam, Iskander Hossain, Nazrul Islam, Mohammad Muhit, Gulam KhandakerBackground
Longitudinal data for high-risk infants in the first 2 years of life are limited, particularly in low- and middle-income countries. We aimed to describe survival, diagnostic, neurological and developmental outcomes of infants at risk of developing cerebral palsy (CP) in Bangladesh.
Methods
We conducted a prospective longitudinal cohort study of neonates with risk factors for CP admitted to a tertiary neonatal intensive care unit in Bangladesh. Outcomes at 24 months included CP, developmental delay (DD), no known disability and death. Assessments up to 24 months of age included the Hammersmith Infant Neurological Examination (HINE), Peabody Developmental Motor Scales, second edition (PDMS-2), Gross Motor Function Measure (GMFM-66), Developmental Assessment of Young Children (DAYC-2), Ages and Stages Questionnaire (ASQ-3). Survival probability was analysed using Kaplan-Meier curves and mortality risk using Cox proportional hazards models.
Results
Of 227 infants enrolled, 27% died at the median age of 41 days (range 3–403). Mortality risk was significantly associated with multiple birth (HR 6.66; 95% CI 2.08 to 21.32) and neonatal encephalopathy (grade 3 vs grade 1–2: HR 2.40; 95% CI 1.29 to 4.44). Of 125 infants assessed at 24 months, 29% were diagnosed with CP, 10% with DD and 61% had no known disability. Among infants with CP, median HINE scores were 27.5, 29.5 and 34 at 3, 12 and 24 months respectively, with 57–64% scoring <40 across these time points. Motor scores on PDMS-2 were significantly lower in infants with CP than in those with DD ( p ≤0.005) and those with no known disability ( p <0.001) at 3, 12 and 24 months.
Conclusions
One-third of the infants died, and an additional third of the survivors developed CP, most with non-ambulant CP. These findings underscore the need for context-specific early detection and intervention strategies for high-risk infants in Bangladesh.