Date of Award

10-2020

Degree Type

Thesis

Degree Name

MS in Epidemiology & Biostatistics

First Advisor

Dr Imran Nisar

Second Advisor

Dr Batool Fatima

Third Advisor

Sir Iqbal Azam

Department

Community Health Sciences

Abstract

Introduction Preterm babies are at risk of various short and long-term adverse neurodevelopment outcomes. Although the brain continues to mature after birth, there is a vast difference in maturation trajectory. Early screening and monitoring allows early recognition and management for adverse neurodevelopmental outcomes. For this purpose, various screening tools are used for measuring the functional and structural capacity of children from 0-5 years. Ages and Stages Questionnaire edition 3 (ASQ-3) is the tool of choice for assessment in a large population, as it is a comprehensive tool that assesses five developmental domains and is validated in Pakistan.
Method This study was a follow up of Alliance for Maternal and New-born Health Improvement (AMANHI) gestational age assessment study done from 2014 -2017 in a peri urban areas of Karachi, Pakistan. Gestational age in the parent AMANHI study was determined using ‘gold standard’ first trimester ultrasound. New-borns were then followed for 28 days for mortality outcome. In this project we looked at the long term neurodevelopmental outcome of222preterm and 222 age-matched full-term babies who were 3-5 years of age in May-July 2020. Ages and Stages Questionnaire was used to measure neurodevelopmental outcome. Other mother and child related characteristics were assessed using Ten Questions (TQ), Adverse Childhood Experiences (ACE), Strength and Difficulty Questions (SDQ) and some questions adopted from Pakistan Demographic andHealth Survey 2017-2018.The risk ratios for delay in one domain in ASQ were compared in preterm and full term usingcox proportional hazard model.
Result: Out of them, 222 matched pairs 27.7% preterm were screened positive in one domain of delay in ASQ, while in term-born, 25% were screened positive in one domain of delay in ASQ. We found insignificant association between preterm birth and neurodevelopmental outcome (RR: 1.56, CI=0.92- 2.65)There was a significant association between low(RR=2.37, CI:1.10 -5.08) and middle socio economic status(RR=1.56, CI:0.80 - 3.05),delay in emotional domain(RR=1.84, CI:1.19 - 2.83), delay in conduct domain (RR=1.72, CI:1.03 - 2.89) and child ever went to Montessori(RR=1.72, CI:1.08 - 2.74). Whereas, interaction between preterm birth and weight for age (z scores) was significant (RR=2.31, CI=2.18-2.44).
Conclusion There is a significant association between preterm births with adverse neurodevelopment outcomes with one unit increase in weight for age (z scores). In a country like Pakistan, with highest preterm birth rate, intermittent screening of preterm born child is necessary to identify development delay early to facilitate prompt rehabilitation that can improve the quality of life of the survived preterm born baby.

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Last Page

102

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