INTERGROWTH-21st Project international INTER-NDA standards for child development at 2 years of age: an international prospective population-based study

Michelle Fernandes, José Villar, Alan Stein, Eleonora Staines Urias, Cutberto Garza, Cesar G. Victora, Fernando C. Barros, Enrico Bertino, Manorama Purwar, Maria Carvalho, Francesca Giuliani, Katharina Wulff, Amina A. Abubakar, Michael Kihara, Leila Cheikh Ismail, Luis Aranzeta, Elaine Albernaz, Naina Kunnawar, Paola Di Nicola, Roseline OchiengTamsin Sandells, Sandy Savini, Sophie Temple, Elizabeth Murray, Eric O. Ohuma, Michael G. Gravett, Ruyan Pang, Yasmine A. Jaffer, Julia Alison Noble, Adele Winsey, Ann Lambert, Aris T. Papageorghiou, Zulfiqar Bhutta, Stephen Kennedy

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)

Abstract

OBJECTIVES: To describe the construction of the international INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) standards for child development at 2 years by reporting the cognitive, language, motor and behaviour outcomes in optimally healthy and nourished children in the INTERGROWTH-21st Project. DESIGN: Population-based cohort study, the INTERGROWTH-21st Project. SETTING: Brazil, India, Italy, Kenya and the UK. PARTICIPANTS: 1181 children prospectively recruited from early fetal life according to the prescriptive WHO approach, and confirmed to be at low risk of adverse perinatal and postnatal outcomes. PRIMARY MEASURES: Scaled INTER-NDA domain scores for cognition, language, fine and gross motor skills and behaviour; vision outcomes measured on the Cardiff tests; attentional problems and emotional reactivity measured on the respective subscales of the preschool Child Behaviour Checklist; and the age of acquisition of the WHO gross motor milestones. RESULTS: Scaled INTER-NDA domain scores are presented as centiles, which were constructed according to the prescriptive WHO approach and excluded children born preterm and those with significant postnatal/neurological morbidity. For all domains, except negative behaviour, higher scores reflect better outcomes and the threshold for normality was defined as ≥10th centile. For the INTER-NDA's cognitive, fine motor, gross motor, language and positive behaviour domains these are ≥38.5, ≥25.7, ≥51.7, ≥17.8 and ≥51.4, respectively. The threshold for normality for the INTER-NDA's negative behaviour domain is ≤50.0, that is, ≤90th centile. At 22-30 months of age, the cohort overlapped with the WHO motor milestone centiles, showed low postnatal morbidity (<10%), and vision outcomes, attentional problems and emotional reactivity scores within the respective normative ranges. CONCLUSIONS: From this large, healthy and well-nourished, international cohort, we have constructed, using the WHO prescriptive methodology, international INTER-NDA standards for child development at 2 years of age. Standards, rather than references, are recommended for population-level screening and the identification of children at risk of adverse outcomes.

Original languageEnglish
Pages (from-to)e035258
JournalBMJ Open
Volume10
Issue number6
DOIs
Publication statusPublished - 7 Jun 2020
Externally publishedYes

Keywords

  • community child health
  • developmental neurology & neurodisability
  • epidemiology
  • paediatrics

Fingerprint

Dive into the research topics of 'INTERGROWTH-21st Project international INTER-NDA standards for child development at 2 years of age: an international prospective population-based study'. Together they form a unique fingerprint.

Cite this