INTERGROWTH-21st Project international INTER-NDA standards for child development at 2 years of age: an international prospective population-based study.
Fernandes, Michelle;
Villar, José;
Stein, Alan;
Staines Urias, Eleonora;
Garza, Cutberto;
Victora, Cesar G;
Barros, Fernando C;
Bertino, Enrico;
Purwar, Manorama;
Carvalho, Maria;
+24 more...Giuliani, Francesca;
Wulff, Katharina;
Abubakar, Amina A;
Kihara, Michael;
Cheikh Ismail, Leila;
Aranzeta, Luis;
Albernaz, Elaine;
Kunnawar, Naina;
Di Nicola, Paola;
Ochieng, Roseline;
Sandells, Tamsin;
Savini, Sandy;
Temple, Sophie;
Murray, Elizabeth;
Ohuma, Eric O;
Gravett, Michael G;
Pang, Ruyan;
Jaffer, Yasmine A;
Noble, Julia Alison;
Winsey, Adele;
Lambert, Ann;
Papageorghiou, Aris T;
Bhutta, Zulfiqar;
Kennedy, Stephen;
(2020)
INTERGROWTH-21st Project international INTER-NDA standards for child development at 2 years of age: an international prospective population-based study.
BMJ open, 10 (6).
e035258-.
ISSN 2044-6055
DOI: https://doi.org/10.1136/bmjopen-2019-035258
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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.
