INTERGROWTH-21st Project international INTER-NDA standards for child development at 2 years of age: an international prospective population-based study.
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Fernandes Michelle, Villar José, Stein Alan, Staines Urias Eleonora, Garza Cutberto, Victora Cesar G, Barros Fernando C, Bertino Enrico, Purwar Manorama, Carvalho Maria, 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
Аннотация
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.