Surveillance for neurodevelopmental impairment (NDI) in high-risk neonates: a cohort study at a tertiary care hospital in Pakistan.

BACKGROUND: High-risk neonates are at greater risk for neurodevelopmental impairment (NDI) despite improved neonatal survival. In low-income and middle-income countries, including Pakistan, developmental trajectories across infancy and toddlerhood of high-risk neonates are not well studied, especially when the survival is improving. METHODS: This 2-year longitudinal cohort study was performed at the neonatal intensive care unit and Child Development and Rehabilitation Centre of Aga Khan University Hospital in Pakistan. High-risk neonates who met predefined clinical criteria were enrolled and evaluated at 6 months, 12 months and 24 months of age using the Bayley Scales of Infant and Toddler Development, Fourth Edition. NDI has been defined as moderate-severe hearing or visual impairment, cerebral palsy or global developmental delay (ie, ≥2 SD delay in ≥2 Bayley domains). RESULTS: Out of 369 eligible neonates, 198 of them had at least one assessment. NDI prevalence increased to 15.7% at 2 years compared with 8.2% at 6 months. Overall, language impairment showed the largest increase (2.6%-9.6%), while cognitive (5.2%-7.1%) and motor (5.2%-7.6%) impairments rose modestly.Placental abruption was linked to the risk of NDI in univariable analysis (HR=3.53, 95% CI 1.07 to 11.62). Low birth weight was associated with gross motor impairments (HR=2.90, p=0.01), while preterm birth also showed association with gross motor (HR=3.66, p=0.01) and receptive (HR=2.61, p=0.02) impairments. Receptive language impairment was related to pre-eclampsia (HR=2.06, 95% CI 1.17 to 3.64) and preterm premature rupture of membranes (HR=2.24, 95% CI 1.22 to 4.09). Expressive impairment was linked to prolonged hospital stay (HR=1.81, 95% CI 1.04 to 3.14) and lower household income (HR=2.07, 95% CI 1.24 to 3.45). CONCLUSION: Approximately 15% of high-risk neonatal survivors showed evidence of NDI by 2 years of age with evolving language vulnerabilities and persistent gross motor risks. Overall, study findings highlight the need for urgent structured developmental surveillance and early child development intervention programmes for high-risk infants in Pakistan, as part of routine neonatal care pathways.