Every newborn - simplified measurement integrating longitudinal neurodevelopment and growth

This project outlines an extension to the Every Newborn Birth Indicator Research Tracking in Hospitals (EN-BIRTH) study in Tanzania, Bangaladesh and Nepal. EN-BIRTH is an observational study of 20,000 births in five facilities in Tanzania, Bangaladesh and Nepal, between mid- 2017 and mid-2018. We propose to add developmental follow-up a cohort of newborns identified through EN-BIRTH, who have been exposed to basic newborn interventions at participating health facilities in Tanzania, Bangaladesh and Nepal.

This add-on cohort study will be called EN-SMILING, following these children to the age of 5 years to extend the current research on simplified metrics from the time of birth to include metrics for child development, and to promote early identification of adverse developmental outcomes after exposure to basic newborn interventions, including newborn resuscitation, KMC and treatment for presumed bacterial infections.

The link between newborn health and early child development (ECD) is crucial. Birth is a time of great risk and opportunity for death, disability and child development. Nearly 10% Disability Adjusted Life Years (DALYs) globally are due to newborn death and impartment after newborn complications. Less is known about developmental consequences for newborns who had basic interventions, such as basic resuscitation, kangaroo mother care (KMC) and inpatient treatment for presumed neonatal infection.

Early Child development (ECD) is central to the SDGs, linking health (SGD3), educational attainment (SDG4), economic growth (SDG 8) and inequality reduction (SGD 10). Impaired ECD reflects inequalities between and within countries and keep nations in poverty. Prevention of impairment, early detection and intervention for developmental delays can transform individual and population potential. If routine measurement were simplified and integrated with newborn and child health care, this could lead to earlier intervention and improve school readiness.

Objectives

The study objectives build on EN-BIRTH objectives as follows:

1. Measure: Develop and test a structured approach to child development measurement (simple tools, timing, training) and evaluate accuracy compared to “gold standard” developmental assessment as well feasibility and acceptability for health workers and families.

2. Detect: Assess prevalence of developmental delay from birth to 5 years for a sub-sample of newborns across all three study sites who required basic newborn interventions, compared to randomly selected, matched newborns, not exposed to basic interventions.

3. Integrate Metrics and Care: Expore challenges and enablers for routine use of the simplified, structured early child developmental delays or disability in these three countries.

Infants recruited from EN-BIRTH will be followed up from birth until 5 years of age. Using a simplified ECD measurement approach, they will be assessed at 6,9,12,18,24,36 and 60 months. Through comparison with ‘gold standard’ comprehensive child development assessments (i.e. Bayley Scales of Infant and Toddler Development Third Edition (Bayley III) at 3 years and Wechsler Preschool and Primary Scale of Intelligence (WPPSI) at 5 years performance of the simplified ECD measurement approach will be evaluated.

A mixed method assessment of feasibility and acceptability will inform the possibility of use at scale. This research will inform ECD measurement integration within newborn and child health (such as immunisation appointments), improve understanding of child development impact of basic newborn interventions and inform approaches to improving access to and design of early intervention for those at risk of adverse developmental outcomes.