BRAIN ENDEVR

Developmental Origins of Child Neurodevelopment: Novel approaches to clinical risk prediction using an international meta-dataset

Approximately 250 million children under 5 years, worldwide, are at risk of delayed development. Early neurodevelopmental delays (ENDs) are associated with poorer educational, economic, and health outcomes across the lifecourse. As developmental interventions during this period have enduring positive impacts, identifying children at risk early is key to targeting interventions within this window of sensitivity.

While it technically challenging to assess neurocognitive skills during early infancy, the use of risk profiles presents an alternative, low-cost strategy for the identification of children at risk. However, as yet, there is no such tool to identify, at scale and across international populations, children at high risk of ENDs. Multiple prenatal, perinatal and postnatal risk factors (including prematurity, growth, and health) have been associated with ENDs. However, patterns of associations vary between populations limiting the generalisability of findings.

Understanding risk factors associated with developmental delay, is key to identifying, as early as possible, children at high risk of delay. To study this, this Project will bring together already collected data from 9 studies, representing 8,015 children from 13 high-, middle- and low-income countries. For all children, neurodevelopment at 2 years was measured on the INTER-NDA test. The Project will examine associations between early risk factors and ENDs using hierarchical association analyses; identify risk clusters and construct models to predict risk of developmental delay during early childhood. The resultant models will be validated in an independent study from Mysore, India (n=500). The Project’s key hypothesis is that these risk models will satisfactorily predict ENDs, and if proven, these findings will be translated into an online, open-source tool for early identification of developmental delay in children based on clinical, growth and sociodemographic information at birth and at 1 year.

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The whole-child approach to neurodevelopment

Across the world, improvements in neurodevelopment outcomes during early childhood have consistently lagged behind improvements in child mortality, stunting, wasting and exposure to infectious diseases. 1 in 10 children globally are estimated to have some degree of neurodevelopmental delay. with immediate and long-term consequences on themselves, their families and communities. Over 80% of these delays are due to preventable causes such as poverty and poor nutrition. Effective interventions are available which, in some conditions, reverse delays completed if administered within the first 3 years of life.

Yet we are falling behind in our efforts to help most, if not all, children to achieve their full developmental potential.

We aim to transform current research in early child development by incorporating the 'whole child' approach by looking at all factors affecting a child's early development. This is important because, to tackle a problem as large and important as child development, we need to understand all its causes and how they interact with each other to confer risk. This will enable us to develop a system by which, when a child is born anywhere in the world, healthcare professionals can estimate its risk for developmental delay.

Identifying children at risk of delays is the first step in helping children achieve their full developmental potential. Only if children are identified to be at risk, do they have the opportunity to avail of interventions to support their development.

Who we are working with

We are working closely with research groups in 13 countries. The populations of these countries are geographically and cultural disparate, and the children in each study are representative of each country's population of children. As children in different countries are exposed to different influences during early childhood, we try to capture and examine all of these in this Project.

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