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Neurodevelopmental outcomes for high-risk neonates in a low-resource setting
  1. Kate M Milner1,2,3,
  2. Trevor Duke1,2,4,
  3. Andrew C Steer1,2,4,
  4. Joseph H Kado5,6,
  5. Lanieta Koyamaibole5,
  6. Rakei Kaarira5,
  7. Kelera Namudu5,
  8. Susan Woolfenden7,8,
  9. Anne E Miller1,
  10. Kathryn E O’Heir1,
  11. Eleanor F G Neal1,4,
  12. Gehan Roberts4,9
  1. 1 Department of Paediatrics, Centre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia
  2. 2 Royal Children’s Hospital, Melbourne, Victoria, Australia
  3. 3 Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
  4. 4 Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
  5. 5 Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji
  6. 6 Department of Paediatrics, Fiji National University, Nasinu, Fiji
  7. 7 Community Child Health, Sydney Children’s Hospital, Randwick, Australia
  8. 8 Paediatrics, University of New South Wales, Sydney, New South Wales, Australia
  9. 9 Centre for Community Child Health, Royal Children’s Hospital, Melbourne, Victoria, Australia
  1. Correspondence to Dr Kate M Milner, Centre for International Child Health, Royal Children’s Hospital, Flemington Rd Parkville, VIC 3052, Australia; kate.milner{at}


Worldwide, most neonates who survive prematurity and serious illness reside in low-resource settings where developmental outcome data and follow-up care are limited. This study aimed to assess in Fiji, a low-resource Pacific setting, prevalence and risk factors for moderate to severe neurodevelopmental impairment (NDI) in early childhood among high-risk neonates compared with controls. Retrospective cohort study comparing long-term outcomes for high-risk neonatal intensive care unit patients (n=149) compared with matched term, normal birth weight neonates (n=147) discharged from Colonial War Memorial Hospital between November 2008 and April 2010. NDI was defined as one or more of cerebral palsy, moderate to severe hearing or visual impairment, or global developmental delay using Bayley Scales of Infant and Toddler Development Third Edition (ie, score <70 in ≥1 of cognitive, language or motor domains). At median (IQR) age 36.1 (28.3, 38.0) months, prevalence of moderate to severe NDI % (95% CI, n) in high-risk and control groups was 12 (5 to 17, n=13) and 5 (2 to 12, n=5), respectively, an increased risk ratio (95% CI) of 2.7 (0.8 to 8.9). Median gestational age (weeks (median, IQR)) in the high-risk group was 37.5 (34–40) weeks. Among high-risk neonates, gestational age, birth weight, asphyxia, meningitis and/or respiratory distress were significantly associated with risk of NDI. Prevalence of NDI was high among this predominantly term high-risk neonatal cohort compared with controls. Results, including identified risk factors, inform efforts to strengthen quality of care and models of follow-up for high-risk neonates in this low-resource setting.

  • neurodevelopment
  • tropical paediatrics
  • neonatology

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  • Contributors AEM conceptualised and designed the study, assisted with data collection, analysed data, revised the manuscript and approved the final manuscript as submitted. TD, ACS and GR supervised study design and analysis of data, reviewed and revised the manuscript, and approved the final manuscript as submitted. JHK, RK, KN, SW, AEM and LK and KEO supported, coordinated and completed data collection at the study site and approved the final manuscript as submitted. EFGN assisted with data cleaning and analysis and approved the final manuscript as submitted.

  • Funding Australian Agency for International Development and Cure Kids Fiji.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Ethics approval Fiji National Health Research Committee, Fiji National Health Research Ethics Review Committee and University of Melbourne Human Research Ethics Committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Primary data related to this study and a related substudy exploring developmental screening instruments within the study cohort are stored at Colonial War Memorial Hospital Suva, Fiji, and the Centre for International Child Health, University of Melbourne. Data retention, storage and management are per University of Melbourne stipulations.