Predictive Value of Developmental Quotient at Three Months in Determination of Neurodevelopmental Outcomes at One Year in High-Risk Neonates.

Background:High-risk neonates need intervention to improve their development. Objective:To compare the neurodevelopmental outcomes at one year of age in high-risk babies (cases) and normal babies (control group). Study design: Case comparison study. Materials and methods:Two groups of participants were formed by simple random sampling: one composed of 245 high-risk babies (cases) and the other one of 245 normal babies (controls). Babies were stratified into high and low risk according to the medical diagnosis given in the neonatal intensive care unit and at three months. Standard care was offered to both groups, and subjects in the high-risk group has additionally received stimulation programs from their mother, who were trained. A monthly follow-up of the stimulation program was done. Therapist involvement was needed when the delay was observed despite stimulation given by the mother. Outcomes:Stimulation programs given since birth improve mental and motor development quotient (DQ). Results:Results were interpreted taking the DQ of 70 as a cut-off value for assessing developmental delay. McNemar's test was used to compare changes in proportions of pre- and post-stimulation abnormal outcomes. After one year, a significant reduction in mental developmental delay was observed in both high- and low-risk groups (35.1% and 45.9%, respectively), with this reduction being similar in the two groups as 95% confidence intervals for change in the proportion of developmental delay were overlapping. Likewise, motor development delay has also significantly decreased in both groups by 32.9% and 41.9%, respectively. Conclusions:Indian Standardized Stimulation Programs considering the mother as a therapist helps improve neurodevelopmental outcomes based on DQ assessment using the Developmental Assessment Scale for Indian Infants (DASII), an Indian modification of Bayley scale of infant development (BSID).

Consensus Statement of Indian Academy of Pediatrics on Early Childhood Development.

JUSTIFICATION: Early Childhood Development (ECD) has lifelong impact on learning, education, productivity, socio-emotional functioning, health and disease. A Consensus Statement for promoting ECD is needed to improve patient care and promote research. PROCESS: Indian Academy of Pediatrics convened a National Consultative Meeting on 20 September, 2019 at Surat to discuss the way forward for pediatricians in ECD and form a consensus advisory statement. Experts from Chapters of Infant and Young Child Feeding, Neurodevelopmental Pediatrics, Neonatology, Growth Development and Behavior, Adolescent Health Academy, Parenting for Peace and UNICEF participated. OBJECTIVES: To formulate, endorse and disseminate a consensus advisory statement of working at current levels of resources and to build future framework for ECD from Indian perspective. CONCLUSIONS: Interventions for ECD should begin from conception to adolescence, prioritized in first 3 years, inclusive and equitable for all, especially for high risk, vulnerable and marginalized families. Pediatric clinics can play a pivotal role as cost effective delivery points for guidance and interventions. Age appropriate approaches, active care giver's involvement, advocacy and integration with different sectors, community and policy makers should be done to enable supportive environment. Research should be promoted into finding cost effective novel scalable interventions.

Revised IAP growth charts for height, weight and body mass index for 5- to 18-year-old Indian children.

JUSTIFICATION: The need to revise Indian Academy of Pediatrics (IAP) growth charts for 5- to 18-year-old Indian children and adolescents was felt as India is in nutrition transition and previous IAP charts are based on data which are over two decades old. PROCESS: The Growth Chart Committee was formed by IAP in January 2014 to design revised growth charts. Consultative meeting was held in November 2014 in Mumbai. Studies performed on Indian children's growth, nutritional assessment and anthropometry from upper and middle socioeconomic classes in last decade were identified. Committee contacted 13 study groups; total number of children in the age group of 5 to 18 years were 87022 (54086 boys). Data from fourteen cities (Agartala, Ahmadabad, Chandigarh, Chennai, Delhi, Hyderabad, Kochi, Kolkata, Madurai, Mumbai, Mysore, Pune, Raipur and Surat) in India were collated. Data of children with weight for height Z scores >2 SD were removed from analyses. Data on 33148 children (18170 males, 14978 females) were used to construct growth charts using Cole's LMS method. OBJECTIVE: To construct revised IAP growth charts for 5-18 year old Indian children based on collated national data from published studies performed on apparently healthy children and adolescents in the last 10 years. RECOMMENDATIONS: The IAP growth chart committee recommends these revised growth charts for height, weight and body mass index (BMI) for assessment of growth of 5-18 year old Indian children to replace the previous IAP charts; rest of the recommendations for monitoring height and weight remain as per the IAP guidelines published in 2007. To define overweight and obesity in children from 5-18 years of age, adult equivalent of 23 and 27 cut-offs presented in BMI charts may be used. IAP recommends use of WHO standards for growth assessment of children below 5 years of age.