Maternal and neonatal factors associated with poor cognitive outcomes at 11 years of age in a cohort of low birth weight infants in Jamaica

ABSTRACT

OBJECTIVE: To determine maternal and birth factors that are associated with poor cognitive outcome in a low-birth weight (LBW) cohort enrolled at birth and examined at 11 years of age. The identification of these factors will help to plan intervention strategies to improve cognitive outcomes in LBW infants. DESIGN AND METHODS: In September and October 1986, all Jamaican-born children were enrolled in the Jamaican Perinatal Mortality Survey. At that time, a Main Questionnaire, asking questions about maternal demographic, social, and medical conditions and reviewing aspects of the pregnancy, labour, and delivery, was administered. A geographical subset of children was examined for cognitive abilities at 11 years of age using the Peabody Picture Vocabulary Test and Ravens Progressive Matrices. Former LBW children were included in the testing even though they were outside of the geographical area. Of the 1569 children tested, 107 were former LBW infants. Linear regressiong models were developed associating variables from the Main Quesitionnaire with outcomes on the cognitive tests. Based on the regression models, a Nursery Checklist was developed that could be used to identify children for referral to early intervention programmes. RESULTS: Twenty-one (20 percent) of the 107 ex-LBW children performed two standard deviations below the mean of the entire cohort. Maternal and birth factors associated with poor outcome were living in poor housing conditions, not taking prenatal iron, not working outside the home and the infant not crying at birth. The Nursery Checklist identified 90 percent of the infants with poor cognitive outcomes while only referring 56 percent of the LBW population to intervention services. CONCLUSION: The factors associated with poor cognitive outcome include two socio-economic factors, an indication of infant viability at birth, and a possible nutritional deficiency. These factors can be used to institute primary interventions to ameliorate these conditions and to identify children in need of secondary interventions in early childhood.(Au)