Perinatal and Gestational Determinants of Long-Term Neurodevelopmental Trajectories in Children with Microcephaly: A Retrospective Cohort Study in a Rural Tertiary Care Setting
DOI:
https://doi.org/10.55640/corr-v03i05-01Keywords:
Microcephaly, Preterm Birth, Neurodevelopmental OutcomesAbstract
Background: Microcephaly, an abnormally small head circumference, is a significant marker of impaired brain growth and is associated with substantial long-term neurodevelopmental morbidity. Perinatal factors, especially preterm birth, are known to influence developmental outcomes, but their specific impact on children with microcephaly in resource-limited rural settings is not well-understood. This study aimed to examine the association between gestational age and long-term developmental trajectories in a cohort of children with microcephaly from a rural tertiary care hospital.
Methods: We conducted a retrospective cohort study of all children diagnosed with microcephaly at birth or in the first year of life and followed up to age five years. Data on perinatal factors, developmental milestones, neurological impairments (epilepsy, cerebral palsy), growth patterns, and mortality were extracted from medical records. Microcephaly was defined using INTERGROWTH-21st and WHO growth standards. Univariate and multivariate analyses were performed to assess the association between gestational age and key outcomes.
Results: The cohort included a total of 155 children with microcephaly. Preterm birth was a significant perinatal risk factor, with preterm microcephalic children showing a higher prevalence and greater severity of developmental delay compared to term/post-term children. Preterm status was an independent predictor of severe developmental delay (Adjusted Odds Ratio [AOR]: 3.84; 95% CI: 2.15-6.12) and epilepsy (AOR: 2.56; 95% CI: 1.34-4.89), even after adjusting for confounders. This group also demonstrated slower head growth velocity and a higher prevalence of persistent growth restriction. A substantial proportion of cases (42%) had unknown etiology, reflecting the diagnostic limitations of the rural setting.
Conclusion: Preterm birth is a critical determinant of adverse long-term neurodevelopmental outcomes in children with microcephaly. These findings underscore the need for accurate gestational age assessment, intensive and prolonged follow-up, and targeted early intervention services for this high-risk population in rural healthcare settings. Public health efforts should focus on strengthening prenatal care and diagnostic capabilities to improve outcomes.
References
Leviton A, Holmes LB, Allred EN, et al. Methodologic issues in epidemiologic studies of congenital microcephaly. Early Hum Dev 2002;69:91–105.
Woods CG, Parker A. Investigating microcephaly. Arch Dis Child 2013;98:707–13.
Dobyns WB. Primary microcephaly: new approaches for an old disorder. Am J Med Genet 2002;112:315–7.
Nawathe A, Doherty J, Pandya P. Fetal microcephaly. BMJ 2018;361.
von der Hagen M, Pivarcsi M, Liebe J, et al. Diagnostic approach to microcephaly in childhood: a two-center study and review of the literature. Dev Med Child Neurol 2014;56:732–41.
Woods CG, Bond J, Enard W. Autosomal recessive primary microcephaly (MCPH): a review of clinical, molecular, and evolutionary findings. Am J Hum Genet 2005;76:717–28.
Villar J, Cheikh Ismail L, Victora CG, et al. International standards for newborn weight, length, and head circumference by gestational age and sex: the newborn cross-sectional study of the INTERGROWTH-21st project. Lancet 2014;384:857–68.
Papageorghiou AT, Ohuma EO, Altman DG, et al. International standards for fetal growth based on serial ultrasound measurements: the fetal growth longitudinal study of the INTERGROWTH-21st project. Lancet 2014;384:869–79.
WHO Multicentre Growth Reference Study Group. WHO child growth standards: growth velocity based on weight, length and head circumference: methods and development. Geneva: World Health Organization, 2009: 242. ISBN: 978 92 4 154763 5.
Morris JK, Rankin J, Garne E, et al. Prevalence of microcephaly in Europe: population based study. BMJ 2016;354.
Cragan JD, Isenburg JL, Parker SE, et al. Population-based microcephaly surveillance in the United States, 2009 to 2013: an analysis of potential sources of variation. Birth Defects Res A Clin Mol Teratol 2016;106:972–82.
Graham KA, Fox DJ, Talati A, et al. Prevalence and clinical attributes of congenital microcephaly - New York, 2013-2015. MMWR Morb Mortal Wkly Rep 2017;66:125–9.
Auger N, Quach C, Healy-Profitós J, et al. Congenital microcephaly in Quebec: baseline prevalence, risk factors and outcomes in a large cohort of neonates. Arch Dis Child Fetal Neonatal Ed 2018;103:F167–F172.
Bhide P, Kar A. Birth prevalence of microcephaly in India. Bull World Health Organ 2016;23.
Devakumar D, Bamford A, Ferreira MU, et al. Infectious causes of microcephaly: epidemiology, pathogenesis, diagnosis, and management. Lancet Infect Dis 2018;18.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Dr. Elias J. Moreno (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain the copyright of their manuscripts, and all Open Access articles are disseminated under the terms of the Creative Commons Attribution License 4.0 (CC-BY), which licenses unrestricted use, distribution, and reproduction in any medium, provided that the original work is appropriately cited. The use of general descriptive names, trade names, trademarks, and so forth in this publication, even if not specifically identified, does not imply that these names are not protected by the relevant laws and regulations.