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Perinatal and Gestational Determinants of Long-Term Neurodevelopmental Trajectories in Children with Microcephaly: A Retrospective Cohort Study in a Rural Tertiary Care Setting

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Dr. Elias J. Moreno ¹ ,

⁴ Institute of Public Health, University of Geneva, Geneva, Switzerland

Abstract

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.

Keywords

Microcephaly, Preterm Birth, Neurodevelopmental Outcomes

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Perinatal and Gestational Determinants of Long-Term Neurodevelopmental Trajectories in Children with Microcephaly: A Retrospective Cohort Study in a Rural Tertiary Care Setting

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