INTERNATIONAL JOURNAL OF SPECIAL EDUCATION Vol.37, No.

3, 2022

Cognitive and Motor Development of Children born with low birth weight: A
Systematic Review of Asia

B. Uvarani1* Aayushi Bansal2, Avinash N3

1- Professor, Ph.D. Research scholar, MNR Educational Trust, MNR College of Nursing, Sangareddy,
Telangana, India
2-Associate Professor, HOD Community Health Nursing Department, College of Nursing, LLRM Medical College,
Meerut, India
3- Associate Professor, Sapthagiri College of Nursing, Bengaluru, India
*Corresponding Author
Abstract

Data on neurodevelopment impairment from developed countries suggest that individuals born
with LBW have a higher risk of lower cognitive function, tend to score lower on academic
performance measures, have higher prevalence of mental disorders, serious emotional and
behavioural problems and development delay compared to term healthy counterparts The
presented meta-analysis was developed in response to the publication of several studies
addressing Cognitive and Motor Development of Children born with low birth weight. Online
database search was performed in Pubmed, Cinhal, Medline and relevant studies were included
with no language restriction. Following on from this, databases were accessed to enable a more
in depth search of the literature using key words and Boolean operators to generate articles
relevant to the topic. These articles were filtered using an inclusion /exclusion criteria in order to
refine the results to a manageable level or eight articles. These eight articles were analyzed and
the results showed that there is momentous deficit in cognitive and motor development of
children born with low birth weight compared to those children who born with normal birth
weight. Application of these recommendations would produce more reliable and comparable
studies. This review provides some evidence and supported for impact on cognitive and motor
development of children those who born with low birth weight

Key words: Cognitive, Motor development, children, low birth weight, Asia

Introduction
Infants born preterm are at high risk for the onset of cognitive dysfunctions at school age.(Allen,

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2008) Data on neurodevelopment impairment from developed countries suggest that individuals
born with LBW have a higher risk of lower cognitive function, tend to score lower on academic
performance measures, have higher prevalence of mental disorders, serious emotional and
behavioural problems and development delay compared to term healthy counterparts(Upadhyay
et al., 2019)

Research has largely concentrated on cognitive aspects and has given limited attention to the
significance of motor difficulties, which are frequently reported . Motor development during
these formative years provides a foundation for subsequent development and optimises
occupational performance in the areas of self-care, learning, leisure and play. Minor problems,
which are likely to interfere with learning and success at school, may not be detected until school
age. Motor difficulties then, can impact on a child’s ability to learn and successfully participate
in everyday life at school and home.(Goyen & Lui, n.d.)

Follow-up data were collected into the NRNJ database from registered infants assessed at 18–24
months of corrected age and 3 years of chronological age . Neurodevelopmental outcomes
evaluated in follow-up included neurological, neurosensory, and cognitive impairments. These
impairments have a major long-term impact on children and their families and require long-term
support and interventions . Parents need to be provided with information about long-term
impairments that their child may develop.(Kono, 2020)

One of the theoretical approaches particularly relevant for studying child development is the
embodied cognition approach, which proposes a framework in which motor and cognitive
development are strongly linked. This framework is in many ways rooted in the ecological
psychology approach to perception and action. According to this approach, children develop
cognitive skills through an ongoing interaction with their environment. As children (physically)
explore their environment they learn about the affordances in their environment. The affordances
are possibilities for action which are dependent on both the characteristics of the child (e.g., arm
length, reaching skill, postural control skills) and on the characteristics of the (objects in) the
environment(Oudgenoeg-Paz et al., 2017)

The results of the present study showed that a considerable number of children with birth weight
<1,500 grams have died, and that, among the survivors who were located, 15.2% developed

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severe sequelae. Furthermore, among children who had no major sequelae, there was a higher
frequency of motor coordination and attention problems. These results are consistent with
national and international studies that show worse motor and cognitive performance in children
born preterm and with low birth weight(Oliveira et al., 2011)

Low birth weight (LBW) is one of the risk factors for child morbidity and mortality.1 Birth
weight is an important indicator of a child’s vulnerability to the risk of childhood illnesses and
the chances of survival. Children whose birth weight is less than 2.5 kg, are considered to have
higher risk of early childhood death.2 The public health significance of LBW may be ascribed to
numerous factors and its high incidence such as increased risk of perinatal and infant mortality,
morbidity and disabilities, its association with mental retardation, etc. Worldwide, the magnitude
of LBW problems varies widely from country to country. It is estimated that worldwide 15.5%
of all live births per year are LBW.3 In India, about 30- 35% babies are LBW(Pal et al., 2019)

The final phase of the “Pune Low Birth Weight Study”,showed that infants weighing less than
2kg have been assessed at 18 years. Study followed up 80% of the original cohort of LBW
infants. The LBW cohort and NBW controls were similar in their socio-demographic
characteristics. The study assessed the verbal and performance IQ separately at 12 years by
Weschler’s Intelligence Scale. Hence at 18 years, we used the Raven’s Progressive Matrices,
which is a performance test. The LBW children had lower IQs compared to controls. Similar
findings are reported in a meta-analysis of cognitive outcome in VLBW infants . The lowest IQ
in our study was seen in the preterm SGA children, who had a double biologic jeopardy of
prematurity and intrauterine growth restriction. Males from the study group had lower IQ
compared to male controls.(Chaudhari et al., 2013)

Justification

Very little attention has been paid to the outcome of moderately low birth weight (LBW) infants.
Though a small percentage of these children develop cerebral palsy or mental retardation, long
term follow up studies have shown mild problems in cognition, adjustment and behavior [3] in
early adolescence. These problems continue into adulthood. Adverse socio-demographic factors
affect the outcome and appear to have far greater impact on cognition, than biological
factors(Chaudhari et al., 2013)

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Low birth weight (LBW) children are prone to abnormal neurological signs in tone, coordination
and reflexes, due to neonatal complications which lead to development of motor deficits and
delays.(Pal et al., 2019)

LBW babies are at an increased risk of developing learning, physical and sensory disabilities
(hearing and visual impairments) that will present major challenges to them as developing
children and adolescents in terms of their education and quality of life5 . LBW babies have a
greater chance of serious developmental problems, e.g. learning disabilities and mental
retardation.5 Recent studies have shown that LBW infants are prone to abnormal neurological
signs in tone, coordination and reflexes, due to neonatal complications which lead to the
development of motor deficits and delays(Pal et al., 2019)

Infants born with Low Birth Weight have poorer neuro-developmental outcomes compared to
their counterparts with appropriate weight. Study reported that sepsis in very low birth weight
infants was associated with a worse neuro-developmental outcome and higher incidence of
cerebral palsy. Study revealed that extremely LBW twins had a higher risk of neuro-
developmental handicap. In another study findings shows that higher order extremely low birth
weight births. were associated with an increased risk of death or neuro-developmental
impairment. Hence, concise assessments and follow up of these children is of utmost importance
in enabling early interventions and prevention of subsequent abnormal outcomes. Unfortunately,
although several studies have been conducted to evaluate and examine the developmental
outcomes of LBW infants and motor performance of LBW infants elsewhere, sufficient numbers
of studies have not been conducted in this regard. The aim of the present study was to compare
the motor function of school-age children with normal birth weight (NBW) and children with
LBW.

Aim

This dissertation aims to critically review current evidence contributing to the Cognitive and
Motor Development of Children born with low birth weight

Objectives
1. To critically analyse current literature on Cognitive and Motor Development of Children born
with low birth weight

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2. To draw conclusions from the findings of the eligible studies to enable review study

3. To interpret the findings of the chosen studies, put these into context, and present them in the
form of a summary and conclusion.

Research Question

The research question of this study is how low birth weight baby impacts on Cognitive and
motor development

Review

Most nurses, pre- and post-qualification, will be required to undertake a literature review at some
point, either as part of a course of study, as a key step in the research process, or as part of
clinical practice development or policy. For student nurses and novice researchers it is often seen
as a difficult undertaking. It demands a complex range of skills, such as learning how to define
topics for exploration, acquiring skills of literature searching and retrieval, developing the ability
to analyse and synthesize data as well as becoming adept at writing and reporting, often within a
limited time scale.(Cronin et al., 2008)

However, the main purpose of a thorough literature search is to formulate a research question by
evaluating the available literature with an eye on gaps still amenable to further research. The
authors sought to populate an evidence base of supporting studies that contribute to existing
search practice. Studies were first identified by the authors from their knowledge on this topic
area and, subsequently, through systematic citation chasing key studies with the help of the
search terms. Having determined the key stages to literature searching, we then read and re-read
the sections relating to literature searching again, extracting specific detail relating to the
methodological process of literature searching within each key stage

Overview of low birth weight baby

Birthweight data were not available for 27.1 per cent of newborns in 2020. These estimates
reflect newborns who were unweighed and those who were weighed but whose birthweights
were not captured by key data sources. Estimates of newborns without birthweight data from
administrative systems (e.g., Health Management Information Systems) include unweighed

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births and weighed births not recorded in the system. Estimates from household surveys include
births where weight was not available from an official document (e.g., health card) or could not
be recalled by the respondent at the time of interview..Of the 20.5 million low birthweight babies
born in 2015, nearly half were born in South Asia.(Low Birthweight - UNICEF DATA, n.d.)

Overview of Cognitive and Motor Development of Children

Early childhood development (ECD) has been identified in the international community’s
Sustainable Development Goals as a critical outcome area; in South Asia, 89 million children
under age 5 are still at risk of not reaching their developmental potential. Early childhood
development service provision in the region appears fragmented, and the presence of multiple
government stakeholders with various responsibilities for education, health, children, and youth
complicates both the policy and the implementation landscape. Nutrition and health concerns
include biological risk factors such as prenatal and postnatal growth, nutrient deficiencies,
infectious diseases, and environmental toxins; and psychosocial risks such as parenting factors,
maternal depression, exposure to violence, and poverty. Inequalities by social group in the
development of children’s cognitive skills constitute a serious concern in South Asia.(Béteille et
al., 2020)

Risk Factors

The low birth weight (LBW) is considered as sensitive index of nation’s health and development.
Almost a third of the newborn in the South East Asia region is low birth weight. Over three-
quarters of newborn deaths in Nepal occur in low birth weight babies. The causes of low birth
weight are multi-factorial and birth weight is determined by the interaction of both socio-
demographic and biological factors.(Bansal et al., 2019)

Low birth weight is a preventable public health problem. It is an important determinant of child
survival and development, as well as long-term consequences like the onset of non-
communicable disease in the life course. A large number of mortality and morbidity can be
prevented by addressing the factors associated with low birth weight.(Anil et al., 2020)

Prevalence
Birth weight is generally used as an indicator of a newborn’s wellbeing, and as an indirect

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measure of the intrauterine environment and the nutritional status of the mother during
pregnancy. In developing regions with lower socioeconomic status and poorer nutrition, babies
are lighter and more frequently have adverse birth outcomes compared to developed regions [1].
South Asia has the highest incidence of low birth weight (LBW, <2500 g) in the world (21-28%)
[2] and one of the highest perinatal mortality rates [1]. Despite higher socioeconomic status and
better nutrition, immigrant South Asian babies born in developed countries also tend to be
lighter, shorter, and leaner at birth, and have a higher prevalence of LBW than their native
counterparts [3–5]. However, there is increasing evidence that the lower birth weight and high
rates of LBW and small-for-gestational-age (SGA, birth weight <10th percentile for gestational
age) in these populations are not expressions of fetal growth restriction, but are rather
physiological or constitutional in origin(De Wilde et al., 2013)

Impact

Low birthweight (LBW: <2500 g), of infants small-for-gestational-age (SGA) or preterm,

increases the risks of neonatal mortality [1, 2] and infant mortality [3], poor cognitive
development [4], stunting [5], and lifelong susceptibility to non-communicable diseases [6, 7].
LBW remains a major public health problem in low-income settings, particularly in South Asia
[8] and the WHO has set a target to reduce LBW by 30% by 2025 [9]. The urgency of addressing
intergenerational undernutrition by intervening prenatally or during pregnancy to decrease SGA
and stunting at birth is acknowledged [5, 8, 10], but our understanding of effective means of
doing so is limited. Renewed WHO interest in low birth weight as an indicator for tracking
country health [9] means use of birthweight as an outcome (as opposed to preterm and SGA) is
of particular importance.(Saville et al., 2018)

Low Birth Weight - Relation to Gestation and Intrauterine Growth

The general consensus is that in developing countries, particularly in South Asia, an

overwhelming majority of LBW infants have adequate gestation (are term) but are growth
retarded (IUGR) (15, 16). It would be of interest to examine some pertinent data from the region
in this context. The recent multicentric data from India (3) on over 37,000 live births reveals that
one-third (32.8%) of LBW babies are born preterm; a proportion which certainly can not be
totally ignored. An earlier analysis of hospital and community births in Delhi (India) had

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revealed that in the birth weight group of 1501-2000 g, 30-45% were preterm, while the
corresponding figure 13-15% in the 2001-2500 g category (17). In the NNF study the prevalence
of babies with birth weight (Gogia & Sachdev, 2016)

Public health intervention for LBW

Although there is no specifically instituted program for control of LBW in India, Bangladesh and
Pakistan, majority of the suggested public health interventions are being addressed through the
ongoing programs for population control, maternal and child health, nutrition and literacy. In
India, the important relevant programs include the Reproductive and Child Health Program
(Child Survival and Safe Motherhood Program) focussing on providing access to antenatal care
and family planning including delaying pregnancy in adolescents; the Integrated Child
Development Services Program where apart from new initiatives focussed on adolescent girls,
pregnant mothers are given a nutritional supplement of 500 kcal; and Literacy Mission

In Bangladesh also, the nation wide Maternal Child Health Program has provision for antenatal
care and family planning whereas the recently instituted Bangladesh Integrated Nutrition Project
(BINP) focuses on family planning advice to newly wed couples and nutrition education and
supplementary nutrition (600 kcal) to pregnant women. The BINP, a World Bank assisted
project, currently covers only 6 thanas (sub districts) and will be extended to 40 thanas (out of
460) by the end of 1998 and the entire country by 2000 AD. In addition, NGOs like Bangladesh
Rural Advancement Committee also provide supplementation and counseling to pregnant women
in their operational areas .

in Pakistan the maternal care programs, population planning initiatives and nutritional
supplementation in pregnancy (part of safe motherhood initiative) have components addressing
the problem of LBW .(Gogia & Sachdev, 2016)

Prevention

Currently, prematurity is the leading cause of death among children under five around the
world, and a leading cause of disability and ill health later in life. Sub-Saharan Africa and
south Asia account for over 60 percent of preterm births worldwide. Of the fifteen million
babies born too early each year, more than one million die due to complications related to
preterm birth. Low birth weight (newborns weighing less than 2,500 grams at birth), due to

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prematurity and/or restricted growth in utero, is also a major contributor of newborn and
child deaths, as well as disability and non-communicable diseases globally.

This national level profile provides the most current national-level information on the
status of prevention and care for preterm birth and low birth weight in India. Data
presented highlight a number of risk factors relevant to preterm and low birth weight in
India as well as the coverage of important care for women and newborns from pregnancy,
labor and delivery and the postnatal period. There is also information that provides
insights into the health workforce, health policies, health information and community
mobilization relevant to preterm birth and low birth weight.(India: Profile of Preterm and
Low Birth Weight Prevention and Care - India | ReliefWeb, n.d.)

Methodology

Data gathering is a vital element of systematic reviews since it lays the groundwork for the
conclusions made. This entails ensuring sure data is dependable, accurate, complete, and readily
accessible. Once the review questions have been set, modifications to the protocol should be
allowed only if alternative ways of defining the populations, interventions, outcomes or study
designs become apparent. Multiple resources (both computerized and printed) were searched
without language restrictions. Furthermore, various internet engines were searched for web pages
that might provide references The study selection criteria flowed directly from the review
questions and be specified a priori. Reasons for inclusion and exclusion were recorded. Selected
studies were subjected to a more refined quality assessment by use of general critical appraisal
guides. These detailed quality assessments were used for exploring heterogeneity and informing
decisions regarding suitability of meta-analysis

A comprehensive technique was developed for this assessment in order to determine the
appropriate sample group (see table below). The criteria for evaluating the literature were
developed with P.I.C.O. in mind. This demonstrated that the study question had been addressed
and that publications with an adequate design had been chosen.(David, 2003)

Due to the fact that this research will be examining the efficacy of an intervention, both RCTs
and uncontrolled clinical trials were judged suitable. (Pati & Lorusso, 2018) emphasise though
that the inclusion and technology used to prevent bias in a literature search may add bias,

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detailed documentation of the inclusion and criteria for inclusion may assist generate trust and
credibility. Researchers must justify the exclusion of certain sources from analysis, but concede
that in certain circumstances, determining why certain publications were excluded might be
challenging.

A clinical question needs to be directly relevant to the patient or problem at hand and phrased in
such a way as to facilitate the search for an answer. PICO makes this process easier. It is a
mnemonic for the important parts of a well-built clinical question. It also helps formulate the
search strategy by identifying the key concepts that need to be in the article that can answer the
question[14]

Criteria for PICO

Participants Children born with Low birth Weight

Intervention NA
Comparison/Control Factors for Cognitive and motor development of children
Outcome Cognitive and motor development of children

Data Collection Strategies

Three databases were chosen and utilised throughout the data collection method for this
investigation. PubMed, CINAHL, and also the Cochrane library were consulted. To avoid
oversaturation of the data, keywords were searched and Logical operators were used inside the
search. (Pati & Lorusso, 2018) demonstrate that depending on how a search is conducted,
purposeful or accidental bias may be evident. As a result, it is vital to prove that a thorough,
extensive, and broad search was conducted.

Keywords used as per MeSH: Cognitive, Motor development, Children, Low birth weight (
LBW)

Inclusion/exclusion criteria.

Researchers more than 10 years old to make the search results fair (Lipscomb M. Nursing
literature reviews : a reflection. ) stated that the goal of nurses examining books is to improve

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service. Because nurses are required to practise evidence-based medicine, they must have access
to the most recent research. He does admit, though, that arbitrarily defining time periods may be
counterproductive, since some older content may be just as significant or useful as new
information. Articles were eliminated that have not been originally published in English due to
the probability of linguistic prejudice as a consequence of the authors' limited expertise and the
chance of an incorrect translation (Jüni, P., Holenstein, F., Sterne, J., Bartlett, C., & Egger, M.
(2002)However, they claim that although this technique has minimal effect on overall results,
they acknowledge that studies conducted in French are more prone to be noted by other writers
and to be printed several times. I started by doing a basic Boolean search for relevant terms and
then filtering them using different filters depending on my inclusion criteria (See table below).
This limited my query to 202 CINAHL records, 143 Medline records, and 59 PubMed records.

A PRISMA flow diagram was framed. Numerous things were deleted due to their insignificance
to the study's subject. Duplicates were removed and studied the abstracts of each article.
Additionally, papers were excluded that did not include meta - analytic review, leaving a total of
eight publications that fit the inclusion criteria for this systematic review.

21 studies that we recognised as potentially helpful but later eliminated are included, along with
their respective reasons for exclusion.

Inclusion Criteria Exclusion Criteria

Children born with Low birth Weight Children born with Low birth Weight having
comorbid conditions and serious
complication other than cognitive and motor
related matters
Articles written in English Articles published more than 10 years ago

Articles Free to access Paid articles

Peer reviewed articles Non Peer reviewed articles

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PRISMA FLOWCHART

405 Records identified

through data base search

369 Irrelevant Records

excluded

15 Records excluded based on title

and Duplicate papers

21 full text articles 14 full text articles

assessed for eligibility excluded with reasons

8 full text articles studied

Results

finished compositions will be subjected to critiques and analysis. Eight studies are included in
the The study. The use of a conceptual framework (The C.A.S.P. tool, 2018) enabled the
assessment of the overall and understanding of the literature. The table below summarises each
article.

Author study design Sample Countr Factor Key findings

and Year size/study y
popution
(Upadhya A systematic 19 articles of South Cognitive Children born LBW especially with
y et al., Review south Asia Asia and motor < 2000g birth weight, have
2019) scores substantial cognitive and motor

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among impairment compared to children

LBW and with NBW . Early child
NBW development interventions should
emphasis to children born LBW.
Amrita Cross Children India Growth and Developmental delay is associated
Singh. sectional Under two developmen with underweight stunting and
2017 Studies years of age tal delay wasting among children
from assessed
Urbanized
Village-210
(Christian Prospective Children 7-9 Nepal Neuro Intrauterine growth restrictions is
et al., follow up years of age – cognitive high and may have a negative
2014) 1927 assessment impact on long term cognitive ,
executive and motor function
(Chattop Observationa Special India Neurodevel Incidence of NDD among high risk
adhyay & l Cohort neonatal care pomental new-borns is significantly high with
Mitra, studies unit graduate screening LBW, Prematurity and neonatal
2015) - 427 illnesses are major contributors.
Most NDD go undetected in the
early years of life.
(Shim et Population Very Low Korea Risk factor In Very Low birth weight Infants
al., 2021) based Sudy birth weight for with late inset sepsis, there is a
infants born neurodevelo heightened risk of cognitive delays
at 23- 32 pmental at 18-24 months of corrected age.
weeks of delay Brain injury such as severe IVH and
gestation – PVI, duration of mechanical
2098 ventilation and IUGR, were also
associated with cognitive and motor
selays.
(Kono, Follow up infants (birth Japan physical children born with a VLBW
2020) Studies weight and remained at high risk of NDI in

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≤1,500 g) at comprehens early childhood. It is important to

3 years of age ive establish a network followup
neurodevelo protocol and complete assessments
pmental with fewer dropouts to enable
assessments clarification of the outcomes of
registered infants.
(Avan, 2014) Cross children less Pakista Delayed The relationship between low birth
sectional than 3 years n psychomoto weight and psychomotor
Study of age, 1234 r development appears to be mediated
developmen largely by postnatal growth and
t of children nutritional status. This association
suggests that among undernourished
children there is significant
likelihood of a group that is
developmentally delayed. It is
important to emphasize
developmental needs in programmes
that target underprivileged children.
(Kvestad, 2017 Prospective Infant aged Nepal Coginitve Vitamin B-12 status in infancy is
) follow up 2-12 months function associated with development and
enrolled and and performance on social perception
followed up developmen tasks and visuospatial abilities at 5 y
till five tal of age. The long-term effects of poor
years- 320 neuropsych vitamin B-12 status in infancy need
ological further investigation in randomized
assessemnt controlled trials.
Fig 1:Flowchart presenting the selection of articles for the study

Eight studies were analysed.

South Asia contributes substantially to global low birth weight population (i.e. those with birth
weight < 2500 g). Synthesized evidence is lacking on magnitude of cognitive and motor deficits

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in low birth weight (LBW) children compared to those with normal birth weight (NBW) (i.e.
birth weight ≥ 2500 g). The meta-analysis aimed to generate this essential evidence. Literature
search was performed using PubMed and Google Scholar. Original research articles from south
Asia that compared cognitive and/or motor scores among LBW and NBW individuals were
included. Weighted mean differences (WMD) and pooled relative risks (RR) were calculated. All
analyses were done using STATA 14 software. Nineteen articles (n = 5999) were included in the
analysis. Children < 10 years of age born LBW had lower cognitive (WMD -4.56; 95% CI: -
6.38, − 2.74) and motor scores (WMD -4.16; 95% CI: -5.42, − 2.89) compared to children with
NBW. Within LBW children, those with birth weight < 2000 g had much lower cognitive (WMD
-7.23, 95% CI; − 9.20, − 5.26) and motor scores (WMD -6.45, 95% CI; − 9.64, − 3.27). In south
Asia, children born LBW, especially with < 2000 g birth weight, have substantial cognitive and
motor impairment compared to children with NBW. Early child development interventions
should lay emphasis to children born LBW(Upadhyay et al., 2019)

Development is the process by which each child evolves from helpless infancy to independent
adulthood Developmental delay if detected during early years of life can be prevented from
causing further damage. A community based cross sectional study was conducted in Aliganj,
urban field practice area of Vardhmann Mahavir Medical College, Delhi. A pretested, semi used
for data collection, growth was assessed using WHO growth charts and Developmental delay
was assessed by Ages and Stages Questionnaire, 3rd edition (ASQ analysis was done in SPSS.
Out of 210 children studied, 50 (23.8%) children were underweight, 46 (21.9%) were stunted and
37 (17.6%) children were wasted and 10 (4.8%) had developmental delay. Illiterate father (p
value 0.012), low birth weight child (p value= 0.001), place of delivery ( p v underweight (p
value =0.001), stunting ( p value =0.003) and wasting (0.003) were found to be significantly
associated with developmental delay.
Conclusion: Developmental delay is associated with underweight stunting and wasting among
children(Amrita Singh. 2017)

The long term consequences of low birth weight (LBW), preterm birth, small-for-gestational age
(SGA, defined as birth weight for given gestational age less than the 10th percentile of the
reference), and early newborn morbidity on functional outcomes are not well described in low
income settings. In rural Nepal, we conducted neurocognitive assessment of children (n = 1927)

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at 7-9 y of age, for whom birth condition exposures were available. At follow-up they were
tested on aspects of intellectual, executive, and motor function. The prevalence of LBW (39.6%),
preterm birth (21.2%), and SGA (55.4%) was high, whereas symptoms of birth asphyxia and
sepsis were reported in 6.7% and 9.1% of children. In multivariable regression analyses, adjusted
for confounders, LBW was strongly associated with scores on the Universal Nonverbal
Intelligence Test (UNIT), tests of executive function, and the Movement Assessment Battery for
Children (MABC). Preterm was not associated with any of the test scores. Conversely, SGA was
significantly (all p < 0.005) associated with lower UNIT scores (-2.04 SE = 0.39); higher
proportion failure on Stroop test (0.06, SE = 0.02); and lower scores on the backward digit span
test (-0.16, SE = 0.04), MABC (0.98, SE = 0.25), and finger tapping test (-0.66, SE = 0.22) after
adjusting for confounders. Head circumference at birth was strongly and significantly associated
with all test scores. Neither birth asphyxia nor sepsis symptoms were significantly associated
with scores on cognitive or motor tests. In this rural South Asian setting, intrauterine growth
restriction is high and, may have a negative impact on long term cognitive, executive and motor
function.(Christian et al., 2014)

High risk newborns are most vulnerable to develop neuro-developmental delay (NDD). Early
detection of delay in this group and identification of associated perinatal factors and their
prevention can prevent disability in later life. Observational cohort study. Field based tracking
and neuro-developmental screening of high risk newborns discharged between January 2010 to
June 2012 from a district Hospital in India was conducted by a team of developmental
specialists, using standardized tools like Denver Developmental Screening Tool II, Trivandrum
Developmental Screening Chart and Amiel-Tison method of tone assessment. Associated
perinatal factors were identified. Early intervention was initiated on those detected with NDD.
Developmental delay was detected in 31.6% of study population. Prevalence of NDD was
significantly higher in low birth weight (LBW, >2 kg), preterm (<36 weeks) and twins. Neonatal
sepsis/meningitis and convulsions also showed significant association with NDD. Of the 134
with developmental delay, 61 were preterm, 80 LBW, with h/o sepsis in 52, convulsion in 14,
birth asphyxia in 39 and jaundice in 14 neonates. Incidence of NDD among high risk newborns
is significantly high with LBW, prematurity and neonatal illnesses are major contributors. Most
NDDs go undetected in the early years of life. Improved perinatal care, early detection and early

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intervention at the grass root level will bring down incidence of developmental challenges in this
vulnerable group. (Chattopadhyay & Mitra, 2015)

Preterm infants are prone to sepsis owing to their immature innate immunity and prolonged
hospitalization. We aimed to evaluate the association between late-onset sepsis (LOS) during
hospitalization and neurodevelopmental delay at 18-24 months of corrected age in very low birth
weight infants (VLBWIs), and to ascertain this association when adjusted for perinatal risk
factors. This is a population-based study of VLBWIs born at 23-32 weeks of gestation between
January 2014 and December 2017 who were enrolled in the Korean Neonatal Network. Bayley
scales of infant development were evaluated at 18-24 months of corrected age in 2,098 infants.
To test for LOS as a risk factor for neurodevelopmental delay, multiple logistic regression was
used and adjusted for parental education status and clinical variables. Blood culture positive LOS
was identified in 419 (20.0%) infants. Cognitive and motor delays were found in 392 (18.7%)
and 347 (16.5%) infants, respectively. When multivariate analysis was performed, LOS had a
significant association with cognitive delay (odds ratio, 1.48; 95% confidence interval, 1.02-
2.16), but no association with motor delay in VLBWIs. Both delays were significantly more
frequent in cases of intraventricular hemorrhage (IVH) ≥ grade 3, periventricular leukomalacia
(PVL), and intrauterine growth restriction (IUGR) and duration of mechanical ventilation. Male
sex and necrotizing enterocolitis ≥ grade 2 had an effect on motor delay, whereas paternal
college graduation affected cognitive delay. In VLBWIs with LOS, there is a heightened risk of
cognitive delays at 18-24 months of corrected age. Brain injury, such as severe IVH and PVL,
duration of mechanical ventilation, and IUGR, were also associated with cognitive and motor
delays. (Shim et al., 2021)

The neurodevelopmental outcomes of very low birth weight (VLBW) infants (birth weight
≤1,500 g) at 3 years of age in the Neonatal Research Network of Japan (NRNJ) database in the
past decade and review the methodological issues identified in follow-up studies. The follow-up
protocol for children at 3 years of chronological age in the NRNJ consists of physical and
comprehensive neurodevelopmental assessments in each participating center.
Neurodevelopmental impairment (NDI)-moderate to severe neurological disability-is defined as
cerebral palsy (CP) with a Gross Motor Function Classification System score ≥2, visual
impairment such as uni- or bilateral blindness, hearing impairment requiring hearing

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amplification, or cognitive impairment with a developmental quotient (DQ) of Kyoto Scale of

Psychological Development score <70 or judgment as delayed by pediatricians. We used death
or NDI as an unfavorable outcome in all study subjects and NDI in survivors using number of
assessed infants as the denominator. Follow-up data were collected from 49% of survivors in the
database. Infants with follow-up data had lower birth weights and were of younger gestational
age than those without followup data. Mortality rates of 40,728 VLBW infants born between
2003 and 2012 were 8.2% before discharge and 0.7% after discharge. The impairment rates in
the assessed infants were 7.1% for CP, 1.8% for blindness, 0.9% for hearing impairment, 15.9%
for a DQ <70, and 19.1% for NDI. The mortality or NDI rate in all study subjects, including
infants without followup data, was 17.4%, while that in the subjects with outcome data was
32.5%. The NRNJ follow-up study results suggested that children born with a VLBW remained
at high risk of NDI in early childhood. It is important to establish a network followup protocol
and complete assessments with fewer dropouts to enable clarification of the outcomes of
registered infants.(Kono, 2020)

Low birth weight is known to be associated with postnatal growth failure. It is not yet established
that both conditions are determinants of psychomotor development. The study investigated
whether or not low birth weight leads to delayed psychomotor development of a child, and
whether it can be mitigated by adequate postnatal growth. A cross-sectional study was conducted
in 2002 in 15 rural and 11 urban communities of Sindh province, Pakistan. Assessment of 1234
children less than 3 years of age included Bayley's Scale of Infant Development II,
socioeconomic questionnaire and anthropometry; WHO standards were used to calculate z-
scores of height-for-age, weight-for-height and weight-for-age. The underlying study hypotheses
were tested through multiple regression modelling. Out of 1219 children, 283 (23.2%) had
delayed psychomotor development and 639 (52.4%) were undernourished according to the
composite index of anthropometric failure. Strong negative associations with the psychomotor
development index were detected between stunting and being underweight, with a larger
magnitude of effect for stunting (p<0.001). The strong relationship persisted even when the
analysis was restricted to non-malnourished children. The psychomotor index increased by 2.07
points with every unit increase in height-for-age z-score. The relationship between low birth
weight and psychomotor development appears to be mediated largely by postnatal growth and

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nutritional status. This association suggests that among undernourished children there is
significant likelihood of a group that is developmentally delayed. It is important to emphasize
developmental needs in programmes that target underprivileged children. (Avan , 2014)

Poor vitamin B-12 (cobalamin) status is widespread in South Asia. Insufficient vitamin B-12
status has been linked to poor neurodevelopment in young children.Measured the associations
between vitamin B-12 status in infancy (2-12 mo) and the development and cognitive
functioning in Nepalese children 5 y later. Vitamin B-12 status was assessed in infancy with the
use of plasma cobalamin, total homocysteine (tHcy), and methylmalonic acid (MMA). At 5 y of
age, we measured development with the use of the Ages and Stages Questionnaire, 3rd edition
(ASQ-3), and cognitive functioning by using the Developmental Neuropsychological
Assessment, 2nd edition (NEPSY II), in 320 children. In regression models, we estimated the
associations between vitamin B-12 status, including a combined indicator of vitamin B-12 status
(3cB12) and scores on the ASQ-3 and NEPSY II subtests All markers of vitamin B-12 status
with the exception of plasma cobalamin were significantly associated with the total ASQ-3
scores in the multiple regression models. A 1-unit increase in the 3cB12 score was associated
with an increase in the total ASQ-3 score of 4.88 (95% CI: 2.09, 7.68; P = 0.001). Increases in
both plasma tHcy and MMA (indicating poorer status) were associated with a decrease in scores
on the NEPSY II affect recognition and geometric puzzle subtests. Each unit increment in 3cB12
scores was associated with increases of 0.82 (95% CI: 0.49, 1.14; P < 0.0005), 0.59 (95% CI:
0.10, 1.09; P = 0.020), and 0.24 (95% CI: 0.02, 0.47; P = 0.035) in the affect recognition,
geometric puzzle, and block construction scores, respectively. Vitamin B-12 status in infancy is
associated with development and performance on social perception tasks and visuospatial
abilities at 5 y of age. The long-term effects of poor vitamin B-12 status in infancy need further
investigation in randomized controlled trials. (Kvestad, 2017 )

Discussion

Present study identified eight appropriate studies as per theobjectives and inclusion and
exclusion criteria of the study and revealed that there is noteworthy deficit in cognitive and
motor development in children with low birth weight babies

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Numbers and incidences (%) of infants with death or NDI were 60 (80%) at 22 weeks and 156
(64%) at 23 weeks. In logistic regression analysis, gestational ages of 22 weeks (odds ratio [OR]:
5.40; 95% confidence interval [CI]: 2.48-11.76) and 23 weeks (OR: 2.14; 95% CI: 1.38-3.32)
were associated with increased risk of death or NDI compared with 24 weeks, but a gestational
age of 25 weeks (OR: 0.65; 95% CI: 0.45-0.95) was associated with decreased risk of death or
NDI. In the systematic review, the medians (range) of the incidence of death or NDI in 8 cohorts
were 99% (90%-100%) at 22 weeks and 98% (67%-100%) at 23 weeks.(Ishii et al., 2013)

Limitations

The purpose of this dissertation aims to critically review current evidence contributing to the
cognitive and motor development of Children born with low birth weight The search technique
made use of databases to track for relevant stuff. This was done via the use of keyword
combinations and Boolean operators. Although the study's goals specified that official statistics
would be included, it was not done due to time constraints, and so broad evidence selection bias
may exist. According to (AM et al., 2016), here is where certain research may be overlooked and
all accessible data may be overlooked. While doing a literature search for this research, it
became clear that there was substantially more data accessible in addition to other factors.
Moreover, the selected studies in this review are subject to volunteer bias, where participants
who actively decide to participate in the research may systematically differ from the general
population. This review included cross sectional, prospective study designs and was carried out ,
due to the heterogeneity in both the factors and outcome measures, as well as the difference in
populations and settings. Thus, the results should be interpreted with extreme caution . The
results of this study can be used as an initial motivation and guide for future studies and
contributing to the cognitive and motor development of Children born with low birth weight.

Conclusion

The study reviews concluded that there is momentous deficit in cognitive and motor
development of children born with low birth weight compared to those children who born with
normal birth weight. Application of these recommendations would produce more reliable and
comparable studies.

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