Research%20project%20The%20factors%20affected%20to%200-2%20years%20old%20child%20development%20in%20Naresuan%20University%20Hospital

1
Research projectThe factors affected to 0-2
years old child development in Naresuan
University Hospital

• Advisors
• Assistant Professor Dortor Jiranun Weerakul
• Dortor Suwit Lertkajornsin
• Researchers
• Kongpob Pongtanee 51460742
• Pikom Sirisopausa 51460933
• 5th year medical student of Naresuan University

2
Researchable question

• Primary question
• Is delayed development of children associated
  with perinatal period factor?
• Secondary question
• Is breast feeding associated with delayed
  development of children?

3
Researchable question

• P (Patient or Problem)
• Children with delayed development
• I (Intervention or Exposure)
• Complication of children in peronatal period
• C (Comparison intervention)
• Normal newborn and newborn with complication in
  perinatal period
• O (Outcome)
• Delayed developmental children

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Basic of knowledge

• Definition
• Child development examintion (Denver II and
  Public health department 49)
• Factors associated with delayed development

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Definition

• Infancy child with aged 0-2 years old
• Development The process of starting to
  experience of more function efficiently
• Birthweight the weight of baby at birth
  (2,500-4,000 g)
• Low birth weight - lt2,500 g
• Very low birth weight - lt1,500 g
• Extremely low birth weight - lt1,000 g

Thomas D Matte, senior epidemiologist, Michaeline
Bresnahan, assistant professor, Melissa D
Begg, associate professor, and Ezra Susser,
professor. Influence of variation in birth weight
within normal range and within sibships on IQ at
age 7 years cohort study. BMJ. 2001 August
11 323(7308) 310314.
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Definition

• APGAR score Evaluation is generally based upon
  the assignment of an Apgar score at one and five
  minutes of age. The following signs are given
  values of 0, 1, or 2 and added to compute the
  Apgar score.(Apgar scores of 7 to 10, and
  generally require no further intervention, 4-6
  some resuscitative measure, lt3 requires immediate
  resuscitation)

Christine E. F. Delgado, Sara J. Vagi  Keith G.
Scott. Identification of Early Risk Factors for
Developmental Delay. Exceptionality volume
15, Issue 2, 2007, pages 119-136
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Definition

• Gestational age - normal range 38 to 42 weeks
  (from LMP or Ballard scale)
• Maternal age 20-35 years old
• Exclusive breastfeedingl breastfeeding 6 months

MedicinePlus http//www.nlm.nih.gov/medlineplu
s/ency/article/002367.htm ??????? ??????????,
???????? ???????????????. ????????????????????????
lWHO http//www.who.int/nutrition/topics/exclus
ive_breastfeeding/en/
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Child development

• Denver II or Denver Development Screening Test
  (DDST)
• Used for basic evaluate development of childen
  who aged 2 month-6years.
• Evaluated in 4 parameters (125 Items)
• Personal Social
• Fine Motor Adaptive
• Gross Motor
• Language

From http//hpe4.anamai.moph.go.th/hpe/mch/anama
i49.php
9
Child development

• Public health department 49 examination
• Used for child developmental screening, devided
  in to 15 span of age from birth to 72 months.
• Evaluated in 4 parameters(48 Items)
• Social 
• Language 
• Fine Motors 
• Gross Motors

From http//hpe4.anamai.moph.go.th/hpe/mch/anama
i49.php
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Child development

• From the development research of Thai children
  showed Thai children had language problem more
  than gross motor problem. We have reduce the
  number of items of gross motor for limited the
  number of item to evaluated.

From http//hpe4.anamai.moph.go.th/hpe/mch/anama
i49.php
11
Factors associated with delayed development

• Lack of chance to support thier development such
  as commuinty support or encourage their learning
• Health care process of mother and children
• Individual factors

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Research content

• Chapter 1 Introduction
• Chapter 2 Literature review
• Chapter 3 Methodology
• Chapter 4 Result
• Chapter 5 Discussion
• References
• Appendices

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Chapter 1 Introduction

• From developmental children survey of Department
  of Health of Thailand in 2008 found that children
  1-5 years old had number of normal development
  67.7, which decrease from 2005 (72) and 1999
  (71).
• It means that Thai children about million per
  year have delayed development, especially speech
  development.
• As above this is the major problem and affect to
  their future, such as poor healthy, learning
  problem, etc.

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Chapter 1 Introduction

• Children have the highest development at 0-2
  years old.
• Their brain growth more than 80 when compare
  with brain adult.
• If childrens development were interrupted by any
  factors, it will be major effect to their future.
  

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Chapter 1 Introduction

• Objective
• To study the perinatal period's factors
  associated with delay development in children.
•  Scope
• Population
• Children in Naresuan University Hospital(NUH)
  between 2009-2011
• Research period
• 5th 26th January 2012

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Chapter 1 Introduction

• Benefit from the research
• Know the factors associated with delayed
  development in children lt 2 years.
• Useful for mother and health care provider to
  increase awareness of ANC and health care for
  prevent the preterm labor.

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Chapter 2 Literature review

• Chaimay B, Thinkhamrop B, Thinkhamrop J. Risk
  factors associated with language development
  problems in childhooda literature review. J Med
  Assoc Thai. 2006 Jul89(7)1080-6. PubMed
• Found that, risk factors for delayed development
  associated with antenatal care, APGAR scores,
  birth weight, breast feeding, gender, birth
  order, parental education, environmental factors,
  and family history with language developmental
  delays.

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Chapter 2 Literature review

• Christine E. F. Delgado, Sara J. Vagi  Keith G.
  Scott. Identification of Early Risk Factors for
  Developmental Delay. Exceptionality volume
  15, Issue 2, 2007, pages 119-136
• Found that, perinatal child factors (gestational
  age, birth weight, APGAR score, multiple birth,
  newborn condition, congenital abnormality)
  associated with delay development (risk ratio gt
  2)

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Literature review

• Ni TL, Huang CC, Guo NW. Executive function
  deficit in preschool children born very low birth
  weight with normal early development. Early Hum
  Dev. 2011 Feb87(2)137-41. Epub 2010 Dec 30.
  ELSEVIER
• Rieger-Fackeldey E, Blank C, Dinger J,
  Steinmacher J, Bode H, Schulze A. Growth,
  neurological and cognitive development in infants
  with a birthweight lt501 g at age 5 years. Acta
  Paediatr. 2010 Sep99(9)1350-5. doi
  10.1111/j.1651-2227.2010.01762.x. WILEY
• Slining M, Adair LS, Goldman BD, Borja JB,
  Bentley M. Infant overweight is associated with
  delayed motor development. J Pediatr. 2010
  Jul157(1)20-25.e1. Epub 2010 Mar 15. ELSEVIER
• Kosztolányi G. Hypothesis epigenetic effects
  will require a review of the genetics of child
  development. J Community Genet. 2011
  Jun2(2)91-6. Epub 2011 Feb 20. SpringerLink
• Barros AJ, Matijasevich A, Santos IS, Halpern R.
  Child development in a birth cohort effect of
  child stimulation is stronger in less educated
  mothers. Int J Epidemiol. 2010 Feb39(1)285-94.
  Epub 2009 Aug 28. Oxford Journals

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Chapter 3 Material and Methods

• Research question
• Primary question
• Is delayed development of children associated
  with perinatal period factor?
• Secondary question
• Is breast feeding associated with delayed
  development of children?

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Chapter 3 Material and Methods

• Population
• Matching groups by year of birth between case and
  control group
• Subject cases
• Inclusion
• Children with delayed development that follow up
  in NUH during 2009-2011
• Patient who had 0-2 years old
• Mather who was antenatal care (ANC) at NUH
• Exclusion
• Children who had genetic abnormality - such as
  Downs syndrome
• Children who had ANC abnormality such as
  infection during pregnancy

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Chapter 3 Material and Methods

• Control cases
• Inclusion
• Children with normal development that follow up
  in NUH during 2009-2011
• Patient who had 0-2 years old
• Mather who was antenatal care (ANC) at NUH
• Exclusion
• Children who had genetic abnormality - such as
  Downs syndrome
• Children who had ANC abnormality such as
  infection during pregnancy

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Chapter 3 Material and Methods

• Location
• Out Patient Department (OPD) of Pediatrics of NUH
• Medical record department at NUH
• Data source
• Medical records that record child with normal
  development
• Medical records that record child with abnormal
  development
• Study design
• Case control study

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Chapter 3 Material and Methods

• Statistical analysis
• Analyze data by odds ratio and adjusted odds
• Calculation by STATA program

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Chapter 4 Result
Case Control
n Mean n Mean
Gender Male Female 14 4 77.78 22.22 23 31 42.59 57.41
Age (at Dx) lt 1 1-2 gt2 3 15 0
Delay Fine movement Gross movement Language Social 5 5 15 1
Growth Less Appropriate More 2 16 0 11.11 88.89 0 5 44 5 9.26 81.48 9.26
Table 1 Demographics between the subject cases
and the control cases
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Chapter 4 Result
Case Control
n Mean n Mean
Birth weight lt2500 2500-4000 gt4000 7 11 0 38.89 61.11 0 2,676 7 45 2 12.97 83.33 3.7 2,973
Apgar score (at 5 min.) 0-3 4-6 7-10 0 1 17 0 5.56 94.44 9.56 0 0 54 0 0 100 9.87
GA (by U/S) lt38 38-42 gt42 7 11 0 38.89 61.11 0 366 7 47 0 12.96 87.04 0 38
Maternal age lt20 20-35 gt35 5 12 1 27.78 66.66 5.56 26 11 37 6 20.37 68.52 11.11 27.11
Breast feeding lt6 gt6 15 3 83.33 16.67 39 15 72.22 27.78
Table 1 Demographics between the subject cases
and the control cases (con.)
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Table 2 univariate logistic regression
Chapter 4 Result
Variable Odd ratio 95 CI p-value
Male 4.72 1.37-16.22 0.014
Low birthweight 3.18 0.97-10.43 0.056
Preterm 10.55 3.06-36.33 lt0.001
Teenage, elderly pregnancy 1.09 0.35-3.39 0.884
Brest feeding lt 6mo. 1.92 0.49-7.61 0.351
Apgar lt 7 (at 5 min) 0.107 0.00-3.35 0.351
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Table 3 Multi-variate logistic regression
Chapter 4 Result
variable Adjusted OR 95CI p-value
Male 4.39 1.10-17.53 0.036
Low birthweight 2.16 0.31-15.08 0.439
Preterm 15.97 2.53-100.81 0.003
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Chapter 5 Discussion

• From child health record, which collect delayed
  developmental children in NUH from 2009 to 2011,
  found that children with delayed development were
  increased.
• In 2009, 12 numbers of children with delayed
  development
• In 2010, 18 numbers of children with delayed
  development
• This is match with developmental children survey
  of Department of Health of Thailand in 2008

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Chapter 5 Discussion

• We collected 18 patients data from child health
  record in NUH
• We have gotten few subjects because someone loss
  follow up in NUH, someone dose not born or ANC in
  NUH, which were inadequate data from this group.

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Chapter 5 Discussion

• From study found that
• Gender had associated with delay development
  significantly. Related to the previous study of
  Bhunyabhadh Chaimay MPH that showed the male was
  a risk factor for delay development more than the
  female by 41. Those study was similar to our
  research at Odds ratio 4.72

Chaimay B, Thinkhamrop B, Thinkhamrop J. Risk
factors associated with language development
problems in childhood--a literature review. J Med
Assoc Thai. 2006 Jul89(7)1080-6.
37
Chapter 5 Discussion

• The study of gestational age showed the preterm
  has associated with delay development
  significantly. Related to the stury of Luoma et
  al that showed delay language was associated
  with preterm.

Luoma L, Herrgard E, Martikainen A, Ahonen T.
Speech and language development of children born
atltor32 weeks gestation a 5-year prospective
follow-up study. Dev Med Child Neurol 1998
40380-7
38
Chapter 5 Discussion

• Other factors may be associated with delay
  development such as maternal age, breast feeding
  but in our research showed both maternal age and
  breast feeding wasn't associated with delay
  development significantly may be from the less
  population in this research.

39
Chapter 5 Discussion

• From the study by Khonkaen University showed
  newborn with APGAR score lt 3 at 5 minutes was a
  higher risk factor of delay development than
  newborn with APGAR score 7 at 5 minutes by
  double.
• The case in this research had only one child with
  APGAR score lt 7 and the control group hadn't
  child with APGAR score lt 7 at 5 minutes, these
  cause may be deviate in statistic method.
• Because of the children with APGAR score lt 3 at 5
  minute had low survival rate, so we can't collect
  the data for this research.
• So, this research had a different result may be
  cause of the population.

Chaimay B, Thinkhamrop B, Thinkhamrop J. Risk
factors associated with language development
problems in childhood--a literature review. J Med
Assoc Thai. 2006 Jul89(7)1080-6.
40
Chapter 5 Discussion

• Benefit from the research
• Know the factors associated with delayed
  development in children lt 2 years.
• Useful for mother and health care provider to
  increase awareness of ANC and health care for
  prevent the preterm labor.

41
Chapter 5 Discussion

• Problem of the research
• 1. Inadequate population in this research -
  because the retrospective study have many
  confounding factors, so we need more population.
• 2. The limited of case because some children
  wasn't born in NUH, so they hadn't some
  important data for the research.

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Chapter 5 Discussion

• Problem of the research (cont.)
• 3. Other factors associated with delayed
  development such as ANC, Birth order, Parental
  education and environmental factor were
  interesting factors. But we can't study because
  of limitation of time in the research

43
Chapter 5 Discussion

• Suggestions
• 1. Study of other factors associated with delayed
  development for more benefit.
• 2. Campaign of early ANC for decrease of preterm
  newborn that the risk factors of delayed
  development.

44
References

• ??????????????????????????? ????????????????????
  ??.4
• http//hpe4.anamai.moph.go.th/hpe/index.php
  (Healthy Promotion and Environmental Health)
• http//www.rajanukul.com/main/index.php?modeacade
  micgroup1submodeacademicidgroup12
• ??????????????????????? ???????????? ???????
  2550-2551

45
Appendices
46
Denver Developmental Screening Test II (DDST II)
From DENVER DEVELOPMENTAL SCREENING TEST
II Margaret S. Modequillo, MD, DPPS, FPNA
Gullas College of Medicine
47
Denver Developmental Screening Test II (DDST
II) (Cont.)
From DENVER DEVELOPMENTAL SCREENING TEST
II Margaret S. Modequillo, MD, DPPS, FPNA
Gullas College of Medicine
48
Apgar score
From Johns Hopkins The Harriet Lane Handbook,
18th ed.
49
Ethical review

• Confidentiality of patients data such as copy
  patients name by code, and restrict to access
  patients data by other people
• Deny to access subjects data that didnt
  associated with this study