Title: Research project The factors affected to 0-2 years old child development in Naresuan University Hospital
1Research 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
2Researchable question
- Primary question
- Is delayed development of children associated
with perinatal period factor? - Secondary question
- Is breast feeding associated with delayed
development of children?
3Researchable 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
4Basic of knowledge
- Definition
- Child development examintion (Denver II and
Public health department 49) - Factors associated with delayed development
5Definition
- 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.
6Definition
- 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
7Definition
- 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/
8Child 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
9Child 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
10Child 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
11Factors 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
12Research content
- Chapter 1 Introduction
- Chapter 2 Literature review
- Chapter 3 Methodology
- Chapter 4 Result
- Chapter 5 Discussion
- References
- Appendices
13Chapter 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.
14Chapter 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.
15Chapter 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
16Chapter 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.
17Chapter 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.
18Chapter 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)
19Literature 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
20Chapter 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?
21Chapter 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
22Chapter 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
23Chapter 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
24Chapter 3 Material and Methods
- Statistical analysis
- Analyze data by odds ratio and adjusted odds
- Calculation by STATA program
25Chapter 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
26Chapter 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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32Table 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
33Table 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
34Chapter 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
35Chapter 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.
36Chapter 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.
37Chapter 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
38Chapter 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.
39Chapter 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.
40Chapter 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.
41Chapter 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.
42Chapter 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
43Chapter 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.
44References
- ??????????????????????????? ????????????????????
??.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
45Appendices
46Denver Developmental Screening Test II (DDST II)
From DENVER DEVELOPMENTAL SCREENING TEST
II Margaret S. Modequillo, MD, DPPS, FPNA
Gullas College of Medicine
47Denver Developmental Screening Test II (DDST
II) (Cont.)
From DENVER DEVELOPMENTAL SCREENING TEST
II Margaret S. Modequillo, MD, DPPS, FPNA
Gullas College of Medicine
48Apgar score
From Johns Hopkins The Harriet Lane Handbook,
18th ed.
49Ethical 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