HIV exposure and neurodevelopmental outcome in very low birth weight infants in a low-middle income setting: a prospective cohort study

ABSTRACT

Neurodevelopmental impairment is common in premature infants. We aimed to describe neurodevelopmental outcomes in very low birth weight (VLBW) infants at 12 months postmenstrual age (PMA) and correlated with maternal HIV status. A single-centre, prospective cohort study was conducted from 1 June 2017 to 31 January 2019 with follow-up to 12 months. In-born infants with birth weight <1500 g were enrolled. Follow-up care was provided to 12 months PMA. Participants provided informed consent and ethics approval was obtained. A total of 279 patients were enrolled of which 84 (30.1%) died before 12 months and 91 (32.6%) were lost to follow-up. Neurodevelopmental assessment was performed on 104 participants. Mean general development quotient was 106.8, 2 (2.0%) patients had moderate-to-severe impairment and 1 (1.0%) mild impairment. HIV exposure was associated with lower developmental scores (104.3 vs. 109.0; p=0.005), whilst antenatal treatment with magnesium sulphate (109.6 vs. 105.2; p=0.01) and breastfeeding (108.0 vs. 104.0; p = 0.03) were associated with higher developmental scores. Neurodevelopmental outcome at 12 months PMA correlated with maternal HIV status. HIV exposure in VLBW infants is associated with lower neurodevelopmental scores at 12 months PMA. Antenatal treatment with magnesium sulphate and breastfeeding are associated with improved outcomes.

Keywords:

• neonatology
• HIV-exposed uninfected
• prematurity
• neurodevelopment

Acknowledgements

We would like to thank Mrs Cathy Connolly for statistical support and Prof Miriam Adhikari for her guidance and mentorship. This research was funded by grants from the University of Kwazulu-Natal, the Discovery Foundation and the South African Medical Research Council. The authors have no conflicts of interest to declare.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

CM: Protocol development, data collection, manuscript development and revision; RM: Protocol development, manuscript development and revision, research supervision.

Additional information

Funding

This work was supported by Inyuvesi Yakwazulu-Natali; Discovery Foundation; South African Medical Research Council.