Unravelling Global Developmental Delay: Risk Factors and Comorbidities in Young Children at a Tertiary Care Hospital
DOI:
https://doi.org/10.55489/ijmr.1303202584Keywords:
Global Developmental Delay, Risk Factors, Comorbidities, Perinatal Asphyxia, Malnutrition, NeuroimagingAbstract
Background: Global developmental delay (GDD) significantly impacts children’s motor, cognitive, language, and social development, with India bearing a high burden. Early identification of risk factors and comorbidities is crucial for timely interventions, yet regional data, particularly from areas like Rohilkhand, remain limited. This study aimed to identify risk factors and associated comorbidities in children with GDD presenting to a tertiary care teaching hospital.
Methods: A hospital-based descriptive observational study was conducted at SRMS Institute of Medical Sciences, Bareilly, from May 2023 to October 2024. Forty-five children aged 1 month to 5 years with GDD were enrolled. Data on demographics, clinical examinations, developmental domains (via Denver Developmental Screening Test II), and diagnostic investigations (neuroimaging, EEG, BERA, etc.) were collected using a structured questionnaire. Risk factors (maternal, prenatal, perinatal, postnatal) and comorbidities were analyzed using descriptive statistics in Epi-Info software.
Results: Most children were aged 13–24 months (31.11%) and male (62.22%). Perinatal asphyxia (46.67%) and low socioeconomic status (68.89%) were prominent risk factors. Common comorbidities included pallor (93.33%), malnutrition (82.22%), epilepsy (51.11%), and hearing impairment (42.22%). Neuroimaging showed abnormalities in 70.00%, primarily hypoxic-ischemic sequelae. All children had gross motor delay, with 88.89% exhibiting language delay.
Conclusion: GDD is associated with preventable risk factors like perinatal asphyxia and manageable comorbidities like malnutrition, emphasizing the need for early screening and multidisciplinary interventions to improve outcomes in affected children.
References
1. Shevell M, Ashwal S, Donley D, et al. Practice parameter: Evaluation of the child with global developmental delay: Report of the Quality Standards Subcommittee of the American Academy of Neurology and The Practice Committee of the Child Neurology Society. Neurology. 2003;60(3):367-380. DOI: https://doi.org/10.1212/01.WNL.0000031431.81555.16 PMid:12578916
2. Majnemer A, Shevell MI. Diagnostic yield of the neurologic assessment of the developmentally delayed child. J Pediatr. 1995;127(2):193-199. DOI: https://doi.org/10.1016/S0022-3476(95)70294-6 PMid:7543566
3. Shonkoff JP, Phillips DA, eds. From Neurons to Neighborhoods: The Science of Early Childhood Development. National Academies Press; 2000.
4. Nicolson RI, Fawcett AJ. Developmental dyslexia: The role of the cerebellum. Dyslexia. 1999;5(3):155-177. DOI: https://doi.org/10.1002/(SICI)1099-0909(199909)5:3<155::AID-DYS143>3.0.CO;2-4
5. Bishop DVM. The underlying nature of specific language impairment. J Child Psychol Psychiatry. 1992;33(1):3-66. DOI: https://doi.org/10.1111/j.1469-7610.1992.tb00858.x PMid:1737831
6. Nair MKC, Radhakrishnan SR. Early childhood development in deprived urban settlements. Indian Pediatr. 2004;41(3):227-237.
7. Juneja M, Mohanty M, Jain R, Ramji S. Ages and Stages Questionnaire as a screening tool for developmental delay in Indian children. Indian Pediatr. 2012;49(6):457-461. DOI: https://doi.org/10.1007/s13312-012-0074-9 PMid:22080617
8. Anderson LM, Shinn C, Fullilove MT, et al. The effectiveness of early childhood development programs: A systematic review. Am J Prev Med. 2003;24(3 Suppl):32-46. DOI: https://doi.org/10.1016/S0749-3797(02)00655-4 PMid:12668197
9. Spittle A, Orton J, Anderson PJ, Boyd R, Doyle LW. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairments in preterm infants. Cochrane Database Syst Rev. 2015;2015(11):CD005495. DOI: https://doi.org/10.1002/14651858.CD005495.pub4 PMid:26597166 PMCid:PMC8612699
10. Lipkin PH, Okamoto J; Council on Children with Disabilities; Council on School Health. The Individuals with Disabilities Education Act (IDEA) for children with special educational needs. Pediatrics. 2015;136(6):e1650-e1662. DOI: https://doi.org/10.1542/peds.2015-3409 PMid:26620061
11. Odom SL, Horner RH, Snell ME, Blacher J. Handbook of Developmental Disabilities. Guilford Press; 2007.
12. Moeschler JB, Shevell M; Committee on Genetics. Comprehensive evaluation of the child with intellectual disability or global developmental delays. Pediatrics. 2014;134(3):e903-e918. DOI: https://doi.org/10.1542/peds.2014-1839 PMid:25157020 PMCid:PMC9923626
13. Global Research on Developmental Disabilities Collaborators. Developmental disabilities among children younger than 5 years in 195 countries and territories, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Glob Health. 2018;6(10):e1100-e1121. DOI: https://doi.org/10.1016/S2214-109X(18)30309-7 PMid:30172774
14. Grantham-McGregor S, Cheung YB, Cueto S, et al. Developmental potential in the first 5 years for children in developing countries. Lancet. 2007;369(9555):60-70. DOI: https://doi.org/10.1016/S0140-6736(07)60032-4 PMid:17208643
15. Srour M, Mazer B, Shevell MI. Analysis of clinical features predicting etiologic yield in the assessment of global developmental delay. Pediatrics. 2006;118(1):139-145. DOI: https://doi.org/10.1542/peds.2005-2702 PMid:16818559
16. Aggarwal S, Bogula VR, Mandal K, et al. Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India. PLoS Med. 2018;15(7):e1002615. DOI: https://doi.org/10.1371/journal.pmed.1002615 PMid:30040859 PMCid:PMC6057634
17. Potdukhe A, Jigjinni S, Pande B, et al. Prevalence and determinants of developmental delay among children less than 5 years of age in an urban slum area of Mumbai: A cross-sectional exploratory study. Indian J Child Health. 2024;11(2):e6252. DOI: https://doi.org/10.32677/ijch.v11i2.6252
18. Lozoff B, Jimenez E, Smith JB. Double burden of iron deficiency in infancy and low socioeconomic status: a longitudinal analysis of cognitive test scores to age 19 years. Arch Pediatr Adolesc Med. 2006 Nov;160(11):1108-13. DOI: https://doi.org/10.1001/archpedi.160.11.1108 PMid:17088512 PMCid:PMC1866361
19. Nurliyana AR, Shariff ZM, Mohd Taib MN, Gan WY, Tan KA. Early nutrition, growth and cognitive development of infants from birth to 2 years in Malaysia: a study protocol. BMC Pediatr. 2016;16(1):160. DOI: https://doi.org/10.1186/s12887-016-0700-0 PMid:27687906 PMCid:PMC5043613
20. Ferdi, J., Bardosono, S., & Medise, B. E. Iron status and developmental delay among children aged 24-36 months. Paediatrica Indonesiana, 2022;62(4), 256-64. DOI: https://doi.org/10.14238/pi62.4.2022.256-64
21. Lozoff B, Georgieff MK. Iron deficiency and brain development. Semin Pediatr Neurol. 2006;13(3):158-165. DOI: https://doi.org/10.1016/j.spen.2006.08.004 PMid:17101454
22. Michel GF, Babik I, Nelson EL, et al. Evolution and development of handedness: An Evo-Devo approach. Prog Brain Res. 2018;238:347-374. DOI: https://doi.org/10.1016/bs.pbr.2018.06.007 PMid:30097200
23. McDonald L, Rennie A, Tolmie J, et al. Investigation of global developmental delay. Arch Dis Child. 2006;91(8):701-705. DOI: https://doi.org/10.1136/adc.2005.078147 PMid:16861488 PMCid:PMC2083045
24. Kakoza-Mwesige A, Byanyima RK, Tumwine JK, et al. Systematic review of MRI findings in children with developmental delay or cognitive impairment. Brain Dev. 2017;39(8):644-655. DOI: https://doi.org/10.1016/j.braindev.2017.04.006 PMid:28457518
25. Van Karnebeek CD, Shevell M, Zschocke J, Moeschler JB, Stockler S. The metabolic evaluation of the child with an intellectual developmental disorder: diagnostic algorithm for identification of treatable causes and new digital resource. Mol Genet Metab. 2014 Apr;111(4):428-38. DOI: https://doi.org/10.1016/j.ymgme.2014.01.011 PMid:24518794
26. Rossi A, Blok LS, Neuser S, Klöckner C, Platzer K, Faivre LO, et al. POU3F3-related disorder: Defining the phenotype and expanding the molecular spectrum. Clin Genet. 2023 Aug;104(2):186-197. DOI: https://doi.org/10.1111/cge.14353 PMID: 37165752 PMCID: PMC10330344
27. Resegue R, Puccini RF, Silva EM. Risk factors associated with developmental abnormalities among high-risk children attended at a multidisciplinary clinic. Sao Paulo Med J. 2008 Jan 2;126(1):4-10. DOI: https://doi.org/10.1590/s1516-31802008000100002 PMID: 18425280 PMCID: PMC11020518
28. Ozkan M, Senel S, Arslan EA, Karacan CD. The socioeconomic and biological risk factors for developmental delay in early childhood. Eur J Pediatr. 2012 Dec;171(12):1815-1821. DOI: https://doi.org/10.1007/s00431-012-1826-1 PMid:22983025
29. Robertson CM, Finer NN. Perinatal and early postnatal factors underlying developmental delay and disabilities. Dev Disabil Res Rev. 2011;17(2):109-119. DOI: https://doi.org/10.1002/ddrr.110 PMid:20818726
30. Thomaidis L, Zantopoulos GZ, Fouzas S, Mantagou L, Bakoula C, Konstantopoulos A. Predictors of severity and outcome of global developmental delay without definitive etiologic yield: a prospective observational study. BMC Pediatr. 2014 Feb 12;14:40. DOI: https://doi.org/10.1186/1471-2431-14-40 PMid:24521451 PMCid:PMC3933196
31. Yaghini O, Kelishadi R, Keikha M, Niknam N, Sadeghi S, Najafpour E, Ghazavi M. Prevalence of Developmental Delay in Apparently Normal Preschool Children in Isfahan,Central Iran. Iran J Child Neurol. 2015 Summer;9(3):17-23. PMID: 26401149; PMCID: PMC4577694.
32. Haddow JE, Palomaki GE, Allan WC, et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med. 1999;341(8):549-555. DOI: https://doi.org/10.1056/NEJM199908193410801 PMid:10451459
33. Tye C, Runicles AK, Whitehouse AJO, et al. Characterizing the interplay between autism spectrum disorder and comorbid medical conditions: An integrative review. Front Psychiatry. 2019;9:751. DOI: https://doi.org/10.3389/fpsyt.2018.00751 PMid:30733689 PMCid:PMC6354568
34. Van Dijck A, Vulto-van Silfhout AT, et al. Clinical Presentation of a Complex Neurodevelopmental Disorder Caused by Mutations in ADNP. Biol Psychiatry. 2019 Feb 15;85(4):287-297. DOI: https://doi.org/10.1016/j.biopsych.2018.02.1173 PMID: 29724491 PMCID: PMC6139063
35. Cassidy C, Mannion A, Whelan S, Tones M, Heussler H, Bellgard M, Leader G. Association Between Feeding Problems and Gastrointestinal Symptoms, Language, and Developmental History in Adults With Angelman Syndrome. Am J Med Genet A. 2025 June;197(11):e64137. DOI: https://doi.org/10.1002/ajmg.a.64137 PMid:40583285
36. Leader G, Killeen C, Whelan S, Coyne R, Tones M, Mannion A. Factors associated with sleep disturbances in children and adolescents with Angelman Syndrome. Sleep Med. 2024 May;117:9-17. DOI: https://doi.org/10.1016/j.sleep.2024.02.038 PMid:38479041
37. Shan L, Feng JY, Wang TT, Xu ZD, Jia FY. Prevalence and Developmental Profiles of Autism Spectrum Disorders in Children with Global Developmental Delay. Front Psychiatry. 2022 Jan 18;12:794238. DOI: https://doi.org/10.3389/fpsyt.2021.794238 PMid:35115968 PMCid:PMC8803654
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Mayank Gupta, Surabhi Chandra, Vandana Negi
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
The authors retain the copyright of their article, with first publication rights granted to Medsci Publications.
