Neurodevelopmental Status and Developmental Delay in Children With Severe Acute Malnutrition: A Prospective Observational Study

Abstract

Background: Severe acute malnutrition (SAM) occurs during a period of rapid brain growth and may adversely affect motor and mental development. Objective: To describe neurodevelopmental status in hospitalized children with SAM and examine the relationship of developmental quotients with mid-upper arm circumference (MUAC), head circumference, and anemia. Methods: This prospective observational study included 204 children aged 6-30 months admitted with SAM to the department of paediatrics, SSG Hospital and Medical College, Vadodara, during 2023-2024. Children with organic causes of malnutrition or known pre-existing developmental delay were excluded. After stabilization and nutritional rehabilitation, neurodevelopment was assessed using the Developmental Assessment Scale for Indian Infants (DASII). Motor developmental quotient (DMoQ), mental developmental quotient (DMeQ), and mean DQ were calculated. Results: Mean mental DQ was 62, mean motor DQ was 59, and mean composite DQ was 61.5. Based on mean DQ, 14.7% had no delay, 75.98% had mild delay, and 9.31% had moderate delay; no child had severe delay. Children with MUAC <11.5 cm had lower mental DQ (62.5±24.1 vs 78.5±16.2; p<0.0001) and lower mean DQ (63.1±24.5 vs 74.3±17.5; p=0.0009) than children with MUAC >11.5 cm. Mental DQ was also lower in children with microcephaly (62.8±14.4 vs 73.2±22.5; p=0.003). DQ values declined progressively across increasing grades of anemia; children with severe anemia had mean mental, motor, and composite DQ values of 58.6, 56.5, and 57.9, respectively. Conclusion: Developmental delay was common in hospitalized children with SAM, with mild delay predominating. Lower MUAC and smaller head circumference were associated with poorer developmental performance, particularly in the mental domain, while lower DQ values were observed with increasing severity of anemia. Developmental assessment should be incorporated into the clinical care and rehabilitation of young children with SAM.