DEVELOPMENTAL STATUS OF HIV EXPOSED PREMATURE INFANTS

C. Cox¹, J. Potterton¹, S. Rosie¹

Background: South Africa is responsible for many new Human Immunodeficiency Virus (HIV) infections annually. HIV+ pregnant women can transmit the virus to their infants during the in-utero and intrapartum periods. HIV infected women are at greater risk of premature delivery whether they are receiving antiretroviral therapy (ART) or not. HIV infection can have a negative impact on the development of children but it remains uncertain whether HIV and ART exposure in-utero have an impact on the developing foetus.

Purpose: The aim of this study was to determine if there is a difference between the development of premature infants that are HIV unexposed uninfected (HUU) compared to premature HIV exposed uninfected (HEU) infants. Other objectives included to determine whether clinical and demographic factors are predictive of developmental status.

Methods: This non-experimental cross sectional study was conducted in a regional state hospital in South Africa. A once off assessment was done on 30 HIV exposed uninfected infants and 30 unexposed uninfected infants born between 28 and 36 weeks gestational age. Infants were assessed using the Bayley Scales of Infant and Toddler Development III when they were between 16 days and six months corrected age. Cognitive, language and motor development was assessed and compared between the two groups.

Results: The two groups were well matched for demographic and clinical variables. The mean developmental scores for both groups fell within the normal range and no differences were found in motor (p=0.04) language (p=0.0) or cognitive (p=0.97) scores between the two groups. HUU infants were more likely to present with neonatal complications such as meningitis and neonatal jaundice (NNJ) and were more likely to present with language and motor delay when compared to the HEU infants. There was some evidence that HEU infants may present with mild motor delay but the neonatal complications had more effect of the neurodevelopment of infants than the HIV and ARV exposure in-utero. Socioeconomic factors such as housing, access to running water, electricity and family structure did not have a significant effect on the infant’s development in this sample.

Conclusion(s): This study suggests that HUU premature infants with neonatal complications are at greater risk of developmental delay than HEU premature infants. Neonatal complications such as meningitis and NNJ have more impact on infant development than in-utero HIV and ART exposure. These complications have an effect on expressive language, gross motor and fine motor development. It is of utmost importance for all premature infants to be screened on a regular basis in order to determine delays early on during development in order to ensure early intervention and improved quality of life.

Implications: Premature infants should be followed up by healthcare professionals post discharge for early intervention.
Premature infants should be monitored post birth for complications such as meningitis and NNJ. 
ART in pregnancy are important to ensure prevention of mother to child transmission.
Healthcare professionals should be educated on child development and provided with screening tools.

Funding, acknowledgements: This study did not require funding

Keywords: HIV exposed, Premature, Development

Topic: Paediatrics

Did this work require ethics approval? Yes

Institution: University of the Witwatersrand

Committee: Human Research Ethics Committee

Ethics number: M160438