Developmental status of HIV exposed premature infants

Abstract

South Africa is responsible for a large number of new HIV infections annually. HIV+ pregnant women can transmit the virus to their unborn children during the in-utero and intrapartum periods if they are not on antiretrovirals (ARVs). In South Africa all HIV+ pregnant women, regardless of CD4 count, can receive ARVs in order to prevent mother-child-transmission. It is due to this that fewer infants are being born HIV+. Studies have shown that premature delivery is likely to occur when a mother is HIV+. Being born prematurely can have an impact of the development of an infant as some body systems are not yet fully mature. It has been proven that HIV can have a negative impact on the development and functioning of children but few studies have been done to determine whether HIV and ARV exposure in-utero have an impact on the developing foetus. Therefore, the aim of this study was to determine if there is a difference between the development of premature infants born at 28-37 weeks gestational age that are HIV exposed uninfected compared to HIV unexposed uninfected at 16 days to six months corrected age. Other objectives included to determine whether clinical and demographic factors are predictive of developmental status. This non-experimental cross sectional quantitative study was done in a regional state hospital in Gauteng, SA. A once off assessment was done on 30 HIV exposed uninfected (HEU) infants and 30 unexposed uninfected (HUU) infants. They were assessed using the Bayley Scales of Infant and Toddler Development III which assesses cognitive, language and motor development. The mean developmental scores for all facets of development were within one standard deviation of the norm for both groups. It was found that the HUU infants had lower developmental scores when compared to the HEU infants in the language (p=0.003) and motor (p=0.037) subscales. Expressive language was more affected than receptive language (p=0.00) and both fine (p=0.00) and gross motor (p=0.03) were affected. HUU infants with neonatal complications such as meningitis (p=0.02) and NNJ (p=0.01) are 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 some motor delay but the neonatal complications had more affect of the neurodevelopment of infants than the HIV and ARV exposure in-utero. Socioeconomic factors such as housing, water, electricity and family structure were well matched between the two groups. This study suggests that HUU infants with neonatal complications may be more delayed when compared to HEU infected infants. Neonatal complications such as meningitis and NNJ have more impact on infant development than in-utero HIV and ARV 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.