PT  - JOURNAL ARTICLE
AU  - Michelle Fernandes
AU  - José Villar
AU  - Alan Stein
AU  - Eleonora Staines Urias
AU  - Cutberto Garza
AU  - Cesar G Victora
AU  - Fernando C Barros
AU  - Enrico Bertino
AU  - Manorama Purwar
AU  - Maria Carvalho
AU  - Francesca Giuliani
AU  - Katharina Wulff
AU  - Amina A Abubakar
AU  - Michael Kihara
AU  - Leila Cheikh Ismail
AU  - Luis Aranzeta
AU  - Elaine Albernaz
AU  - Naina Kunnawar
AU  - Paola Di Nicola
AU  - Roseline Ochieng
AU  - Tamsin Sandells
AU  - Sandy Savini
AU  - Sophie Temple
AU  - Elizabeth Murray
AU  - Eric O Ohuma
AU  - Michael G Gravett
AU  - Ruyan Pang
AU  - Yasmine A Jaffer
AU  - Julia Alison Noble
AU  - Adele Winsey
AU  - Ann Lambert
AU  - Aris T Papageorghiou
AU  - Zulfiqar Bhutta
AU  - Stephen Kennedy
TI  - INTERGROWTH-21st Project international INTER-NDA standards for child development at 2 years of age: an international prospective population-based study
AID  - 10.1136/bmjopen-2019-035258
DP  - 2020 Jun 01
TA  - BMJ Open
PG  - e035258
VI  - 10
IP  - 6
4099  - http://bmjopen.bmj.com/content/10/6/e035258.short
4100  - http://bmjopen.bmj.com/content/10/6/e035258.full
SO  - BMJ Open2020 Jun 01; 10
AB  - Objectives To describe the construction of the international INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) standards for child development at 2 years by reporting the cognitive, language, motor and behaviour outcomes in optimally healthy and nourished children in the INTERGROWTH-21st Project.Design Population-based cohort study, the INTERGROWTH-21st Project.Setting Brazil, India, Italy, Kenya and the UK.Participants 1181 children prospectively recruited from early fetal life according to the prescriptive WHO approach, and confirmed to be at low risk of adverse perinatal and postnatal outcomes.Primary measures Scaled INTER-NDA domain scores for cognition, language, fine and gross motor skills and behaviour; vision outcomes measured on the Cardiff tests; attentional problems and emotional reactivity measured on the respective subscales of the preschool Child Behaviour Checklist; and the age of acquisition of the WHO gross motor milestones.Results Scaled INTER-NDA domain scores are presented as centiles, which were constructed according to the prescriptive WHO approach and excluded children born preterm and those with significant postnatal/neurological morbidity. For all domains, except negative behaviour, higher scores reflect better outcomes and the threshold for normality was defined as ≥10th centile. For the INTER-NDA’s cognitive, fine motor, gross motor, language and positive behaviour domains these are ≥38.5, ≥25.7, ≥51.7, ≥17.8 and ≥51.4, respectively. The threshold for normality for the INTER-NDA’s negative behaviour domain is ≤50.0, that is, ≤90th centile. At 22–30 months of age, the cohort overlapped with the WHO motor milestone centiles, showed low postnatal morbidity (<10%), and vision outcomes, attentional problems and emotional reactivity scores within the respective normative ranges.Conclusions From this large, healthy and well-nourished, international cohort, we have constructed, using the WHO prescriptive methodology, international INTER-NDA standards for child development at 2 years of age. Standards, rather than references, are recommended for population-level screening and the identification of children at risk of adverse outcomes.