To study the clinical features, etiology and predictors of severity in children below the age of five years with developmental delay.

Global developmental delay (GDD) is a significant cause of morbidity, affecting 1-3% of children worldwide. Its etiology varies greatly from place to place and is commonly multifactorial, especially in developing countries.

A prospective observational study was conducted, which recruited consecutive children (6 months-5 years) presenting to the neurology clinic with GDD over one year. Their antenatal/birth records and clinical characteristics were noted. Developmental age and developmental quotient (DQ) was calculated using the Denver II developmental screening test. The predictors of significant delay (DQ<70), and severe delay (DQ<55) were analyzed using SPSS software.

The study included 123 children (66.7% males) with a mean age of 2.25 ± 1.37 years. The etiology of GDD was multifactorial, with majority due to birth asphyxia (68%) and low birth weight (44%). Others included premature delivery (11%), neonatal sepsis (6%), consanguinity (9%), increased maternal age (4%) and oligohydramnios (1%).  Nearly 66% required intensive care, 61% had seizures, 37% had weakness, 35% had spasticity and 11% had hypotonia.  One-third had microcephaly, and 38% had craniofacial dysmorphism. 

White matter abnormalities were the most common MRI abnormality (74%) and EEG was normal in 79%.

The mean Global DQ was 42.47 ± 22.26. Nearly 107 (87%) had significant delay, 72% had severe delay and 20% children had profound delay (DQ<20). 

Birth asphyxia was the single significant predictor of significant delay (92%vs77%; p0.04). Birth asphyxia, microcephaly and facial dysmorphism were significant predictors of severe delay (77%vs59%; p0.05, 90%vs63%; p0.002, 83%vs65%; p0.04 respectively) 

Nearly 87% had significant developmental delay (DQ<70) and 72% had severe developmental delay (DQ<55). Birth asphyxia and low birth weight were the most common causes. Birth asphyxia, microcephaly and facial dysmorphism were significant predictors of severe developmental delay.