{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T06:00:44Z","timestamp":1775800844397,"version":"3.50.1"},"reference-count":34,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2020,6,7]],"date-time":"2020-06-07T00:00:00Z","timestamp":1591488000000},"content-version":"unspecified","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["49038"],"award-info":[{"award-number":["49038"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,4,30]]},"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Population-based cohort study, the INTERGROWTH-21st Project.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Brazil, India, Italy, Kenya and the UK.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary measures<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 \u226510th centile. For the INTER-NDA\u2019s cognitive, fine motor, gross motor, language and positive behaviour domains these are \u226538.5, \u226525.7, \u226551.7, \u226517.8 and \u226551.4, respectively. The threshold for normality for the INTER-NDA\u2019s negative behaviour domain is \u226450.0, that is, \u226490th centile. At 22\u201330 months of age, the cohort overlapped with the WHO motor milestone centiles, showed low postnatal morbidity (&lt;10%), and vision outcomes, attentional problems and emotional reactivity scores within the respective normative ranges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-035258","type":"journal-article","created":{"date-parts":[[2020,6,8]],"date-time":"2020-06-08T07:05:00Z","timestamp":1591599900000},"page":"e035258","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":36,"title":["INTERGROWTH-21st Project international INTER-NDA standards for child development at 2 years of age: an international prospective population-based study"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0051-3389","authenticated-orcid":false,"given":"Michelle","family":"Fernandes","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Department of Paediatrics, University of Southampton, Southampton, UK"},{"name":"Nuffield Department of Women\u2019s & Reproductive 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UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cutberto","family":"Garza","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cesar G","family":"Victora","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando C","family":"Barros","sequence":"additional","affiliation":[{"name":"Post-Graduate Program in Health and Behavior, Universidade Catolica de Pelotas, Pelotas, Rio Grande do Sul, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrico","family":"Bertino","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Pediatriche e dell\u2019 Adolescenza, SCDU Neonatologia, Universita di Torino, Torino, 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