title: Environment as a risk factor in delayed development in premature, low-birthweight and mild asphyxia children.
abstract: BACKGROUND
  Premature infants with low birthweight (LBW) and asphyxia are at high risk of delay of language and visual-motor development. Environmental risk factors contributing to the delay include parents' education, family income, number of children in the family, exclusive breast-feeding, and the mother's parenting time. Lack of research in Indonesia on premature, LBW and mild asphyxia children minimizes information to parents on the importance of an optimal environment. The aim of this study was to observe the role of the environment as a risk factor for delay in language and visual-motor development.
  
  
  METHODS
  A cross-sectional study was carried out from June to December 2011 of 12-24-month-old children born premature, with LBW and mild asphyxia at the Hasan Sadikin, Bandung City, and Muhammadiyah Hospitals. Language and visual-motor development were measured by Capute scales. Risk factors were analyzed using chi-squared test and multivariate logistic regression analysis.
  
  
  RESULTS
  Of the 70 subjects, 49% had language and visual-motor delay. Environmental factors related to the delay were low parental education, low family income, non-exclusive breast-feeding (P < 0.001) and full-time maternal parenting (P < 0.05). On multivariate analysis non-exclusive breast-feeding was associated with a 175-fold risk (prevalence rate [PR], 174.756; 95% confidence interval [CI]: 10.407-2934.516, P < 0.001), and low family income, a 0.042-fold risk (PR 0.042; 95%CI: 0.005-0.321, P < 0.05).
  
  
  CONCLUSIONS
  Low family income and non-exclusive breast-feeding are risk factors for delay in language and visual-motor development in 12-24-month-old children born premature, with LBW and mild asphyxia.
authors.affiliation: Department of Child Health, Medical School, Padjadjaran University, Bandung, Indonesia.
authors.forename: Hestu Putri
authors.initials: HP
authors.lastname: Yanuarti
authors.forename: Kusnandi
authors.initials: K
authors.lastname: Rusmil
authors.forename: Sjarif Hidajat
authors.initials: SH
authors.lastname: Effendi
mesh_terms: D001238:Asphyxia Neonatorum / Q000150:complications; D003430:Cross-Sectional Studies; D002658:Developmental Disabilities / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007234:Infant, Premature; D008297:Male; D019957:Motor Skills Disorders / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D012931:Social Environment; D014796:Visual Perception
keywords: developmental delay; environmental risk factors; low birthweight; mild asphyxia; premature