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Studying brain growth, health and development during the first 1000 days of life

The first 1000 days of life, from conception to age 2, are foundational to brain development. During this period, the developing brain is highly sensitive to environmental influences, both positive and adverse, with multi-system and enduring effects through the life course. This period is also a critical window of opportunity to promote generational physical and mental health in the context of global maternal and child health.

Approximately one in three children, globally, is at risk of not achieving their full developmental potential by age 5 years. Owing to a lack of screening resources, many do not receive the interventions they require within the first 1000 days “golden window” of brain development because they are only identified at school age or later.

The F1000 research group applies a ‘whole-child’ approach to early brain development involving the pillars of early identification, intervention and impact, towards making a positive difference to the most vulnerable children, internationally, at risk of developmental delay. 

We seek to:

  1. study the mechanisms that drive both typical and atypical brain development during the first 1000 days

  2. describe phenotypes and trajectories of typical and atypical early child development, 

  3. develop novel, scalable tools to identify children at risk as early as possible, 

  4. investigate innovative intervention strategies to mitigate this risk, and, where possible, rescue neurodevelopment and 

  5. work with international partners to develop regional and local capacity in early child development surveillance and intervention.  

Led by Dr Michelle Fernandes, the F1000 research group is based at the Department of Paediatrics, and brings together scientists, clinicians, psychologists, public health experts and community partners from 21 countries to further our understanding of typical and atypical patterns of brain development. The group works closely with the Oxford Maternal and Perinatal Health Institute and the Nuffield Department of Women’s & Reproductive Health at the University of Oxford; the MRC Lifecourse Epidemiology Centre at the University of Southampton;  the Turku Brain and Mind Center and Department of Public Health at the University of Turku, Finland; the Caribbean Centre of Child Neurodevelopment at WINDREF, Grenada and JNMC Women’s & Children’s Health Research Unit at KLE University, India to deliver on its cross-disciplinary and international research.

Our research focuses on human brain growth, health and development during the first 1000 days if life, and maps its effects on brain, health and social outcomes through childhood, adolescence and adulthood. We undertake methodology development (psychometric tools, international standards of foetal bran growth and early child development (ECD)), mechanistic research, intervention trials (including randomized controlled trials) and programmatic evaluations. We also engage in ECD-focused public health, capacity development and advocacy initiatives regionally and internationally.

Our aim is to develop evidence-based, cross-culturally applicable ECD (i) tools (ii) interventions and (iii) processes which can be applied rapidly and at minimal costs to all children globally without the need for specialist professionals or infrastructure. 

Themes

Trajectories & Targets:

We undertake mechanistic research, employing multi-modal techniques to study early brain structure and function including neuropsychometric, neuroimaging, neurophysiological, epidemiological and multi-omics approaches.

Our aims are:

i. To understand trajectories of typical & atypical brain development from early fetal life to age 2 years

ii. To identify key modifiable & non-modifiable factors influencing trajectory divergence

iii. To identify key targets & windows for intervention specific to developmental domains

Early Identification

We focus on the construction, validation and dissemination of novel methods to rapidly and sensitively identify children with developmental delay at key points of contact with healthcare services i.e. birth, 1 and 2 years. Specifically, we ensure that these tools are designed to enable their international uptake and scalability, and that they do not require specialist professionals or infrastructure for their use.

Our aims are:

i. To develop and validate novel  international, rapid, early child development assessment toolkits for neonates, infants and preschoolers

ii. To construct prescriptive, international standards of early child development & brain growth during  the first 1000 days of life

iii. To construct, validate and test a neurodevelopmental risk calculator for universal application in all babies at birth and at 1 year

Intervention

We work with our international collaborators to develop and test novel interventions to promote and/or rescue neurodevelopment in vulnerable children. We utilize community-driven, whole-child approaches leveraging the first 1000 days period and targeting key drivers of developmental delay simultaneously. 

Our aims are:

i. To develop and validate novel whole-child interventions to promote brain development leveraging as much of the first 1000 day window as possible

ii. To engage with local stakeholders to develop sustainable models of intervention delivery within communities

iii. To construct an evidence-based of interventions and local capacity to deliver these in key global regions

Research Outputs

The INTERgROWTH-21st Project Neurodevelopment Assessment:       INTER-NDA

Michelle baby 2

The INTER-NDA is a rapid, mixed-methodology, multi-dimensional, standardized, neurodevelopment assessment toolkit for preschoolers (22-30 months) for use in research and for clinical screening and programmatic evaluations. It measures cognitive, language, motor and behavioural outcomes in <15 minutes and can be administered reliably by non-specialist assessors across high-, low- and middle-income countries. 

Download manual

Download form

Access translations

Read more

Developmental Origins of Child Neurodevelopment: Novel Approaches to Clinical RISK PREDICTION USING AN INTERNATIONAL META-DATASET

Michelle baby 6

BRAINENDEVR is a novel, data-driven approach to developmental risk prediction during early childhood. Using data from 9 studies, representing over 5000 children from 13 high-, middle- and low-income countries, we aim to examine associations between early risk factors and developmental risk; describe phenotypes of early developmental delay, identify risk clusters and construct models to predict risk of developmental delay during early childhood.

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Funder's statement

The Oxford Neurodevelopmental Assessment: OX-NDA

The OX-NDA is a rapid, multi-dimensional, standardized, neurodevelopment assessment toolkit for infants (10-14 months) for use in research and for clinical screening and programmatic evaluations. It measures cognitive, language, motor and behavioural outcomes in 20-25 minutes and can be administered reliably by non-specialist assessors across high-, low- and middle-income countries. 

Request manual

Request form

Read more

          INTER-NDA web calculator

A free, web-application for rapid and automated standardized, domain score and developmental risk calculation and interpretation, with easy download functionality. Suitable for INTER-NDA assessments performed at individual level only. 

Access the INTER-NDA web calculator here.

  First international prospective Early Child Development Standards for Children aged 22 to 30 months

The INTER-NDA is the first early child development assessment whose norms are standards of early child development, constructed according to the WHO Multicentre Growth Reference Study's guidelines.

Download INTER-NDA standards chart

INTER-NDA normative centiles

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The Neonatal Neurobehavioural Assessment: Neo-NBA

Michelle baby 1

The Neo-NBA is a mixed-methodology, multi-dimensional, standardized, neurobehavioural, neurological and neuromaturity assessment for neonates (0-28 days) for use in research and for clinical screening and programmatic evaluations. This tool is in development, validation studies are ongoing in Italy, India and the UK. 

Current Research Projects

  1. BRAINENDEVR : Developmental origins of child development; Novel approaches to clinical risk prediction using an international metadataset, University of Oxford (2021-2028) 

  2. Fetal brain maturation, infant feeding and neurodevelopment: Influences on sleep patterns of 2-year old children in geographically diverse populations; University of Oxford (2024-2025) 

  3. INTER-NEO: Rapid, standardised neurodevelopment surveillance at age 2 years in neonatal follow-up clinics on the INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA): A Feasibility Study, University Hospitals Southampton NHS Foundation Trust, Southampton, UK (2023-2024)

  4. The Neonatal Neurobehavioural Assessment (Neo-NBA), University of Turin, Italy (2022-2025)

Collaborations with the Oxford Maternal & Perinatal Health Institute (OMPHI) & the NUFFIELD DEPARTMENT OF WOMEN's & REPRODUCTIVE HEALTH:

  1. The INTERGROWTH-21st Project

  2. The INTERBIO-21st Study

  3. INTERPRACTICE-21st 

External Collaborations:

  1. UKRI Action Against Stunting Hub, University College London, UK (2021-2027)

  2. The Omama Project, Cesta Von, Slovakia (2019-) 

  3. The FinnBrain Birth Cohort Study, University of Turku, Finland (2015-)

  4. First UAE National-Representative Birth Cohort Study, UAE University, UAE (2018-2024)

  5. National Birth Cohort Study of Preterm Infants in the United Arab EmiratesUniversity of Sharjah, UAE (2022-2025)

Global Collaborators

Global CollaborATOrs

List of collaborating institutions:

UK:

Oxford Maternal and Perinatal Health Institute, University of Oxford

MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton

Institute of Education, University College London, London

Europe:

University of Turku, Turku, Finland

University of Regensburg, Regensburg, Germany

CESTA VON, Bratislava, Slovakia

Umea University, Umea, Sweden

University of Turin, Turin, Italy

University of Zaragoza, Zaragoza, Spain

Asia:

KLE University, Belagavi, India

CSI Holdsworth Memorial Hospital, Mysore, India

Aga Khan University, Karachi, Pakistan

United Arab Emirates University, Dubai, UAE

University of Sharjah, Sharjah, UAE

Africa:

College of Medicine, University of Ibadan, Nigeria

Université Cheikh Anta DIOP de Dakar, Senegal

University of Kabale, Kabale, Uganda

University of the Witwatersrand, Johannesburg, South Africa

Americas:

University of Colorado School of Medicine, USA

Prematurity Research Centre, Stanford University, USA

Caribbean Centre of Child Neurodevelopment, Grenada, West Indies

Windward Islands Research amd Education Foundation, Grenada, West Indies

Universidade Federal de Pelotas, Pelotas, Brazil

Asociación San Lucas - San Martín, Moyobamba, Perú

Albergue para niños en crisis “Casa Josefina”, Cusco, Perú

Hospital Materno Infantil Ramón Sardá, Argentina

National & International Organisations:

WHO Global Scales of Early Development Initiative

DEPRESSD Collaboration

RCPCH Global Links Lebanon Programme

NeoTRIPS Collaborative Group