Studying the effect of different environmental influences on early structural brain development in neonates followed up at 5 years old in Uttar .....

A third of young children in low and middle-income countries (LMICs) fail to reach basic milestones in their cognitive or socioemotional development (McCoy, 2016). From conception, the developing brain increasingly specialises in response to the infant's environment. Exposure to adversity in the environment during this time may permanently affect developmental trajectories and ultimately result in cognitive deficits and neurological disorders later on in life. Neonatal neuroimaging can be used as an intermediate phenotype to demonstrate the effect of genetic, environmental and prenatal influences on the developing brain (Jha et al., 2018).

There are many challenges involved using neuroimaging techniques in low resource settings and behavioural batteries have cultural biases because they were developed for high resource contexts. As a result, there is a very limited representation of LMICs in developmental neuroimaging or neurocognitive studies, despite the fact that 90% of young people (10-24 years old) live in developing countries (United Nations Development Report 2016). Structural MRI (Elwell, C 2020) has the potential to provide objective, universally-applicable biomarkers to assess normative development, by charting brain development over time. To address this, structural MRI data has been acquired longitudinally in a cohort of infants and toddlers at a hospital in Uttar Pradesh, India, then followed up at 5 years old.

Uttar Pradesh is the most populous state in India with over 200 million people and 80% of this population live in rural areas (https://censusindia.gov.in/). The maternal and child health outcomes in Uttar Pradesh are some of the worst in India (Vora et al., 2009). Male child preference is deeply rooted in the patriarchal structure of Indian culture and society. It has culminated in female infanticide, systemic bias, neglect and abandonment of female children (Guilmoto et al., 2018). A longitudinal approach to imaging the developing brain allows us to generate normative models of brain development and identify deviants from this trajectory to investigate risk and resilience factors, monitor developmental pathways and identify windows for effective intervention. The Uttar Pradesh cohort can be used as a case study to investigate the effects of urbanicity and cultural gender bias on brain development, by comparing different features of structural brain growth with cohorts of infants in the UK and USA.