Bayley-III Cognitive and Language Scales in Preterm Children

Abstract

BACKGROUND: This study aimed to assess the sensitivity and specificity of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III), Cognitive and Language scales at 24 months for predicting cognitive impairments in preterm children at 4 years.METHODS: Children born ,30 weeks' gestation completed the Bayley-III at 24 months and the Differential Ability Scale, Second Edition (DAS-II), at 4 years to assess cognitive functioning. Test norms and local term-born reference data were used to classify delay on the Bayley-III Cognitive and Language scales. Impairment on the DAS-II Global Conceptual Ability, Verbal, and Nonverbal Reasoning indices was classified relative to test norms. Scores , 21 SD relative to the mean were classified as mild/moderate delay or impairment, and scores , 22 SDs were classified as moderate delay or impairment.RESULTS: A total of 105 children completed the Bayley-III and DAS-II. The sensitivity of mild/ moderate cognitive delay on the Bayley-III for predicting impairment on DAS-II indices ranged from 29.4% to 38.5% and specificity ranged from 92.3% to 95.5%. The sensitivity of mild/moderate language delay on the Bayley-III for predicting impairment on DAS-II indices ranged from 40% to 46.7% and specificity ranged from 81.1% to 85.7%. The use of local reference data at 24 months to classify delay increased sensitivity but reduced specificity. Receiver operating curve analysis identified optimum cut-point scores for the Bayley-III that were more consistent with using local reference data than Bayley-III normative data.CONCLUSIONS: In our cohort of very preterm children, delay on the Bayley-III Cognitive and Language scales was not strongly predictive of future impairments. More children destined for later cognitive impairment were identified by using cut-points based on local reference data than Bayley-III norms.

Short- and Long-Term Outcomes for Extremely Preterm Infants

“…By contrast, the Bayley-3 rd edition, using the scale mean of 100 as a reference, may underestimate delay at 2yr of age 79 . Concerns have also been raised regarding how well the Bayley-3 rd edition performed at 2yr predicts 4yr cognitive outcomes 80 . In addition, a recent study demonstrates that parental socioeconomic status has an important effect in cognitive gains over time 81 .…”

Survival and Neurodevelopmental Outcomes Among Periviable Infants

“…Although early neurodevelopmental assessment is important for the timely identification of children at risk for long-term neurologic impairment or developmental delay, its capacity to predict later functioning is limited. [35][36][37] Many children will catch up to their peers by school age, whereas other children will have persistent impairment. Conversely, some children without signs of neurodevelopmental impairment in early childhood will have impairments that manifest at school age.…”

“…37,38 Bayley-II Mental Developmental Index and Bayley-III Cognitive Composite scores have been shown to correlate with later cognitive outcomes but account for only a minority of the variance in later cognitive functioning. 35,36,39 Reported rates of impairment at school age among children who were born extremely premature are generally lower than those reported in early childhood, but studies have been limited by small sample sizes and heterogeneous results. 35,37,40 Additional research is needed to better understand long-term outcomes among periviable infants.…”

Neurodevelopmental outcomes of a 25 - week premature infant at three years of age

“…Concerns have been raised about assessing cognitive and language development with the Bayley III [13][14][15][16]. Reports highlight the potential underestimation of developmental delays by the Bayley III A number of factors may have been responsible for enhancing the developmental outcomes for this child during his first 32 months of life.…”