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Re-evaluating preterm infants with the Bayley-III: patterns and predictors of change
Michelle M Greene1, Kousiki Patra, Jean M Silvestri
1Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, United States. Michelle_Greene@rush.edu
Insights
Developmental scores for preterm infants often decline between 8 and 20 months. Neonatal factors and sociodemographic variables predict these changes, highlighting the need for comprehensive assessment using the Bayley Scales of Infant and Toddler Development (Bayley-III).
Area of Science:
- Neonatal development
- Pediatric neurodevelopmental assessment
Background:
- Preterm infants face unique developmental challenges.
- Longitudinal assessment is crucial for understanding developmental trajectories in this population.
Purpose of the Study:
- To evaluate the psychometric properties of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III).
- To identify predictors of score changes in preterm infants from 8 to 20 months corrected age.
Main Methods:
- Longitudinal study of 131 preterm infants assessed using the Bayley-III at two time points.
- Analysis of mean score differences, test-retest reliability, and classification stability.
- Investigation of birth, neonatal, and sociodemographic predictors of score changes.
Main Results:
- Cognitive, Receptive Language, and Fine Motor scores declined; Gross Motor scores remained stable.
- Bayley-III test-retest reliability was fair to moderate.
- Developmental delay classifications were often unstable, with significant shifts observed.
- Small for gestational age status predicted better language and motor scores.
- Public insurance, sepsis history, lower gestational age, race, and necrotizing enterocolitis predicted score declines.
Conclusions:
- Bayley-III scores can change significantly in preterm infants during the first two years.
- Neonatal risk factors and sociodemographic variables are important predictors of developmental trajectories.
- Comprehensive assessment and early intervention are vital for preterm infants.
Abstract:
This study investigates the Third Edition of the Bayley Scales of Infant and Toddler Development (Bayley-III) and (1) mean difference scores, (2) test-retest correlation coefficients, (3) changes in rates of delay and classification from "delayed" to "not delayed," and (4) infant birth, neonatal and sociodemographic predictors of change in scores from the first to second year of life among 131 preterm infants. Cognitive, Receptive Language and Fine Motor Subscale scores decrease and mean Gross Motor Subscale scores remain consistent from the first to second year of life. Bayley-III test-retest reliability ranged from small/fair to moderate from 8 to 20 months corrected age. Classification of delay is not stable over the first two years of life. One in 6 infants' Language Index scores changed from a classification of not delayed at 8 months to delayed at 20 months. One in 10 infants' Gross Motor Subscale scores changed from a classification of delayed at 8 months to not delayed at 20 months. Small for gestational age status predicts improved to nearly consistent Bayley Language Index and Receptive Subscale scores. Public insurance and history of sepsis predict decline in Bayley Language Index and Receptive Subscale scores from 8 to 20 months. Lower gestational age, race, and history of necrotizing enterocolitis and/or intestinal perforation also predict decline in Bayley Cognitive Index from 8 to 20 months. Predictors of decline in performance confirm known neonatal risk factors, are consistent with emerging evidence of detrimental immune related processes, and highlight the importance of inclusion of sociodemographic variables in understanding development in preterm infants.
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