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Updated: Apr 1, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurodevelopmental outcome of extremely low birth weight infants at 24 months corrected age: a comparison between
Odoardo Picciolini1, Chiara Squarza2, Camilla Fontana3
1NICU, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Della Commenda 12, Milan, 20122, Italy. odoardo.picciolini@mangiagalli.it.
Insights
The Bayley-III scale shows better agreement with the Griffiths Mental Development Scales Revised for assessing neurodevelopmental outcomes in extremely low birth weight infants. However, Bayley-III may underestimate impairment, while Bayley-II may overestimate it.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Neurodevelopmental Assessment
Background:
- Accurate neurodevelopmental assessment tools are crucial for early detection of risks in infants.
- Extremely low birth weight (ELBW) infants are at higher risk for adverse neurodevelopmental outcomes.
- Comparing different versions of the Bayley Scales is essential for refining assessment protocols.
Purpose of the Study:
- To compare the agreement between Bayley Scales (II vs. III) and Griffiths Mental Development Scales Revised.
- To evaluate the performance of Bayley-II and Bayley-III in ELBW infants at 24 months corrected age.
- To determine which Bayley Scale edition offers superior concordance with the Griffiths Scales.
Main Methods:
- Single-center prospective cohort study of infants born with birth weight 401-1000g and/or gestational age < 28 weeks.
- Exclusion of infants with neurosensory disabilities or genetic abnormalities.
- Neurodevelopmental evaluation at 24 months corrected age using Griffiths Scales and either Bayley-II or Bayley-III.
Main Results:
- Bayley-III demonstrated excellent concordance with Griffiths Scales for cognitive-language (k=0.80) and motor abilities (k=0.81).
- Bayley-II showed poorer concordance with Griffiths Scales (k=0.63 for cognitive-language, k=0.50 for motor).
- Bayley-III identified fewer infants with impairment compared to Griffiths, while Bayley-II identified more, indicating potential under- and overestimation, respectively.
Conclusions:
- Bayley-III exhibits higher agreement with Griffiths Scales than Bayley-II in ELBW infants.
- Bayley-III may slightly underestimate neurodevelopmental impairment, whereas Bayley-II may overestimate it.
- Recommend using multiple measures for comprehensive neurodevelopmental outcome assessment in ELBW infants.
Background:
The availability of accurate assessment tools for the early detection of infants at risk for adverse neurodevelopmental outcomes is a major issue. The purpose of this study is to compare the outcomes of the Bayley Scales (Bayley-II vs Bayley-III) in a cohort of extremely low birth weight infants at 24 months corrected age, to define which edition shows the highest agreement with the Griffiths Mental Development Scales Revised.
Methods:
We performed a single-centre cohort study. We prospectively enrolled infants with a birth weight of 401-1000 g and/or gestational age < 28 weeks. Exclusion criteria were the presence of neurosensory disabilities and/or genetic abnormalities. Infants underwent neurodevelopmental evaluation at 24 months corrected age using the Griffiths and either the Bayley-II (birth years 2003-2006) or the Bayley-III (birth years 2007-2010).
Results:
A total of 194 infants were enrolled. Concordance was excellent between the Griffiths and the Bayley-III composite scores for both cognitive language and motor abilities (weighted K = 0.80 and 0.81, respectively) but poorer for the Bayley-II (weighted K = 0.63 and 0.50, respectively). The Youden's Index revealed higher values for the Bayley-III than for the Bayley-II (75.9 vs 69.6%). Compared with the Griffiths, the Bayley-III found 3% fewer infants as being severely impaired in cognitive-language abilities and 7.8% fewer infants as being mildly impaired in motor skills while the Bayley-II showed, compared with the Griffiths, higher rates of severely impaired children both for cognitive-language and motor abilities (14.1 and 15.3% more infants respectively).
Discussion:
Our study suggests that the Bayley-III, although having a higher agreement with the Griffiths compared to the Bayley-II, slightly tends to underestimate neurodevelopmental impairment compared with the Griffiths, whereas the Bayley-II tends to overestimate it.
Conclusions:
On the basis of these findings, we recommend the use of multiple measures to assess neurodevelopmental outcomes of extremely low birth weight infants at 24 months.
