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The Bayley-III scale may underestimate neurodevelopmental disability after cardiac surgery in infants

Andrew B Goldstone1, Michael Baiocchi2, David Wypij3

  • 1Department of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|April 22, 2019
PubMed

Insights

The Bayley-III scale shows higher neurodevelopmental scores in infants after heart surgery compared to the BSID-II. This difference means scores cannot be directly compared across different versions for tracking progress.

Area of Science:

  • Pediatric Cardiology
  • Neurodevelopmental Pediatrics
  • Medical Statistics

Background:

  • Congenital heart disease (CHD) survivors face a high risk of neurodevelopmental disability.
  • Standardized assessments like the Bayley Scales of Infant and Toddler Development are crucial for evaluating neurodevelopmental outcomes.
  • The Bayley-III, the latest edition, is reported to provide higher scores than its predecessor, the BSID-II.

Purpose of the Study:

  • To compare neurodevelopmental assessment scores between the Bayley Scales of Infant and Toddler Development 3rd Edition (Bayley-III) and the Bayley Scales of Infant Development 2nd Edition (BSID-II) in infants following cardiac surgery.
  • To determine if the Bayley-III classifies fewer children as impaired compared to the BSID-II in this population.

Main Methods:

  • A cohort of 2198 infants undergoing cardiac surgery with cardiopulmonary bypass between 1996 and 2009 was evaluated.
  • Propensity score matching was employed in a subset of 705 patients to mitigate confounding by indication.
  • Neurodevelopmental outcomes were assessed using both BSID-II and Bayley-III.

Main Results:

  • Unadjusted Bayley-III motor, cognitive, and language scores were significantly higher than BSID-II scores.
  • In propensity-matched analyses, Bayley-III motor scores were substantially higher (absolute difference 14.1), and fewer children were classified with severe or mild-to-moderate impairment.
  • While Bayley-III cognitive and language scores were also higher, the proportion of children with severe cognitive/language impairment did not differ between the two scales.

Conclusions:

  • The Bayley-III scale demonstrates a systematic bias towards higher scores compared to the BSID-II in infants post-cardiac surgery.
  • This score inflation with the Bayley-III prevents direct, valid comparisons of neurodevelopmental outcomes between historical (BSID-II) and contemporary (Bayley-III) cohorts.
  • Clinical interpretation and longitudinal tracking require careful consideration of the specific Bayley scale edition used.
Abstract

Keywords:
Congenital heart surgeryNeurodevelopmentPropensity score matching

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