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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Predictive Value of the BSID-II and the Bayley-III for Early School Age Cognitive Function in Very Preterm Infants
Rachel S Flynn1,2, Matthew D Huber1, Sara B DeMauro1,2
1Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Insights
The Bayley Scales of Infant Development, Second Edition (BSID-II) better predicted cognitive function in very preterm infants than the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). The Bayley-III may miss at-risk children, warranting caution with its use.
Area of Science:
- Neonatal development
- Developmental psychology
- Pediatric neurocognition
Background:
- Very preterm infants (<32 weeks gestation) face neurodevelopmental challenges.
- Accurate cognitive assessment in early childhood is crucial for timely intervention.
- The predictive validity of different Bayley Scales editions for long-term outcomes requires comparison.
Purpose of the Study:
- To compare the predictive validity of the Bayley Scales of Infant Development, Second Edition (BSID-II) and the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III).
- To assess cognitive function at early school age in very preterm infants using these scales.
- To inform clinical interpretation and selection of developmental assessment tools for high-risk populations.
Main Methods:
- Seventy-seven very preterm infants completed BSID-II and Bayley-III at 2 years corrected age.
- Cognitive function was assessed using the Wechsler Preschool and Primary Scale of Intelligence Fourth Edition (WPPSI-IV) at approximately 4 years.
- Associations between Bayley scores and WPPSI-IV scores were analyzed using correlation coefficients and linear regression.
Main Results:
- The BSID-II Mental Development Index (MDI) showed a stronger correlation with WPPSI-IV Full Scale IQ (FSIQ) (r=0.54) than the Bayley-III Cognitive composite score (r=0.31).
- The Bayley-III Language composite score demonstrated a modest correlation with FSIQ (r=0.39).
- Linear regression confirmed the BSID-II's closer association with FSIQ, indicating potential underestimation by BSID-II and overestimation by Bayley-III.
Conclusions:
- The BSID-II demonstrated superior predictive validity for early school-age cognitive function in very preterm infants compared to the Bayley-III.
- The Bayley-III may overestimate cognitive abilities, potentially leading to missed identification of children requiring support.
- Caution is advised when interpreting scores from the Bayley-III, and further research on the new Bayley-4 is needed.
Objective:
To compare the predictive validity of the Bayley Scales of Infant Development, Second Edition (BSID-II) and the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) for cognitive function at early school age in very preterm infants.
Methods:
Seventy-seven former preterm infants (born <32 weeks gestation and ≤2000 g) completed both the BSID-II and the Bayley-III at 2 years corrected age. Children enrolled at hospitals that perform follow-up beyond 2 years had cognitive assessments with the Wechsler Preschool and Primary Scale of Intelligence Fourth Edition (WPPSI-IV). Associations between Bayley and WPPSI scores were assessed using correlation coefficients, linear regression, and Bland-Altman plots.
Results:
Thirty-one of 45 eligible children were tested with the WPPSI-IV at 47 ± 11 months. Average BSID-II Mental Development Index (MDI) was 86 ± 19, Bayley-III Cognitive composite score was 101 ± 12 and WPPSI Full Scale IQ (FSIQ) was 96 ± 12. Correlation between MDI and FSIQ was 0.54 (P < .001); correlation between Bayley-III cognitive composite score and FSIQ was 0.31 (P = .03). Bayley-III language composite had a modestly stronger correlation with FSIQ than cognitive composite (correlation coefficient 0.39; P = .005). Linear regression models also demonstrated that BSID-II was more closely correlated with FSIQ than Bayley-III. This bias was consistent across the full range of scores.
Conclusion:
The BSID-II underestimated FSIQ and the Bayley-III overestimated FSIQ. Children at risk for impairment might be missed with the Bayley-III. As the Bayley-4 is introduced, clinicians and researchers should be cautious about interpretation of scores until performance of this new measure is fully understood.
