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Updated: Jul 29, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Bayley trajectories predict school readiness better than single assessments in formerly very preterm preschoolers
Mary Lauren Neel1, Sara Conroy2,3,4, Rachelle Srinivas2
1Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA. mneel@emory.edu.
Insights
Tracking developmental trajectories using the Bayley Scales of Infant Development in very preterm (VPT) children is more predictive of school readiness than single assessments. Early developmental changes, not just initial scores, are crucial for understanding long-term outcomes.
Area of Science:
- Pediatric developmental neuroscience
- Early childhood development research
- Neonatal follow-up care
Background:
- Assessing neurodevelopment in very preterm (VPT) children is vital, often using the Bayley Scales of Infant Development.
- Early Bayley scores may not accurately predict later developmental outcomes.
- This study investigates if developmental trajectories predict school readiness better than single assessments.
Purpose of the Study:
- To determine if Bayley-III trajectories in early childhood predict school readiness in very preterm children.
- To compare the predictive power of developmental trajectories versus single assessments for school readiness.
- To inform follow-up care models and clinical trial designs for neonatal interventions.
Main Methods:
- Prospective evaluation of 53 very preterm children at 4-5 years using standardized school readiness measures.
- Bayley-III scores were collected 1-5 times per child between 6 and 35 months.
- Linear mixed-effects models analyzed individual Bayley score trajectories (intercept and slope) to predict school readiness outcomes.
Main Results:
- Individual developmental trajectories showed significant variability across domains.
- Including change in Bayley scores (slope) improved model fit compared to initial scores alone.
- Models incorporating initial scores and change over time explained substantially more school readiness variability (21-63%) than either measure independently.
Conclusions:
- Multiple assessments of very preterm children in the first three years are more informative for predicting school readiness.
- Early developmental trajectories, rather than single time points, should be considered as outcomes in neonatal intervention research.
- A trajectory-based approach enhances the prediction of school readiness for formerly preterm children.
Background:
Development of children born very preterm (VPT) is evaluated using the Bayley Scales of Infant Development. Early Bayley scores may not predict later outcomes. We studied whether VPT Bayley trajectories in the early years predicted school readiness better than single assessments.
Methods:
We prospectively evaluated 53 VPT at 4-5 years using standardized measures of school readiness, including the domains of cognition, early mathematical and literacy abilities, and motor skills. Predictors were Bayley-III scores obtained 1-5 times/child between 6 and 35 months. Linear mixed models (LMM) with random effects extracted estimated random effect for slope (change in Bayley score/1 year) and fixed+random effect sum for the intercept (initial Bayley score) for each participant, to then evaluate 4-5-year outcomes prediction.
Results:
Variability of individual trajectories prevailed across developmental domains. For the initial LMM, adding Bayley change to models with only initial score improved model fits for several Bayley-III domains. Models containing estimates for initial Bayley scores and Bayley change explained significantly more variability in school readiness scores (21-63%) than either variable alone.
Conclusion:
Neurodevelopmental follow-up of VPT is more relevant to school readiness when children are assessed multiple times in the first 3 years. Neonatal intervention research could use early trajectories rather than single timepoints as outcomes.
Impact:
This study is the first to examine individual Bayley scores and trajectories to predict school readiness of formerly preterm children at 4-5 years. Modeling demonstrated extreme variability of individual trajectories compared to the group's average trajectories. Models containing initial Bayley scores and Bayley change over time explained more variability in preschool readiness than either variable alone. Using the Bayley to predict future school readiness is enhanced by administration across multiple follow-up visits and inclusion of change across the first 3 years. Follow-up care models and clinical trial design for neonatal interventions may benefit from a trajectory-based approach to outcomes evaluation.
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