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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Developmental Trajectories of Very Preterm Infants and Implications for Routine Neurodevelopmental Follow-Up
Nina Gande1, Michael Bloching1, Christoph Hochmayr1
1Department of Paediatrics II (Neonatology), Medical University of Innsbruck, Innsbruck, Austria.
Insights
The 2-year Bayley Scales of Infant and (Toddler) Development assessment better predicts cognitive outcomes in very preterm infants than the 1-year assessment. Combining both assessments offers the strongest prediction for preschool cognitive development.
Area of Science:
- Neonatal development
- Pediatric neurodevelopmental outcomes
- Longitudinal infant studies
Background:
- Very preterm infants face risks for neurodevelopmental challenges.
- Early cognitive assessments are crucial for identifying potential delays.
- Longitudinal tracking is essential to understand developmental trajectories.
Purpose of the Study:
- To assess the longitudinal cognitive development of very preterm infants from 1 to 5 years corrected age.
- To evaluate the predictive accuracy of the Bayley Scales of Infant and (Toddler) Development (BSID(T)D) at 1 and 2 years for preschool cognitive outcomes.
Main Methods:
- 499 very preterm infants were assessed longitudinally.
- Cognitive outcomes were measured using BSID-II/BSITD-III at 1 and 2 years.
- Full-scale intelligence quotient (IQ) was evaluated at 5 years corrected age.
Main Results:
- Most infants showed normal cognitive outcomes at 1, 2, and 5 years (92.2%, 80.3%, 80.9% respectively).
- The 2-year BSID(T)D assessment showed stronger prediction for cognitive delay (AUC 0.88) and IQ scores (R²=46%) at 5 years compared to the 1-year assessment (AUC 0.77, R²=36%).
Conclusions:
- The 1-year BSID(T)D assessment has limited predictive value for preschool cognitive outcomes.
- The 2-year BSID(T)D assessment is a more effective predictor of cognitive development at preschool age.
- Combining 1- and 2-year BSID(T)D assessments provides the optimal prediction for preschool cognitive outcomes.
Aim:
We aimed to assess a longitudinal trajectory of very preterm infants from corrected 1-5 years and examined how well performances on the Bayley Scales of Infant and (Toddler) Development (BSI(T)D) at 1 and 2 years predict cognitive outcome at preschool age.
Methods:
From 2011 to 2018, 499 very preterm infants admitted to the Medical University of Innsbruck were assessed. Cognitive outcomes at 1 and 2 years were measured with BSID-II/BSITD-III, and at 5 years, full scale intelligence quotient (IQ) was evaluated.
Results:
Of the 499 infants, 345 (69.1%) completed assessments at all three time points. Most had normal cognitive outcomes: 92.2% at 1 year, 80.3% at 2 years and 80.9% at 5 years. The 2-year assessment demonstrated a stronger predictive value than the 1-year assessment, both for identifying cognitive delay at 5 years (< 85 points; AUC 0.88 vs. 0.77) and for predicting full-scale IQ scores in linear regression models (R2 = 46% vs. 36%).
Conclusion:
The 1-year assessment had limited predictive value, whereas the 2-year assessment more effectively predicted preschool cognitive outcomes. A combination of BSITD at 1 and 2 years gave the best prediction at preschool age.
