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Correction for prematurity and its consequences for the assessment of the very low birth weight infant
Insights
Correcting developmental test scores for prematurity is appropriate in early infancy. Uncorrected scores provide more accurate predictions of later development and developmental delay after the first year.
Area of Science:
- Developmental Psychology
- Pediatric Neurodevelopment
- Biostatistics
Background:
- Premature infants often exhibit developmental delays compared to full-term infants.
- Assessing neurodevelopmental outcomes in preterm children requires careful consideration of biological maturity.
- Standardized developmental tests may not adequately account for the effects of prematurity.
Purpose of the Study:
- To investigate the impact of correcting developmental test scores for prematurity.
- To compare the predictive validity of corrected versus uncorrected scores.
- To determine the optimal timing for applying prematurity corrections in developmental assessments.
Main Methods:
- Two cohorts of matched preterm and full-term infants were studied.
- Children were administered various developmental assessments (Bayley Scales, Stanford-Binet, etc.) at multiple ages (4 months to 5 years).
- Scores were analyzed with and without correction for degree of prematurity.
Main Results:
- Uncorrected scores were consistently lower in preterm infants, except for some language measures at 5 years.
- Corrected scores were lower early in development but not significantly different at 5 years, except for the Beery VMI.
- Corrected scores showed higher correlations with later test scores in the first year; uncorrected scores showed higher correlations from 12 months onward.
Conclusions:
- Correction for prematurity is appropriate in the initial months of development.
- Using uncorrected scores after the first year offers slightly more accurate prediction of later outcomes and developmental delay.
- Early test scores reflect biological maturity, while environmental influences become more prominent with development.
Abstract:
The consequences of correcting developmental test scores for the degree of prematurity were studied in 2 cohorts of children each composed of demographically matched groups of preterm and full-term infants. The children were administered the Bayley Scales at 4, 8, 12, 18, and 24 months of age; the Stanford-Binet at 3 years; the Reynell Developmental Language Scales at 2, 3, and 4 years; and the McCarthy Scale of Children's Abilities, the ITPA Grammatic Closure, the Northwestern Syntax Screening Test, the Beery Developmental Test of Visual Motor Integration, and the Peabody Picture Vocabulary Test at 5 years. At each point in time, except some language measures at 5 years, the uncorrected scores of the preterms were significantly lower than those of the full-terms. Although the corrected scores were significantly lower early in development, they were not lower at 5 years, with the exception of the Beery VMI, a measure of perceptual-motor skills. In the first year the corrected scores were typically more highly correlated with 3-year and 5-year test scores. From 12 months on the uncorrected scores were usually more highly correlated. The same pattern was evident for the prediction of developmental delay. Correction for degree of prematurity appears to be appropriate in the first few months. After that point, slightly more accurate prediction is achieved by using the uncorrected scores. Early test scores are significantly influenced by the degree of biological maturity, but the impact of environmental influences increases with development.