Abstract
Purpose: To assess the predictive validity of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) cognitive scores at 6 months of corrected age (CA) for cognitive outcomes at 24 months of CA in very-low-birth-weight (VLBW) infants and investigate the predictors of change in cognitive outcomes.Methods: We retrospectively evaluated VLBW children enrolled in the Taiwan Premature Infant Follow-up Network between 2010 and 2015 and completed the Bayley-III at CA of 6 and 24 months. The predictive validity of the cognitive performance at 6-month CA for the cognitive outcomes at 24-month CA was analyzed. The positive and negative predictive factors were also evaluated using logistic regression. Cut-off scores of <70 and <85 were used to identify lower functioning groups based on the Bayley-III definition.Results: A total of 2,972 VLBW children, born with a mean weight of 1116.4 ± 257.5 g and mean gestational age of 29.0 ± 2.8 weeks, were evaluated. A cognitive score of <70 at 6-month CA had a positive predictive value (PPV) of 27.4% (95% confidence interval [CI]: 19.2–35.7%) for a cognitive score of <70 at 24-month CA, while the negative predictive value (NPV) was 97.3% (95% CI: 96.7–97.9%). A cut-off score of 85 had a PPV of 33.6% (95% CI: 28.1–39.0%) and an NPV of 87.7% (95% CI: 86.4–88.9%). Abnormal muscle tone at 6 months was a risk factor for cognitive function decline at 24 months for both Bayley-III cognitive cut-off scores: scores of 70 (adjusted odds ratio [AOR]: 2.8; 95% CI: 1.5–5.5) and 85 (AOR: 2.6; 95% CI: 1.6–4.1). Lower maternal socioeconomic status was associated with a worsening of the cognitive function in infants at 24 months who scored ≥85 at 6 months (AOR: 1.6; 95% CI: 1.2–2.0).Conclusion: Subnormal Bayley-III cognitive scores at 6-month CA were not predictive of subnormal cognitive function at 24-month CA. In children with normal cognition during early infancy, abnormal muscle tone and lower maternal socioeconomic status may influence the cognitive developing process; this highlighted the importance of early identification of high risk infants and complete preterm infant-associated public health policies to promote an improved neurodevelopmental outcome.
Highlights
Advances in perinatal and neonatal care have markedly improved the survival of very-low-birth-weight (VLBW, ≤1,500 g) infants [1,2,3]
We focused on the cognitive scale, which estimates general cognitive functioning based on non-verbal activities involving memory, problem solving, and manipulation
Of the 6,850 VLBW infants born between 2010 and 2015, 866 (12.6%) infants did not survive till hospital discharge, and 48 (0.7%) infants with major congenital anomalies and 21 (0.3%) infants with major congenital heart disease were excluded (Figure 1)
Summary
Advances in perinatal and neonatal care have markedly improved the survival of very-low-birth-weight (VLBW, ≤1,500 g) infants [1,2,3]. Do the surviving VLBW infants experience high rates of short-term neonatal morbidities, but they are at a high risk of long-term neurodevelopmental impairment [4]. Intervention may improve cognitive and motor outcomes at infancy [8], highlighting the importance of regular neurodevelopmental monitoring and screening of VLBW infants after hospital discharge and the need for a reliable, sensitive screening tool to identify developmental deficits in early infancy. The Bayley Scales of Infant Development has been widely used for the early identification and quantification of developmental delay and for determining eligibility for early intervention services in high-risk infants. The Bayley Scales of Infant and Toddler Development, 3rd Edition (Bayley-III) [9] has been updated to include index scores for cognitive, language, and motor domains
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