Bayley-III Scales Research Articles

Neuroimaging young children and associations with neurocognitive development in a South African birth cohort study

Magnetic resonance imaging (MRI) is an indispensable tool for investigating brain development in young children and the neurobiological mechanisms underlying developmental risk and resilience. Sub-Saharan Africa has the highest proportion of children at risk of developmental delay worldwide, yet in this region there is very limited neuroimaging research focusing on the neurobiology of such impairment. Furthermore, paediatric MRI imaging is challenging in any setting due to motion sensitivity. Although sedation and anesthesia are routinely used in clinical practice to minimise movement in young children, this may not be ethical in the context of research. Our study aimed to investigate the feasibility of paediatric multimodal MRI at age 2–3 years without sedation, and to explore the relationship between cortical structure and neurocognitive development at this understudied age in a sub-Saharan African setting. A total of 239 children from the Drakenstein Child Health Study, a large observational South African birth cohort, were recruited for neuroimaging at 2–3 years of age. Scans were conducted during natural sleep utilising locally developed techniques. T1-MEMPRAGE and T2-weighted structural imaging, resting state functional MRI, diffusion tensor imaging and magnetic resonance spectroscopy sequences were included. Child neurodevelopment was assessed using the Bayley-III Scales of Infant and Toddler Development. Following 23 pilot scans, 216 children underwent scanning and T1-weighted images were obtained from 167/216 (77%) of children (median age 34.8 months). Furthermore, we found cortical surface area and thickness within frontal regions were associated with cognitive development, and in temporal and frontal regions with language development (beta coefficient ≥0.20). Overall, we demonstrate the feasibility of carrying out a neuroimaging study of young children during natural sleep in sub-Saharan Africa. Our findings indicate that dynamic morphological changes in heteromodal association regions are associated with cognitive and language development at this young age. These proof-of-concept analyses suggest similar links between the brain and cognition as prior literature from high income countries, enhancing understanding of the interplay between cortical structure and function during brain maturation.

Thyroid function in preterm infants and neurodevelopment at 2 years

ObjectivesPostnatal thyroid dysfunction is common in preterm infants but the relationship between mild dysfunction and neurodevelopment is unclear. Our aim is to describe the relationship between thyroid function and neurodevelopment.DesignCohort...

Parental age effects on neonatal white matter development

ObjectiveAdvanced paternal age is associated with poor offspring developmental outcome. Though an increase in paternal age-related germline mutations may affect offspring white matter development, outcome differences could also be due to psychosocial factors. Here we investigate possible cerebral changes prior to strong environmental influences using brain MRI in a cohort of healthy term-born neonates. MethodsWe used structural and diffusion MRI images acquired soon after birth from a cohort (n = 275) of healthy term-born neonates. Images were analysed using a customised tract based spatial statistics (TBSS) processing pipeline. Neurodevelopmental assessment using the Bayley-III scales was offered to all participants at age 18 months. For statistical analysis neonates were compared in two groups, representing the upper quartile (paternal age ≥38 years) and lower three quartiles. The same method was used to assess associations with maternal age. ResultsIn infants with older fathers (≥38 years), fractional anisotropy, a marker of white matter organisation, was significantly reduced in three early maturing anatomical locations (the corticospinal tract, the corpus callosum, and the optic radiation). Fractional anisotropy in these locations correlated positively with Bayley-III cognitive composite score at 18 months in the advanced paternal age group. A small but significant reduction in total brain volume was also observed in in the infants of older fathers. No significant associations were found between advanced maternal age and neonatal imaging. ConclusionsThe epidemiological association between advanced paternal age and offspring outcome is extremely robust. We have for the first time demonstrated a neuroimaging phenotype of advanced paternal age before sustained parental interaction that correlates with later outcome.

Cerebral Palsy in Children With Congenital Zika Syndrome: A 2-Year Neurodevelopmental Follow-up.

To describe the 2-year neurodevelopmental outcome in children with cerebral palsy associated with congenital Zika (CZ) and explore variables associated with a more severe presentation. Data on 69 children with cerebral palsy associated with CZ, followed in a neurorehabilitation hospital, who consecutively attended the neurodevelopmental assessment at 2 years of age, were collected. Bayley III Scales of Infant and Toddler Development, Hammersmith Infant Neurological Examination, and Gross Motor Function Classification System were used for the outcome evaluation. Descriptive and inferential statistical analysis were performed. The median age at follow-up was of 24.0 (23-32) months. Only 3 (4.3%) children were not microcephalic. The majority presented with bilateral (94.2%), spastic (100.0%), Gross Motor Function Classification System grade IV or V (92.8%) cerebral palsy, epilepsy (73.1%), extremely low performances on cognitive (94.2%), language (95.7%), and motor (95.7%) Bayley-III Scales of Infant and Toddler Development Test scores. The median Hammersmith Infant Neurological Examination score was of 21.0 (range 9-75). There was a correlation between birth head circumference with the cognitive (r = 0.3, P < .01), language (r = 0.3, P < .01), and motor (r = 0.3, P < .01) Bayley-III Scales of Infant and Toddler Development Test scores, as well as with the Hammersmith Infant Neurological Examination score (r = 0.2, P < .03). An association was observed between an inferior median Hammersmith Infant Neurological Examination score with congenital microcephaly (P = .04), arthrogryposis (P = .02), and epilepsy in the first year (P < .01). Cerebral palsy related to CZ presents with a severe global impairment at a 2-year follow-up. Birth head circumference, arthrogryposis, and early epilepsy are associated with a worse outcome and may be considered as prognostic markers. These findings are important for the neurorehabilitation planning, parents' guiding, and future prognostic studies.

P.105INCEPTUS pre-phase 1, prospective, non-interventional, natural history run-in study to evaluate subjects aged 4 years and younger with X-linked myotubular myopathy (XLMTM)

XLMTM is a rare disease caused by mutations in the MTM1 gene, leading to profound muscle weakness, respiratory failure and early death. INCEPTUS (NCT02704273) is a prospective, non-interventional study in patients (pts) ≤4 years old to characterize the course and natural history of XLMTM using neuromuscular and respiratory assessments and to identify adverse events (AEs). INCEPTUS will generate within-pt control data to support a Phase 1/2 gene therapy clinical trial (ASPIRO). As of 22MAR19, 32 male pts (0.3-4.6 years of age) have been enrolled and assessed every 3 months for up to 24 months. There were 3 deaths and 61 serious AEs, mainly due to respiratory tract infections. neuromuscular function is severely compromised. Children's Hospital of Philadelphia Infant test of neuromuscular disorders (CHOP INTEND) was performed in all pts. Mean CHOP INTEND scores show a 2.7-point annual decline from baseline (mean [SD, min-max]= 33.3 [8.1, 17-52]) to month 12 (30.6 [5.8, 19-40]). A healthy pt may score a maximum of 64 points. Developmental milestones (per Bayley-III scales) were evaluated if pts scored >45 points on the CHOP INTEND or if they were able to sit. In INCEPTUS, 27 pts (87%) have no or very poor head control, a motor milestone typically reached by 4 months of age in healthy pts. Similarly, while healthy pts can roll by 5 months, none of the INCEPTUS pts achieved this milestone. Only 3 pts (9%) in INCEPTUS were able to sit without assistance >30 seconds. Most pts (n=24, 75%) require invasive ventilatory support; 21 pts for 24h/day. Respiratory muscle strength measured as maximum inspiratory pressure (MIP, cmH2O) is very low at baseline (34.5 [12.2, 17.6-64.5]) and declines by 6.3 cmH2O over 12 months' follow-up (28.3 [7.9, 15.1-41.4]). INCEPTUS prospectively demonstrates that neuromuscular and respiratory functions are severely impaired and slowly worsen over time in pts ≤4 years old, reinforcing that XLMTM is a severe, life-threatening childhood disorder.

Risk and protective factors for child development: An observational South African birth cohort.

BackgroundApproximately 250 million (43%) children under the age of 5 years in low- and middle-income countries (LMICs) are failing to meet their developmental potential. Risk factors are recognised to contribute to this loss of human potential. Expanding understanding of the risks that lead to poor outcomes and which protective factors contribute to resilience in children may be critical to improving disparities.Methods and findingsThe Drakenstein Child Health Study is a population-based birth cohort in the Western Cape, South Africa. Pregnant women were enrolled between 20 and 28 weeks’ gestation from two community clinics from 2012 to 2015; sociodemographic and psychosocial data were collected antenatally. Mothers and children were followed through birth until 2 years of age. Developmental assessments were conducted by trained assessors blinded to background, using the Bayley-III Scales of Infant and Toddler Development (BSID-III), validated for use in South Africa, at 24 months of age. The study assessed all available children at 24 months; however, some children were not able to attend, because of loss to follow-up or unavailability of a caregiver or child at the correct age. Of 1,143 live births, 1,002 were in follow-up at 24 months, and a total of 734 children (73%) had developmental assessments, of which 354 (48.2%) were girls. This sample was characterised by low household employment (n = 183; 24.9%) and household income (n = 287; 39.1% earning <R1,000 per month), and high prevalence of maternal psychosocial risk factors including alcohol use in pregnancy (n = 95; 14.5%), smoking (n = 241; 34.7%), depression (n = 156; 23.7%), lifetime intimate partner violence (n = 310; 47.3%), and history of maternal childhood trauma (n = 228; 34.7%). A high proportion of children were categorised as delayed (defined by scoring < −1 standard deviation below the mean scaled score calculated using the BSID-III norms from a United States population) in different domains (369 [50.5%] cognition, 402 [55.6%] receptive language, 389 [55.4%] expressive language, 169 [23.2%] fine motor, and 267 [38.4%] gross motor). Four hundred five (55.3%) children had >1 domain affected, and 75 (10.2%) had delay in all domains. Bivariate and multivariable analyses revealed several factors that were associated with developmental outcomes. These included protective factors (maternal education, higher birth weight, and socioeconomic status) and risk factors (maternal anaemia in pregnancy, depression or lifetime intimate partner violence, and maternal HIV infection). Boys consistently performed worse than girls (in cognition [β = −0.74; 95% CI −1.46 to −0.03, p = 0.042], receptive language [β = −1.10; 95% CI −1.70 to −0.49, p < 0.001], expressive language [β = −1.65; 95% CI −2.46 to −0.84, p < 0.001], and fine motor [β = −0.70; 95% CI −1.20 to −0.20, p = 0.006] scales). There was evidence that child sex interacted with risk and protective factors including birth weight, maternal anaemia in pregnancy, and socioeconomic factors. Important limitations of the study include attrition of sample from birth to assessment age and missing data in some exposure areas from those assessed.ConclusionsThis study provides reliable developmental data from a sub-Saharan African setting in a well-characterised sample of mother–child dyads. Our findings highlight not only the important protective effects of maternal education, birth weight, and socioeconomic status for developmental outcomes but also sex differences in developmental outcomes and key risk and protective factors for each group.

Developing routinely recorded clinical data from electronic patient records as a national resource to improve neonatal health care: the Medicines for Neonates research programme

Developing routinely recorded clinical data from electronic patient records as a national resource to improve neonatal health care: the Medicines for Neonates research programme

Effects of in-utero exposure to chemotherapy on fetal brain growth

ObjectiveChildren exposed to chemotherapy in the prenatal period demonstrate normal neurocognitive development at 3 years but concerns regarding fetal brain growth remain high considering its vulnerability to external stimuli. Our...

The association of the cerebral oxygenation during neonatal sepsis with the Bayley-III Scale of Infant and Toddler Development index scores at 18–24 months of age

BackgroundNeonatal sepsis has been associated with poor neurodevelopmental outcome, however the evidence regarding the exact mechanism of the inflammation to the developing neonatal brain are inconclusive. AimsTo investigate association between cerebral oxygenation during neonatal sepsis and neurodevelopmental outcome. Study designFollow-up assessment of a previously described prospective case-control study. SubjectsA cohort of late preterm (34–37 weeks' gestation) and preterm (<34 weeks' gestation) infants with sepsis and healthy controls, evaluated at 18–24 months of corrected gestational age with Bayley-III Scales for Infant and Toddler Development (BSID-III). Outcome measuresTo evaluate the association between cerebral tissue oxygenation index (cTOI) and fractional tissue oxygen extraction (FTOE), measured with near-infrared spectroscopy, during sepsis and the composite cognitive and motor index scores. ResultsThirty-one infants with blood culture confirmed neonatal sepsis and thirty-five controls were recruited. The cerebral oxygenation was significantly lower in septic neonates, compared to controls (61 ± 7 compared to 72 ± 5; p < 0.001). Infants with sepsis had significantly lower cognitive and motor index scores and higher proportion of suboptimal cognitive (16% compared to 3%, p = 0.045) and motor (16% compared to none, p = 0.008) index score. The low mean cTOI and FTOE noted in septic infants were significantly associated with worse cognitive and motor composite index scores. ConclusionsInfants with lower cerebral oxygenation during neonatal sepsis are at increased risk of worse cognitive and motor scores in the neurodevelopmental assessment.

Early caloric deprivation in preterm infants affects Bayley-III scales performance at 18–24 months of corrected age

BackgroundAdequate nutrition is essential for optimal neurodevelopment to preterm infants. Our aim was to evaluate the impact of caloric deprivation on Bayley-III scales performance at 18–24 months of corrected age, in a cohort of preterm infants. MethodsWe prospectively enrolled infants with gestational age <30 weeks and birth weight <1500 g. Apart from a whole cohort analysis, we performed a subgroup analysis between infants received inadequate calories (<85 Kcal/kg/day) during the first two weeks of age, compared to a standard nutrition group. All infants underwent a Bayley-III assessment at 18–24 months of corrected age. ResultsFrom the 63 preterm infants analysed, 25% had caloric deprivation compared to 75% with adequate nutrition. Caloric deprived infants were of lower gestational age and birth weight, and received a lower amount of enteral feeding during the first 14 days of age. There were no differences between the two groups regarding the common neonatal co-morbidities. Caloric deprived infants had significantly lower composite index scores at 18–24 months of corrected age. Caloric deprivation, late onset sepsis, necrotizing enterocolitis, and bronchopulmonary dysplasia were significant risk factors of neurodevelopmental impairment. ConclusionsSeveral neonatal factors affect the neurodevelopmental outcome of preterm infants, and nutrition may pose an important role.

HIV Exposure Without Infection Impacts Early Language Development: Outcomes from a South African Birth Cohort Study

Background: Whereas HIV infection is known to cause developmental delay, effects of HIV and antiretroviral drugs (ARVs) in HIV-exposed uninfected (HEU) children are unclear. We compared developmental outcomes of HEU and HIV-unexposed uninfected (HUU) children during their first 2 years of life in the South African population-based Drakenstein Child Health cohort study. Methods: Between 2012-2015, pregnant women were enrolled antenatally in a peri-urban setting. Mothers and children received HIV testing and ARVs per local guidelines. Developmental assessments were conducted blinded to HIV/ARV status, using the Bayley-III Scales of Infant and Toddler Development(BSID-III). Of 1143 live births, 1065(93%) children were in follow-up at 6 months and 1000(87%) at 24 months excluding two HIV-infected children. 260(24%) randomly selected children (61 HEU, 199 HUU) had BSID-III assessments at 6 months and 732(73%)(168 HEU, 564 HUU) at 24 months. All HEU children were exposed to ARVs (88% to maternal triple antiretroviral therapy). Outcomes were similar for HEU and HUU children at 6 months (p>0·10). At 24 months, HEU children scored lower than HUU in receptive language (adjusted difference -1·03, 95% confidence interval[CI] -1·69 to -0·37) and expressive language (-1·17, 95%CI -2·09 to -0·24); in contrast, cognitive, fine and gross motor domains were similar (all p>0·24). Corresponding to this, HEU children had higher proportions of developmental delay (score<-2SD) compared to HUU in receptive (14%vs7%, adjusted odds ratio[aOR] 1·96, 95%CI 1·09 to 3·52) and expressive language(11%vs6%, aOR 2·14, 95%CI 1·11 to 4·15). Interpretation: We found uninfected children exposed to maternal HIV and ARVs had two-fold increased odds of receptive and expressive language delay at two years. Given almost a quarter of South African children are HIV-exposed, and the importance of language in society, further long-term work to understand developmental outcomes of HEU children is needed. Funding Statement: The study was funded by the Bill & Melinda Gates Foundation [OPP 1017641]. Additional support for HJZ, DJS and KAD was provided by the South African Medical Research Council. CJW is supported by the Wellcome Trust through a Research Training Fellowship [203525/Z/16/Z]. KAD is additionally supported by the NRF, an Academy of Medical Sciences Newton Advanced Fellowship (NAF002/1001) funded by the UK Government’s Newton Fund, by NIAAA via (R21AA023887), by the Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD) developmental grant (U24 AA014811), and by the US Brain and Behaviour Foundation Independent Investigator grant (24467). AMR is additionally supported by the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement which is also part of the EDCTP2 programme supported by the European Union grant reference (MR/R010161/1). WB is supported by the SAMRC National Health Scholars programme. Declaration of Interests: The authors state: No conflicts of interest. Ethics Approval Statement: The study was approved by the Faculty of Health Sciences, Human Research Ethics Committee, University of Cape Town (401/2009 and 044/2017) and the London School of Hygiene & Tropical Medicine Observational/Interventions Research Ethics committee (11903).

Residue Levels of Organochlorine Pesticides in Breast Milk and Its Associations with Cord Blood Thyroid Hormones and the Offspring's Neurodevelopment.

Previous studies have demonstrated that organochlorine pesticide (OCP) exposure has a negative impact on the neurological function of infants. Only a few reports have investigated the thyroid and growth hormones and their relationship to neurodevelopment after human exposure to OCPs, especially in the case of infants. Our goal was to determine whether breastmilk OCP residues were associated with negative impacts and/or alterations in the neurodevelopment of infants among specific southern Taiwanese mother–breastfed infant pairs. Our subjects (n = 55 pairs) were recruited from southern Taiwan between 2007 and 2010. The thyroid and growth hormone levels in the cord blood samples collected after childbirth were determined. The breastmilk was gathered within one month after childbirth for the determination of OCP levels using a high-resolution gas chromatograph with mass spectrometry, and the neurodevelopment of 10–12-month-old infants was examined using the Bayley Scales of Infant and Toddler Development®, Third Edition (Bayley-III). It was observed that 4,4′-dichlorodiphenyl-dichloroethylene (4,4′-DDE) (mean = 10.3 ng/g lipid) was the most predominant OCP compound in the breastmilk samples. At higher concentrations (>75th percentile), specific OCPs were associated with significantly lower levels of thyroid and growth hormones than at lower concentrations (<75th percentile). Significantly higher odds ratios (ORs) were observed for binary cognitive (OR = 8.09, p = 0.025 for 4,4′-DDT), language (OR = 11.9, p = 0.013 for 4,4′-DDT) and social–emotional (OR = 6.06, p = 0.01 for trans-CHL) composite scores for specific OCPs belonging to the lower exposure group as compared to the higher OCP exposure group. The five domain Bayley-III infant neurodevelopment outcomes were negatively associated with specific OCPs in the breast milk samples based on the redundancy analysis (RDA) test. Bayley-III scales, which include cognitive, language, motor, social-emotional, and adaptive behavior scales, could be predicted by 4,4′-DDT, endrin, endosulfan I, heptachlor, or heptachlor epoxide using multivariate linear regression models with adjustment for maternal age, pre-pregnant BMI, parity, and infant gender. In conclusion, although our study showed that postnatal exposure to breast milk OCPs may be associated with infant neurodevelopmental outcomes and that prenatal exposure, if extrapolated from breastmilk levels, is associated with changes in thyroid and growth hormones that may have effects on neurodevelopment, these associations are only suggestive; thus, further studies are recommended for confirmation.

Clinical and neurodevelopmental features in children with cerebral palsy and probable congenital Zika

ObjectiveTo describe the neurological and neurodevelopmental features at 1 year of age in children with cerebral palsy (CP) related to probable congenital Zika (CZ), followed in a referral neurorehabilitation hospital. MethodsData on 82 children with CP associated with probable CZ, who consecutively attended the neurodevelopmental and neurological assessment around one year of age, were collected. For neurodevelopmental evaluation, Bayley-III Scales of Infant and Toddler Development was used. Descriptive statistical analysis was performed. ResultsThe children were admitted into the rehabilitation program at a young age (mean age: 4.8 months, SD 3.1), followed beyond the first year of life (mean age of follow up: 13.2 months, SD 2.1), born to young mothers (mean age: 28.1 years, SD 5.9), in their first pregnancy (62.2%). The majority had severe congenital microcephaly (62.0%), spastic CP (96.3%), epilepsy (63.4%), absent expected postural reactions (93.2%), abnormal persistence of primitive reflexes (94.7%), and severe neuroimaging abnormalities, predominantly calcifications (97.6%). Extremely low performances on cognitive (95.1%), language (97.6%) and motor (97.6%) developmental composite scores were observed. There was a correlation between the cognitive score with the birth head circumference (HC) (r = 0.3, p = 0.01) and with the follow up HC (r = 0.4, p < 0.01), as well as between the follow up HC with the motor score (r = 0.2, p = 0.03). ConclusionCongenital Zika may be associated with a severe form of CP, mainly bilateral spastic, with a severe global neurodevelopmental impairment and early signs of a poor prognosis for independent walking. Head circumference may be a prognostic marker among those children. These results may help establish goals for the rehabilitation program and identify priority health services.

Does early object exploration support gesture and language development in extremely preterm infants and full-term infants?

BackgroundAn increasing body of research on typically and atypically developing infants has shown that motor skills play an important role in language development. To date, however, the role of specific object exploration skills for early gesture and vocabulary development has not been investigated in extremely low gestational age infants (ELGA, GA < 28 weeks), who are at greater risk for motor and language delays than full-term (FT) infants. PurposeThis longitudinal study examined relations between 6-month active exploratory behaviors and 12- month word comprehension, gestures and vocal production, controlling for cognitive performance and neonatal condition (ELGA vs FT). MethodsForty infants, 20 ELGA and 20 FT, and their mothers participated in the study. Mother-infant play interaction was video-recorded at 6 and 12 months. Oral and manual object exploration at 6 months and spontaneous gestures and vocal production at 12 months were coded. Word comprehension was evaluated with the Italian version of the MacArthur-Bates CDI parent questionnaire at 12 months. Cognitive performance was examined with the Griffiths Mental Developmental Scales at 6 months and the Bayley-III Scales at 12 months. ResultsRegression analyses showed that after accounting for cognitive performance and neonatal condition, oral exploration was related to word comprehension, and manual exploration to gestures and vocal production in the overall sample. ConclusionsCascading effects of specific object exploration skills on gestures and language comprehension and production in preterm infants and FT infants are discussed. Clinical implications for early assessment of and interventions involving object exploration skills, which may affect language development, are considered for the preterm population.

Assessment of neurodevelopment in children of different gestational age with neonatal seizures

To assess psychomotor development in infants with neonatal seizures (NS) born with different gestational age, by means of Bayley-III scales of infant and toddler development, in their corrected age of 1 year. The study included 52 infants, who had NS and were born with different gestational age: 28 weeks or less (n=26) - group I, 29-32 weeks (n=16) - group II, 33-36 weeks (n=3) - group III, 37-41 weeks (n=7) - group IV. The infants' neurodevelopment was evaluated in their corrected age of 1 year by means of N. Bayley scales of infant and toddler development, third edition: Cognitive, Language, Motor, Social-Emotional, and Adaptive Behavior. Only 17 (32,7%) of 52 examined infants did not demonstrate any developmental delay on each of five Bayley-III scales. Significant developmental delay (composite score <70) on at least one scale was revealed in 23 (44,2%) patients, including 12 (46,2%) in group I, 5 (31,3%) in group II, 6 (60%) of 10 in the combined group III-IV. In most cases, neurodevelopmental delays were attributed to only one domain and could be indicated as partial. The conclusion about global developmental retardation (the composite scores 55 or less on all five scales) was done in 3 patients, each of whom had a co-morbidity of cerebral palsy and epilepsy.

Neurodevelopmental outcome of Italian preterm children at 1 year of corrected age by Bayley-III scales: An assessment using local norms

BackgroundPremature birth is often associated with neurodevelopmental difficulties throughout childhood. In the first three years of life, the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) constitute one of the most used tools for assessing child development. Since Bayley-III original norms are based on United States (US) population, it remains uncertain whether their use in other countries (e.g., European) is appropriate. AimsThis research aimed to examine neurodevelopment of preterm infants and full-term infants, using Bayley-III US norms in comparison to Italian (IT) norms. Patterns of developmental outcomes for both infant groups were also explored. Methods104 preterm and 58 full-term infants were included in the study. Bayley-III was used for neurodevelopmental assessment at 1year of corrected age, considering both IT and US norms for scores computation. ResultsComparing scores obtained with IT vs US norms, differences in means were all significant across five subscales (p<0.05 at least) for preterm infants, whereas for full-term peers significant differences were found only for Receptive Language and Fine Motor subscales (p<0.001). Effect size (η2) ranged from 0.22 to 0.94. Within each group, significant discrepancies across subscales were found. Moreover, Italian preterm infants had significantly lower performances than full-term peers, excepting for Expressive Language and Gross Motor subscales. ConclusionsAs regards to Italian 1-year children, our study seems to provide evidence for the tendency of Bayley-III US norms to overestimate development compared to IT norms. These findings emphasize the need to early detect children at risk for developmental delay and to plan early intervention.

Parenting stress trajectories in mothers of very preterm infants to 2 years

ObjectiveTo examine levels of parenting stress in mothers of preterm and term infants when the children were 2 years old; to determine the trajectory of stress over three time periods...

A Longitudinal Study of Motor and Cognitive Development in Infants With Congenital Idiopathic Clubfoot

It was the aim of this study to examine the motor and cognitive development of infants with congenital idiopathic clubfoot, compared with typically developing infants. We repeatedly tested the gross motor, fine motor, and cognitive abilities of 12 infants with clubfoot and 12 typically developing infants at the ages of 4, 6, 9, and 12 months with the Bayley-III Scales. All infants with clubfoot were treated with the Ponseti method, which led to a restriction of normal movements of the lower extremities in the first months of life. They showed a great delay in gross motor development but not in fine motor or cognitive development. However, in the clubfoot group, we found some slight deficits in specific cognitive tasks, including problem solving and spatial memory. In addition, our results revealed significant correlations between gross and fine motor performance and cognitive performance in the control group but only between fine motor and cognitive performance in infants with clubfoot, indicating that both, fine and gross motor skills, are related to cognitive processes and can mutually replace each other to a certain degree. Further research is needed to gain a deeper understanding of clubfoot infants’ development and to clarify the need for mobility training.

Assessment of Preterm Infants Using the Bayley-III Scales in Korea.

ObjectiveTo assess the well-being of preterm newborns using the Bayley-III scales in a Korean-based population, and to evaluate the perinatal risk factors influencing developmental outcome.MethodsUsing the Bayley-III scales, we assessed 120 preterm infants who were referred for evaluation of neurodevelopmental performance. We subdivided them into an extremely preterm group (n=18) and a very/moderate to late preterm group (n=102). Bayley-III mean scores and the rate of infants showing a delay were compared for both groups. The relationship between perinatal risk factors and Bayley-III scores was analyzed. The risk factors were considered as very low birth weight, history of neonatal medical problems, and abnormal radiologic findings in brain magnetic resonance images (MRIs).ResultsAlthough no significant differences in mean scores were observed between the extremely preterm group and the very/moderate to late preterm group, the rate of babies showing developmental delay in motor composite scores was significantly higher in the extremely preterm group. The proportions of preterm infants with cognitive, language, and motor delays were 38.3%, 26.7%, and 35.0%, respectively. Very low birth weight was a significant risk factor for low cognitive, language, and motor composite scores. Also, abnormal radiologic findings on brain MRI were significant indicators of lower motor composite scores.ConclusionCognitive development was the most frequently delayed domain in preterm infants and motor development was more frequently delayed in the extremely preterm group. The very low birth weight and abnormal radiologic findings in brain MRI were predictive factors for neurodevelopmental outcome.

Assessing developmental delay in early childhood — concerns with the Bayley-III scales

Objective: Early detection of children with developmental delay is crucial for determining which children require close surveillance and intervention services. For many decades, the Bayley Scales has been the most widely used objective measure of early developmental delay, both in clinical and research settings. Significant structural changes were incorporated in the most recent edition, the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). This article reviews the psychometric properties of the Bayley-III and investigates criticisms raised on the Bayley-III, namely that it overestimates developmental status and is a poor predictor of later functioning. Method: This critical review examines the literature on the Bayley-III, which was released in 2006. Results: The Cognitive, Language, and Motor composites of the Bayley-III overestimate development, resulting in an under-identification of children with developmental delay. A range of strategies have been proposed for dealing with the inflated scores on the Bayley-III, none of which are ideal. Evidence to date suggests that the Bayley-III is a poor predictor of later cognitive and motor impairments. Conclusions: The Bayley-III needs new norms, or alternatively, it may be time for a new edition of the Bayley Scales.