T Moore

Relationship between test scores using the second and third editions of the Bayley Scales in extremely preterm children.

OBJECTIVE To define the relationship between current Bayley Scales of Infant and Toddler Development, Third edition (Bayley-III) scores and the Bayley Scales of Infant Development, second edition Mental Development Index (MDI) to aid the comparison of population outcomes. STUDY DESIGN MDI and Bayley-III cognitive/language scales were administered concurrently in 185 extremely preterm children (≤26 weeks) at 29-41 months of age. Cognitive and language scores were combined (combined Bayley-III score [CB-III scores]) for comparison with MDI scores. RESULTS Bayley-III cognitive and language scores were 10 and 3 points higher than MDI scores, respectively; CB-III scores were 7 points higher. The relationship between CB-III and MDI scores was not a simple offset: CB-III values were increasingly higher than MDI at lower scores. Bayley-III scores underidentified MDI scores <70 (sensitivity 58%; specificity 100%). An algorithm for converting Bayley-III scores into MDI scores improved predictive value (sensitivity 95%; specificity 97%). Bayley-III scores <80 were similarly predictive (sensitivity 89%; specificity 99%). CONCLUSIONS We recommend caution in the interpretation of Bayley-III scores in population studies as the correlation with the previous edition appears worse at lower test score values and the predictive value for IQ is as yet unclear.

Using the Bayley-III to assess neurodevelopmental delay: which cut-off should be used?

Background:As the latest edition of the Bayley Scales (Bayley-III) produces higher scores than its predecessor (BSID-II), there is uncertainty about how to classify moderate–severe neurodevelopmental delay. We have investigated agreement between classifications of delay made using the BSID-II and Bayley-III.Methods:BSID-II Mental Development Index (MDI) and Bayley-III cognitive and language scales were administered in 185 extremely preterm (<27 wk) children. A combined Bayley-III score (CB-III) was computed. Agreement between delay classified using MDI scores <70 and various Bayley-III cut-offs was assessed.Results:Bayley-III cognitive and language scores were close to the normative mean and were higher than BSID-II MDI scores. Nineteen (10.2%) children had MDI <70. Bayley-III scores <70 significantly underestimated the proportion with MDI <70. Bayley-III cognitive and language scores <85 had 99% agreement with MDI <70 and underestimated delay by 1.1%. CB-III scores <80 had 98% agreement and produced the same proportion with delay.Conclusion:Bayley-III cognitive and language scores <85 or CB-III scores <80 provide the best definition of moderate-severe neurodevelopmental delay for equivalence with MDI <70. CB-III scores have the advantage of producing a single continuous outcome measure but require further validation. The relative accuracy of both tests for predicting long-term outcomes requires investigation.

Screening for Autism in Extremely Preterm Infants: Problems in Interpretation.

Aim  The aim of this article was to report the prevalence of, and risk factors for, positive autism screens using the Modified Checklist for Autism in Toddlers (M‐CHAT) in children born extremely preterm in England.

Screening for autism in extremely preterm infants: problems in interpretation.

Aim  The aim of this article was to report the prevalence of, and risk factors for, positive autism screens using the Modified Checklist for Autism in Toddlers (M‐CHAT) in children born extremely preterm in England.

The bayley-III cognitive and language scales: how do scores relate to the bayley ii?

Background The widely used Mental Developmental Index (MDI) of the Bayley Scales of Infant Development-II has recently been superseded by the Bayley-III – in which cognitive and language development are assessed separately. Comparing developmental outcomes between cohorts assessed using two different editions of this test is problematic. Aims To compare MDI and Bayley-III cognitive and language scores, evaluate the agreement between classifications of disability made using the two tests, and develop an algorithm for converting Bayley-III scores into corresponding MDI scores. Methods 185 children (derived from a sub-cohort of the EPICure-2 study) aged 29–41 months were administered the MDI and Bayley-III concurrently. An average of Bayley-III cognitive and language scores (CB-III score) was calculated for comparison with MDI scores. Results Bayley-III cognitive, language and CB-III scores were 3-, 10- and 7-points higher respectively than MDI scores, but the relationship was non-linear: the CB-III progressively overestimated developmental scores at lower MDI scores. Using a conventional cut-off score <70, CB-III scores under-detected developmental impairment compared with the MDI (sensitivity 58%, specificity 100%). Predictive validity was improved using a CB-III cut-off <80 (sensitivity 89%, specificity 99%). An algorithm was derived for transforming CB-III scores into MDI-equivalent scores, with further improvement in classification of children with MDI<70 (sensitivity 95%, specificity 97%). Conclusions Caution should be exercised in classifying developmental outcomes using the Bayley-III for research purposes. To produce equivalent identification of children who would have an MDI <70, we recommend using a CB-III scores <80 or predicted-MDI scores <70.

The epicure studies: better survival, better outcomes?

Background Despite increases in survival after extremely preterm (EP) birth, it is unclear whether the prevalence of neurodevelopmental morbidity has changed. Aim To compare the prevalence of disability between national cohorts of EP children born in 1995 and 2006, respectively. Methods Independent assessors evaluated children born at 25 weeks of gestation or less in England in 1995 (EPICure) and 2006 (EPICure-2). Bayley-III scores were adjusted to produce MDI-equivalent scores for comparison purposes. Results Of the 260 eligible children in the EPICure cohort, 235 (90%) underwent formal neurodevelopmental assessment at 29–36 months corrected age. In the EPICure-2 cohort, 325/586 (55%) children were assessed at 27–48 months. Use of antenatal steroids, surfactant and effective hypothermia prevention were higher and postnatal steroid use lower in the 2006 cohort compared to 1995 births. Multiple imputation to correct for selective dropout revealed no differences in severe disability (18.9% vs 19.9% respectively) or cerebral palsy (20.1% vs 19.9%). Conclusions Despite improved survival and reduced early morbidity in EP children between 1995 and 2006, we were unable to detect significant improvements in neurodevelopmental morbidity during early childhood. Abstract 12.3 Table 1 EPICure (1995) n=235 EPICure-2 (2006) n=325 p Gestational age (weeks) 22/23 10% 12% 0.74 24 32% 30% 25 58% 58% Moderate/Severe Disability (%) Cognitive 26% 20% 0.08 Motor 24% 20% 0.23 Vision 13% 9% 0.14 Hearing 3% 6% 0.09 Overall 40% 34% 0.10 Cerebral palsy 19% 18% 0.63 Severe disability 18% 18% 0.96

Growth attainment in extremely preterm children-has it changed over time? the epicure 2 study

Background Children born extremely preterm have poor growth attainment; it is not known whether recent advances in neonatal care have led to an improvement. Aim To compare SD scores of growth parameters at 35 months corrected age for children born ≤25 weeks in England in 1995 (EPICure) and 2006 (EPICure-2). Methods Measures of height (ht), weight (wt), head circumference (HC) and mid upper arm circumference (MUAC) were taken as part of a neurodevelopmental assessment. Body mass index (BMI) and SD scores were calculated using British Growth Foundation normative data. Results In 2006 325/586 (55%) of survivors ≤25 week were seen, of whom 98% had growth measures. Weight, height, MUAC and BMI were all significantly improved at 35 months corrected age compared to the 1995 EPICure cohort (table 1). There was no significant difference in HC. Improvement in weight gain was due to greater post-discharge growth. Abstract PB.01 Table 1 Comparison of growth SD scores at 2.5-3 years n EPICure (1995) n EPICure2 (2006) p Wt 223 −1.19 (−1.37, −1.02) 317 −0.67 (−0.82, −0.52) <0.001 HC 229 −1.64 (−1.83, −1.45) 319 −1.78 (−1.94, −1.61) 0.29 Ht 214 −0.65 (−0.83, −0.49) 303 −0.40 (−0.57, −0.23) <0.05 BMI 209 −1.06 (−1.25, −0.87) 301 −0.59 (−0.78, −0.40) <0.001 MUAC 229 −0.74 (−0.87, −0.62) 314 −0.43 (−0.52, −0.33) <0.001 Conclusion There has been a significant improvement since 1995 in all growth parameters except HC at 35 months corrected age. Improved weight gain at 35 months was attributable to post-discharge catch-up growth.

Screening for autism in extremely preterm infants: potential pitfalls

Objectives Recent studies using screening tests have raised concern of a high prevalence of autism in extremely preterm children. However, the specificity of screening in infancy may be confounded by the high prevalence of neuro-developmental sequelae in this population. The authors have investigated neuro-developmental correlates of positive autism screening in extremely preterm infants. Method All babies born <27 weeks gestational age in England in 2006 were recruited to the EPICure 2 study. Parents of 559 (55%) survivors completed the modified checklist for autism in toddlers (M-CHAT) to screen for autistic features, the Parent Report of Childrens Abilities—Revised to screen for cognitive disability and questionnaire items to assess motor and sensory impairment at 2 years corrected age. Results Based on parent report, cognitive impairment was present in 340 (61%), motor impairment in 71 (13%), visual impairment in 10 (2%) and hearing impairment in 6 (1%) survivors. 216 (41%) screened positive for autistic features. Males were twice (OR 1.9; 95% CI 1.3 to 2.7) as likely to screen positive than females. Risk of a positive M-CHAT screen was significantly associated with motor (41.7; 12.9 to 135), cognitive (5.3; 3.5 to 8.0) and sensory impairment (p<0.005). Among 200 children without neuro-developmental disability, 33 (16.5%) had positive M-CHAT screens (3.6; 2.6 to 5.0). Conclusions A high proportion of extremely preterm infants screened positive for autistic features. Positive screens were significantly associated with neuro-developmental impairment potentially yielding a high false-positive rate. Caution should be observed when screening for autism in this population and results should be interpreted in light of other clinical findings. Follow-up at school age is necessary to establish autism spectrum disorder diagnoses.