Journal
PEDIATRICS
Volume 135, Issue 5, Pages E1258-E1265Publisher
AMER ACAD PEDIATRICS
DOI: 10.1542/peds.2014-3039
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Funding
- National Health and Medical Council [284512, 1053767, 1081288]
- National Health and Medical Council (Centre of Research Excellence) [1060733]
- Cerebral Palsy Alliance
- Murdoch Children's Research Institute
- Myer Foundation
- Allens Arthur Robinson
- Thyne Reid Foundation
- Victorian Government's Operational Infrastructure Support Program
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BACKGROUND: This study aimed to assess the sensitivity and specificity of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III), Cognitive and Language scales at 24 months for predicting cognitive impairments in preterm children at 4 years. METHODS: Children born,30 weeks' gestation completed the Bayley-III at 24 months and the Differential Ability Scale, Second Edition (DAS-II), at 4 years to assess cognitive functioning. Test norms and local term-born reference data were used to classify delay on the Bayley-III Cognitive and Language scales. Impairment on the DAS-II Global Conceptual Ability, Verbal, and Nonverbal Reasoning indices was classified relative to test norms. Scores, 21 SD relative to the mean were classified as mild/moderate delay or impairment, and scores, 22 SDs were classified as moderate delay or impairment. RESULTS: A total of 105 children completed the Bayley-III and DAS-II. The sensitivity of mild/moderate cognitive delay on the Bayley-III for predicting impairment on DAS-II indices ranged from 29.4% to 38.5% and specificity ranged from 92.3% to 95.5%. The sensitivity of mild/moderate language delay on the Bayley-III for predicting impairment on DAS-II indices ranged from 40% to 46.7% and specificity ranged from 81.1% to 85.7%. The use of local reference data at 24 months to classify delay increased sensitivity but reduced specificity. Receiver operating curve analysis identified optimum cut-point scores for the Bayley-III that were more consistent with using local reference data than Bayley-III normative data. CONCLUSIONS: In our cohort of very preterm children, delay on the Bayley-III Cognitive and Language scales was not strongly predictive of future impairments. More children destined for later cognitive impairment were identified by using cut-points based on local reference data than Bayley-III norms.
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