Bayley Scales of Infant and Toddler Development, 3rd edition (BSID-III) Article Summary
Title: Association Between Moderate and Late Preterm Birth and Neurodevelopment and Social-Emotional Development at Age 2 Years
Authors: Jeanie L. Cheong, MD; Lex W. Doyle, MD; Alice C. Burnett, PhD; Katherine J. Lee, PhD; Jennifer M. Walsh, MD; Cody R. Potter, PhD; Karli Treyvaud, PhD; Deanne K. Thompson, PhD; Joy E. Olsen, PhD; Peter J. Anderson, PhD; Alicia J. Spittle, PhD
Citation: Cheong JL, Doyle LW, Burnett AC, et al. Association Between Moderate and Late Preterm Birth and Neurodevelopment and Social-Emotional Development at Age 2 Years. JAMA Pediatrics. 2017;171(4). doi:10.1001/jamapediatrics.2016.4805.
Purpose: Prematurity has long been noted as a risk factor for potential developmental issues for children. Previously, many studies have focused on the developmental outcomes for very preterm children (<32 weeks’ gestation). However, often under-recognized is the association between moderate and late preterm (MLPT) births (32-36 weeks’ gestation) and increased risk of developmental problems when compared to their term-born peers. Given that the largest percentage of preterm infants are MLPT, even small adverse outcomes in this population can lead to increased public health concern. Thus, a better understanding of the developmental delays common to MLPT children is needed for improved monitoring, recognition and intervention for these children. Therefore, the purpose of this study was to compare MLPT children and term-born children at 2 years corrected age to determine if differences exist regarding neurosensory outcomes along with cognitive, language, motor, and social-emotional development. Within the MLPT group, further exploration was given to determine if developmental differences existed based on age.
Study Population: MLPT infants (32-36 weeks’ completed gestation) and healthy term-born infants (>37 week’s gestation and birth weight ³ 2500 g). MLPT infants were excluded if genetic syndromes with known effects on development or genital abnormalities were present. Term infants were excluded if resuscitation was received at birth, were admitted to neonatal nursery, were unwell at birth, or were determined to have conditions that could affect growth or development.
Methods/Outcome Measures: Two hundred and one infants were recruited for each the MLPT and the term-born control group. At the 2-year assessment, cerebral palsy, blindness and deafness were determined by a pediatrician. If cerebral palsy was present, the topography and severity was determined using the Gross Motor Function Classification Scale. Visual acuity of less than 6/60 in the better eye determined blindness and the requirement of amplification, a cochlear implant or worse determined deafness. Bayley Scales of Infant Development- Third Edition was utilized to determine impairments in cognitive, language and motor development. Developmental delays were noted as less than -1 SD relative to the mean for the control group for any domain. The Infant Toddler Social Emotional Assessment (ITSEA), a parent-reported questionnaire, was utilized to assess any present social-emotional or behavioral problems. Assessors who were unaware of group allocation and were skilled in neurological as well as the Bayley-III, assessed cognitive, language, motor, and social-emotional development.
Results: The two-year outcomes showed that from the MLPT group, 2 children had cerebral palsy (one with hemiplegia, one with quadriplegia), and there was no blindness or deafness determined among children in either group. Results showed that according to the Bayley-III, children within the MLPT group had poorer cognitive, language, and motor development compared to term-born controls, evident by a mean difference of 0.7 SD. Language development appeared to be most impacted of all domains. Poorer social-emotional development was also seen in the MLPT group, while there were similar findings between controls and MLPT children in the behavioral domains. Within the MLPT group, small differences were found between gestational age at birth with relation to developmental delays.
Strengths: The number of children who participated in this study along with the high follow up rates strengthen the conclusion of this study. The use of the Bayley-III along with the ITSEA allowed for evaluation of various developmental domains by using direct assessments in addition to questionnaires. The high follow up rates and use of direct standard assessments in the MLPT population for assessment of developmental delays is unique to this study.
Limitations: The primary limitation of this study was the involvement of infants from a single tertiary hospital, which may have included higher risk or sicker MLPT infants. This factor may limit the generalizability of this study’s findings to the general population.
Conclusion: The evidence from this study suggest that impairments in neurodevelopment and social-emotional development in MLPT children are greater than in their term-born peers, especially in the language domain. These findings can be used to improve developmental delay surveillance in this population as well as early intervention.
2 responses to “Bayley Scales of Infant and Toddler Development, 3rd edition (BSID-III) Article Summary”
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This is such an interesting article summary with a lot of good information! I think it’s great that this study took such an understudied population (32-36 weeks gestation premature babies) and found significant outcomes from these measures, as compared to full term and age-matched children. I found it appropriate that this study didn’t just utilize parent-reported questionnaires, but that they also included objective and standardized outcome measures to supplement and support the questionnaires. What types of implications do you think this study could have on pediatric PTs for this population? Do you think that with more research pertaining to this topic, pediatric PTs will see an increased case load with this patient population?
I believe that PT’s having the knowledge that MLPT children are at an increased risk for developmental delays, especially in the neurodevelopment domain, will allow for increased surveillance in this population and can allow for earlier PT intervention if deemed necessary. If more children were provided with earlier PT intervention, I believe this would increase the case load for pediatric therapists.