THE PAEDIATRIC NEURODEVELOPMENTAL ASSESSMENT AND THE BAYLEY

SCALES OF INFANT DEVELOPMENT AT 18 MONTHS CORRECTED AGE IN

PREMATURE INFANTS: HOW DO THEY COMPARE?

TM Luu, J Vachon, MA Berry, SP Riley

Neonatal Follow-Up Clinic, Montreal Children's Hospital, Montreal, Quebec

BACKGROUND: The Bayley scales of infant development (BSID-II) are currently being
performed at 18 months corrected age (CA) by the consortium de recherché sur les
enfants nés extrêmement prématurés au Québec to assess developmental functioning.
We hypothesize that a thorough neurodevelopmental (ND) evaluation by experienced
paediatricians is sufficient to detect significant disabilities at this age.
OBJECTIVES: (1) To compare the paediatric evaluation with the Mental Developmental
Index (MDI) and the Psychomotor Developmental Index (PDI) of the BSID-II in
determining ND impairment at 18 months CA in extremely premature infants. (2) To
describe the behavioural portrait of this population.
METHODS: Forty-five of 48 surviving preterm infants born <29 weeks of gestational age
(GA) at McGill University Hospital Centres in 2003 were available for assessment
between 18-22 months CA using the BSID-II and a structured ND examination based on
modified Denver and Palisano evaluations. Developmental delay was defined as an
abnormal ND examination by the paediatrician and as MDI or PDI scores <70. Results
of the paediatric assessment and the BSID-II were compared. Scores <25th percentile
on the behavioural scales of the BSID-II were considered sub-optimal.
RESULTS: To date, results for 40 children are available. Mean GA was 27±1.16 weeks,
mean birth weight was 979±223 grams. Twenty-one (52.5%) children had
developmental delay on the ND assessment, including 8 (20%) with definite or
suspected cerebral palsy. Mean MDI was 69 (95% CI:39,99); mean PDI was 73 (95%
CI:42,104). Almost 1/4 of the patients had sub-optimal behaviour on the
orientation/engagement scale and 1/3 on the emotional regulation scale of the BSID-II.

MDI
Paediatric assessment <70 70-84 ≥ 85
Developmental delay 17 4 1
Normal development 3 9 5
n=39 (1 did not complete all MDI tasks), chi-square for trend = 12.4,
p<0.01

PDI
<70 70-84 ≥ 85
Paediatric assessment Developmental delay 10 7 3
 Normal development 2 6 9
n=37 (3 did not complete all PDI tasks), chi-square for trend = 8.00,
p<0.01

CONCLUSIONS: In this cohort, there was good agreement between the paediatric
assessment and the BSID-II in determining severely abnormal and normal
neurodevelopment at 18 months CA. Furthermore, a significant proportion of this
population demonstrated behavioural difficulties. Hence, allocation of scarce health care
resources may be better served by offering behavioural counselling to parents of
premature infants at this age and delaying formal determination of developmental
quotient to the preschool period for assessment of educational needs