Poor predictive validity of the Bayley Scales of Infant Development for cognitive function of extremely low birth weight children at school age

Objective. The Bayley Scales of Infant Development, Second Edition (BSID II) are commonly used to assess outcomes of extremely low birth weight (ELBW) infants. We sought to assess the predictive validity of the BSID II Mental Developmental Index (MDI) for cognitive function at school age. Design/Methods. Of 330 ELBW infants admitted in 1992-1995, 238 (72%) survived to the age of 8 years, of whom 200 (84%) were tested at both 20 months' corrected age (CA) and 8 years. Mean birth weight was 811 g, mean gestational age was 26.4 weeks, 41% were boys, and 60% were black. Measures included the BSID II at 20 months' CA and the Kaufman Assessment Battery for Children (KABC) Mental Processing Composite (MPC) at 8 years' postnatal age. BSID II MDI and MPC scores were compared and the predictive validity calculated for all 200 ELBW children and for the 154 ELBW neurosensory-intact subgroup. Predictors of stability or change in cognitive scores were examined via logistic regression adjusting for gender and sociodemographic status. Results. For all ELBW children, the mean MDI was 75.6 [+ or -] 16 versus a mean KABC of 87.8 [+ or -] 19. For the neurosensory-intact subgroup, the mean MDI was 79.3 [+ or -] 16 and the mean KABC was 92.3 [+ or -] 15. Rates of cognitive impairment, defined as an MDI or KABC of 70. Conclusions. The predictive validity of a subnormal MDI for cognitive function at school age is poor but better for ELBW children who have neurosensory impairments. We are concerned that decisions to provide intensive care for ELBW infants in the delivery room might be biased by reported high rates of cognitive impairments based on the use and presumptive validity of the BSID II MDI. Pediatrics 2005;116:333-341; extremely low birth weight, prematurity, outcome, prediction, intelligence, school age. ABBREVIATIONS. ELBW, extremely low birth weight; MDI, Mental Developmental Index; BSID II, Bayley Scales of Infant Development, Second Edition; CA, corrected age; MPC, Mental Processing Composite; SES, socioeconomic status; CI, confidence interval; VLBW, very low birth weight.
The increased survival of infants of extremely low birth weight (ELBW) in the 1990s, which resulted from advances in perinatal care, has been accompanied by high rates of neonatal complications [...]