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Outcomes assessments should reflect the dynamic and contextual nature of early childhood development

Pediatric Research volume 95, pages 613–614 (2024)Cite this article

In this issue of Pediatric Research, Neel et al. present the results of their study, “Bayley trajectories predict school readiness better than single assessments in formerly very preterm preschoolers.”1 Using repeated measures of child development assessed between 6 and 35 months in a single center, the authors demonstrate that baseline Bayley scores plus score trajectories during early childhood predict school readiness at age 4–5 years better than either baseline or trajectory values individually. This conceptually and methodologically robust analysis has important implications for clinical prediction, individual expectation- and goal-setting, and health and education systems design and service delivery.

Accurate and reliable estimations of health and developmental outcomes are of critical importance for parents of infants born preterm and the clinicians who care for them. This is crucial not only for the practicalities of care planning but to allow families to envision their children’s futures, as well. Yet, outcome prediction is an imperfect science, at best. Variably using data available at the time of birth, the first hours of life, and the hospital course, many have attempted to build models to predict neurodevelopmental outcomes in early childhood. Computational complexities, narrow focus on discrete test scores rather than function, and short time horizon limit the clinical utility of existing prediction models.2 And when based on patient data drawn from single centers or geographic regions with homogenous populations, prediction models may not be generalizable nor equitably applicable more broadly, especially those using more sophisticated machine learning approaches.3

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References

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Authors and Affiliations

  1. Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Jonathan S. Litt & Paige Terrien Church

  2. Department of Pediatrics, Harvard Medical School, Boston, MA, USA

    Jonathan S. Litt & Paige Terrien Church

  3. Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA

    Jonathan S. Litt

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  1. Jonathan S. Litt
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  2. Paige Terrien Church
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J.S.L. conceived and drafted the initial manuscript. P.T.C. critically reviewed the manuscript draft and made intellectual and substantive contributions to the work. Both authors approved the final manuscript.

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Correspondence to Jonathan S. Litt.

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Litt, J.S., Church, P.T. Outcomes assessments should reflect the dynamic and contextual nature of early childhood development. Pediatr Res 95, 613–614 (2024). https://doi.org/10.1038/s41390-023-02816-7

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