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Utility of the 21-month neurodevelopmental outcome for predicting neurodevelopmental impairment at 36 months for preterm infants <29 weeks gestation



To determine the sensitivity and specificity of the 21-month neurodevelopmental outcome for predicting the presence of neurodevelopmental impairment at 36 months corrected age in a population of preterm infants under 29 weeks gestation.

Study design

This is a retrospective observational cohort study. Preterm infants born under 29 weeks gestation who were followed up at both 18–21 months and 36 months corrected age with outcome data available were enrolled.


Overall, 713 preterm infants <29 weeks gestation and were included in the final analysis. The specificity of the 21-month assessment for predicting neurodevelopmental impairment at 36 months corrected age was 66% (95% confidence interval[CI] 62–71%) with a positive predictive value of 61% (95% CI 56–66%).


In preterm neonates born <29 weeks gestation, the 18–21 months corrected neurodevelopmental outcome had low specificity and positive predictive value for predicting the presence of neurodevelopmental impairment at 36 months corrected age.

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Fig. 1


  1. Perinatal Health Indicators for Canada 2017. 2017 Available from: Accessed 16 Jul 2023.

  2. Norman M, Hallberg B, Abrahamsson T, Bjorklund LJ, Domellof M, Farooqi A, et al. Association between year of birth and 1-Year survival among extremely preterm infants in Sweden During 2004-2007 and 2014-2016. JAMA. 2019;321:1188–99.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Santhakumaran S, Statnikov Y, Gray D, Battersby C, Ashby D, Modi N, et al. Survival of very preterm infants admitted to neonatal care in England 2008-2014: time trends and regional variation. Arch Dis Child Fetal Neonatal Ed. 2018;103:F208–F215.

    Article  PubMed  Google Scholar 

  4. Varga P, Berecz B, Pete B, Kollar T, Magyar Z, Jeager J, et al. Trends in mortality and morbidity in infants under 500 grams birthweight: observations from our Neonatal Intensive Care Unit (NICU). Med Sci Monit. 2018;24:4474–80.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Synnes AR, Lefebvre F, Cake HA. Current status of neonatal follow-up in Canada. Paediatr Child Health. 2006;11:271–4.

    PubMed  PubMed Central  Google Scholar 

  6. Eliasson AC, Holmefur M. The influence of early modified constraint-induced movement therapy training on the longitudinal development of hand function in children with unilateral cerebral palsy. Dev Med Child Neurol. 2015;57:89–94.

    Article  PubMed  Google Scholar 

  7. Hendson L, Church PT, Banihani R. Follow-up care of the extremely preterm infant after discharge from the neonatal intensive care unit. Paediatr Child Health. 2022;27:359–71.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Follow-up Care of High-Risk Infants. Pediatrics 2004;114:1377–97.

  9. Weisglas-Kuperus N, Baerts W, Smrkovsky M, Sauer PJ. Effects of biological and social factors on the cognitive development of very low birth weight children. Pediatrics. 1993;92:658–65.

    Article  CAS  PubMed  Google Scholar 

  10. Creighton DE, Tang S, Newman J, Hendson L, Sauve R. Establishing Bayley-III cut-off scores at 21 months for predicting low IQ scores at 3 years of age in a preterm cohort. Paediatr Child Health. 2018;23:e163–e169.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hack M, Taylor HG, Drotar D, Schluchter M, Cartar L, Wilson-Costello D, et al. Poor predictive validity of the Bayley Scales of Infant development for cognitive function of extremely low birth weight children at school age. Pediatrics. 2005;116:333–41.

    Article  PubMed  Google Scholar 

  12. Martin JH, Chakrabarty S, Friel KM. Harnessing activity-dependent plasticity to repair the damaged corticospinal tract in an animal model of cerebral palsy. Dev Med Child Neurol. 2011;53:9–13.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bayley N. Bayley scales of infant and toddler development, third edition: technical manual, 3rd ed. Harcourt: San Antonio, TX, 2006.

  14. Wechsler D. WPPSI-III: technical and interpretative manual. The Psychological Corporation. San Antonio, TX.

  15. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39:214–23.

    Article  CAS  PubMed  Google Scholar 

  16. Synnes A, Luu TM, Moddemann D, Church P, Lee D, Vincer M, et al. Determinants of developmental outcomes in a very preterm Canadian cohort. Arch Dis Child Fetal Neonatal Ed. 2017;102:F235–F234.

    Article  PubMed  Google Scholar 

  17. Russman BS, Gage JR. Cerebral palsy. Curr Probl Pediatr. 1989;19:65–111.

    CAS  PubMed  Google Scholar 

  18. Lodha A, Zhu Q, Lee SK, Shah PS, Canadian Neonatal N. Neonatal outcomes of preterm infants in breech presentation according to mode of birth in Canadian NICUs. Postgrad Med J. 2011;87:175–9.

    Article  PubMed  Google Scholar 

  19. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978;92:529–34.

    Article  CAS  PubMed  Google Scholar 

  20. Shennan AT, Dunn MS, Ohlsson A, Lennox K, Hoskins EM. Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period. Pediatrics. 1988;82:527–32.

    Article  CAS  PubMed  Google Scholar 

  21. Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978;187:1–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Patz A. New international classification of retinopathy of prematurity. Pediatrics. 1984;74:160–1.

    Article  CAS  PubMed  Google Scholar 

  23. Trevethan R. Sensitivity, specificity, and predictive values: foundations, pliabilities, and pitfalls in research and practice. Front Public Health. 2017;5:307.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Yates R, Treyvaud K, Doyle LW, Ure A, Cheong JLY, Lee KJ, et al. Rates and stability of mental health disorders in children born very preterm at 7 and 13 years. Pediatrics. 2020;145:e20192699.

    Article  PubMed  Google Scholar 

  25. Novak I, Morgan C, Adde L, Blackman J, Boyd RN, Brunstrom-Hernandez J, et al. Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA Pediatr. 2017;171:897–907.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Spittle A, Orton J, Anderson PJ, Boyd R, Doyle LW. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database Syst Rev. 2015;2015:CD005495.

    PubMed  PubMed Central  Google Scholar 

  27. Morgan C, Novak I, Dale RC, Guzzetta A, Badawi N. Single blind randomised controlled trial of GAME (Goals - Activity - Motor Enrichment) in infants at high risk of cerebral palsy. Res Dev Disabil. 2016;55:256–67.

    Article  PubMed  Google Scholar 

  28. Elkamil AI, Andersen GL, Hagglund G, Lamvik T, Skranes J, Vik T. Prevalence of hip dislocation among children with cerebral palsy in regions with and without a surveillance programme: a cross sectional study in Sweden and Norway. BMC Musculoskelet Disord. 2011;12:284.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Hagglund G, Andersson S, Duppe H, Lauge-Pedersen H, Nordmark E, Westbom L. Prevention of dislocation of the hip in children with cerebral palsy. The first ten years of a population-based prevention programme. J Bone Jt Surg Br. 2005;87:95–101.

    Article  CAS  Google Scholar 

  30. Scrutton D, Baird G, Smeeton N. Hip dysplasia in bilateral cerebral palsy: incidence and natural history in children aged 18 months to 5 years. Dev Med Child Neurol. 2001;43:586–600.

    Article  CAS  PubMed  Google Scholar 

  31. Novak I, Cusick A, Lannin N. Occupational therapy home programs for cerebral palsy: double-blind, randomized, controlled trial. Pediatrics. 2009;124:e606–614.

    Article  PubMed  Google Scholar 

  32. Rostami HR, Malamiri RA. Effect of treatment environment on modified constraint-induced movement therapy results in children with spastic hemiplegic cerebral palsy: a randomized controlled trial. Disabil Rehabil. 2012;34:40–44.

    Article  PubMed  Google Scholar 

  33. Marlow N, Wolke D, Bracewell MA, Samara M, Group EPS. Neurologic and developmental disability at six years of age after extremely preterm birth. N. Engl J Med. 2005;352:9–19.

    Article  CAS  PubMed  Google Scholar 

  34. Lefebvre F, Gagnon MM, Luu TM, Lupien G, Dorval V. In extremely preterm infants, do the movement assessment of Infants and the Alberta Infant Motor Scale predict 18-month outcomes using the Bayley-III? Early Hum Dev. 2016;94:13–17.

    Article  PubMed  Google Scholar 

  35. Bode MM, D’Eugenio DB, Mettelman BB, Gross SJ. Predictive validity of the Bayley, third edition at 2 years for intelligence quotient at 4 years in preterm infants. J Dev Behav Pediatr. 2014;35:570–5.

    Article  PubMed  Google Scholar 

  36. Anderson PJ, De Luca CR, Hutchinson E, Roberts G, Doyle LW. Victorian infant collaborative G. underestimation of developmental delay by the new Bayley-III Scale. Arch Pediatr Adolesc Med. 2010;164:352–6.

    Article  PubMed  Google Scholar 

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We thank the Department of Pediatrics, Alberta Children’s Hospital and Neonatal Follow-up Clinic program for ongoing research support.

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Authors and Affiliations



SMD: Conceptualization, methodology, writing initial manuscript. ST: Methodology, data curation, formal analysis, reviewed final version of the manuscript. HK: Methodology, data curation, reviewed final version of the manuscript. DC: Methodology, data interpretation, reviewed final version of the manuscript. AL: Conceptualization, methodology, supervision, reviewed final version of the manuscript.

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Correspondence to Abhay Lodha.

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The authors declare no competing interests.

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Additional Information Please note that in accordance with the Alberta Health Services Data Disclosure Agreement, we are not able to provide or make available the data for any purpose to a third party without the prior written consent of Alberta Health Services, Calgary, Alberta.

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Doucette, S.M., Tang, S., Kehler, H. et al. Utility of the 21-month neurodevelopmental outcome for predicting neurodevelopmental impairment at 36 months for preterm infants <29 weeks gestation. J Perinatol 43, 1406–1412 (2023).

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