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  • Clinical Research Article
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Bayley trajectories predict school readiness better than single assessments in formerly very preterm preschoolers

Pediatric Research volume 94, pages 1392–1399 (2023)Cite this article

Abstract

Background

Development of children born very preterm (VPT) is evaluated using the Bayley Scales of Infant Development. Early Bayley scores may not predict later outcomes. We studied whether VPT Bayley trajectories in the early years predicted school readiness better than single assessments.

Methods

We prospectively evaluated 53 VPT at 4–5 years using standardized measures of school readiness, including the domains of cognition, early mathematical and literacy abilities, and motor skills. Predictors were Bayley-III scores obtained 1–5 times/child between 6 and 35 months. Linear mixed models (LMM) with random effects extracted estimated random effect for slope (change in Bayley score/1 year) and fixed+random effect sum for the intercept (initial Bayley score) for each participant, to then evaluate 4–5-year outcomes prediction.

Results

Variability of individual trajectories prevailed across developmental domains. For the initial LMM, adding Bayley change to models with only initial score improved model fits for several Bayley-III domains. Models containing estimates for initial Bayley scores and Bayley change explained significantly more variability in school readiness scores (21–63%) than either variable alone.

Conclusion

Neurodevelopmental follow-up of VPT is more relevant to school readiness when children are assessed multiple times in the first 3 years. Neonatal intervention research could use early trajectories rather than single timepoints as outcomes.

Impact

  • This study is the first to examine individual Bayley scores and trajectories to predict school readiness of formerly preterm children at 4–5 years.

  • Modeling demonstrated extreme variability of individual trajectories compared to the group’s average trajectories.

  • Models containing initial Bayley scores and Bayley change over time explained more variability in preschool readiness than either variable alone.

  • Using the Bayley to predict future school readiness is enhanced by administration across multiple follow-up visits and inclusion of change across the first 3 years.

  • Follow-up care models and clinical trial design for neonatal interventions may benefit from a trajectory-based approach to outcomes evaluation.

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Fig. 1: Individual variability in Bayley-III scores across time as compared to the group average.

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Data availability

Non-identifiable data are available on reasonable request for 5 years after the study conclusion from the corresponding authors.

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Acknowledgements

The authors acknowledge the assistance of project coordinators Kerry Orton and Stephanie Burkhardt and research staff members Lelia Emery, Sandra Glazer, Hanan Guzman, Kaleigh Hague, Brianna Laney, Julia Less, Katelyn Levengood, Megan Lightfoot, Sharon McConnell, Ashley Miller, Gabrielle Moots, Caitlin Kjeldsen, Lindsay Pietruszewski, Jessica Purnell, and Brianna Sowers. We thank Guy Brock, PhD, for lending his expertise and suggesting references for the statistical approach, and Lauren Capaci for her assistance in manuscript preparation. We also thank our families for participating. Without their participation, none of this work would be possible.

Funding

Support for this study was provided by the Abigail Wexner Research Institute at Nationwide Children’s Hospital.

Author information

Author notes

  1. These authors contributed equally: Mary Lauren Neel, Sara Conroy.

Authors and Affiliations

  1. Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Mary Lauren Neel & Nathalie L. Maitre

  2. Center for Perinatal Research, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA

    Sara Conroy & Rachelle Srinivas

  3. Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Sara Conroy

  4. Biostatistics Resource at Nationwide Children’s Hospital, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA

    Sara Conroy

  5. Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, USA

    Hudson Gerry Taylor, Aryanne de Silva & Tyler Busch

  6. Center for Biobehavioral Health, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA

    Hudson Gerry Taylor, Aryanne de Silva & Tyler Busch

  7. Department of Neonatology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA

    Ann R. Stark

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Contributions

M.L.N. was responsible for study design, data collection and data analysis, and writing the initial and final drafts. S.C. was responsible for study design, data analysis, writing the initial and final drafts, and creating the tables. R.S. was responsible for data collection, data analysis, and revising the manuscript. H.G.T. was responsible for study design, data collection, data analysis, and revising the manuscript. A.R.S. was responsible for study design, data analysis, and revising the manuscript. A.d.S. was responsible for study design, data collection, and revising the manuscript. T.B. was responsible for data collection and revising the manuscript. N.L.M. was responsible for study design, data collection and analysis, and drafting and revising the manuscript.

Corresponding author

Correspondence to Mary Lauren Neel.

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Neel, M.L., Conroy, S., Srinivas, R. et al. Bayley trajectories predict school readiness better than single assessments in formerly very preterm preschoolers. Pediatr Res 94, 1392–1399 (2023). https://doi.org/10.1038/s41390-023-02656-5

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