Bayley Assessment Results Analysis for Prematurely Born Babies Dr Chrisantha Halahakoon Lead – Long term follow up group By

Dr Chrisantha Halahakoon Objectives Purpose of the project Reasons for the follow up Inclusion Criteria Assessors and Assessments Results Conclusions /way forwards

Dr Chrisantha Halahakoon Why – Follow up Pre-terms are at a greater risk for developmental impairment Outcome is poorly predicted from the neonatal course Monitoring long term morbidity is an important function of neonatal care. Inform ethical debate regarding treatment of babies – Borderline viability

Dr Chrisantha Halahakoon Purpose/Reasons Health status at two years as a Perinatal outcome Quality control purposes Effect of the care on long term development ? Analysis to seek social differences such as deprivation Referrals to be two years if subtle developmental problems are identified

Dr Chrisantha Halahakoon What do we know already 6 years  41% moderately to severe impaired group compared to classmates (-2SD)  31% have mild cognitive impairment (-1SD to -2SD) IQ is directly proportionate to gestational age Boys have a grater risk for impairment than girls At a greater risk for more subtle longer term deficits The above is mirrored often with developmental 2 years.

Dr Chrisantha Halahakoon Inclusion Criteria Babies born in SSBCNN < 31 weeks or birth weight < 1250 gms. Assessors were trained for Bayley III

Dr Chrisantha Halahakoon About Bayley III Widely used standardised developmental test- Gold Std. Test mental (MDI) & psychomotor (PDI) development – aged months Consists of three administered scales  Cognitive scale  Language scale: Receptive & expressive  Motor scale: Fine & Gross Caregiver questionnaires

Dr Chrisantha Halahakoon About Bayley III ctd.. It has derived scores – Raw score – Scaled scores –Composite Scores –Confidence interval –Percentile rank –Developmental age equivalent –Growth scores Scaled Scores represent a child’s performance on a subset relative to his or her same- age peers

Dr Chrisantha Halahakoon Analysis Criteria Relation of Scaled Scores to standard deviations StdRange of ScoreState of Performance  -3SD: 1Severe Impairment  -2SD:2-4Moderate Impairment  -1SD:5-7 Mild Impairment  Mean & above8-19Good Good Validity and Reliability -3SD – predicting later Severe Disability & impaired IQ -3SD to -2SD should also be identified as an at risk group

Data corresponding to: New Borns Birth YearNos Babies Babies Babies Babies Babies Babies Babies No Year5 Babies

Dr Chrisantha Halahakoon

Summary of Morbidity Data 11 Babies Gestation Weeks of total 85 Babies with Morbidity IDGestationGenderBirth Year Birth Weight Hear Imp Hear Imp Unaid Hear Imp Aid TPNSpDiatGastro Sp Diet TextMalfor mation (Birth) Malf Impairs (Two Yrs) AntiCon vu FitsVp Shunt Resp Continu al Support Resp Ltd Exer Toler Treat BlindBlind No Corr Visual Prob 33921Wks 0 Days ?? Wks 4 Days Wks 4 Days Wks 5 Days Wks 3 Days Wks 5 Days Severe Gastro-oesophageal Wks Days Wks 0 Days Wks 2 Days Gastro oesophageal reflux - feeding difficulties Wks 4 Days Wks 4 Days Total Number with Morbidity (% calculated for the Gestation Group) 1 (9.09%) 0002 (18.18) 1 (9.09%) 002 (18.18% 01 (9.09%) 10 (90.90%)

Dr Chrisantha Halahakoon Summary of Morbidity Data 20 Babies Gestation: Weeks of total 85 Babies with Morbidity IDGestationGenderBirth Year Birth Weight Hear Imp Hear Imp Unaid Hear Imp Aid TPNSpDiatGastro Sp Diet TextMalfor mation (Birth) Malf Impairs (2Yrs) AntiCo nvu FitsVp Shunt Resp Continual Support Resp Ltd Exer Toler Treat BlindBlind No Corr Visual Prob 1226Wks Days Wks Days Lactose free Wks 0 Days Wks 1 Days Wks 4 Days Wks 5 Days Wks 6 Days Wks 6 Days Paedisure overnight feeds Wks Days Wks Days Wks 0 Days Wks 1 Days Wks 2 Days Wks 4 Days Wks 4 Days Wks 4 Days Wheat free Wks 4 Days Has Nissan Fundoplication for sliding hiatus hernia, has severe oesophagitis requiring oesophageal dilation 3-4 weekly Wks 5 Days Wks 5 Days Wks 5 Days paediasure plus fibre Total Number with Morbididy Total Number with Morbidity (% calculated for the Gestation Group) 5 (25%)1 (5%)4 (20%)5 (25%) 3 (15%)1 (5%)0 2 (10%) 005 (25%)

Dr Chrisantha Halahakoon Babies With Morbidity and CP IDGestationGenderBirthYearBirthWeightNeurological DiagNeuro Status Hear Imp Sp Diet Mal formation FitsVp Shu nt Resp Ltd Exer Tol Supp BlindBlind Not Corr Visual Prob Add. Of Morb % of Mob of 17 CP Babies 32929Wks 5 Days Hemiplegia: Right sidedHe Wks 5 Days Hemiplegia: Left sidedHe (2) Wks Days Spastic bilateral: 2 limb involvementDi Wks 3 Days Spastic bilateral: 2 limb involvementDi Wks 3 Days Spastic bilateral: 2 limb involvementDi Wks 6 Days Spastic bilateral: 2 limb involvementDi Wks 0 Days Spastic bilateral: 2 limb involvementDi (5) Wks 5 Days Spastic bilateral: 3 limb involvementTr (1) Wks 3 Days Spastic bilateral: 4 limb involvementQu (5.88%) 46130Wks Days Spastic bilateral: 4 limb involvementQu Wks Days Spastic bilateral: 4 limb involvementQu Wks Days02008 Spastic bilateral: 4 limb involvementQu Wks Days Spastic bilateral: 4 limb involvementQu Wks 6 Days Spastic bilateral: 4 limb involvementQu Wks 4 Days Spastic bilateral: 4 limb involvementQu (8) (64.70%) 48824Wks 5 Days Not classifiable?(1) (29.41%)

Dr Chrisantha Halahakoon Babies With CP but no Morbidity IDGestationGenderBirthYearBirthWeightNeurological DiagNeuro Status % of Babies in Each category out of13 Cases 50929Wks 4 Days Hemiplegia: Right sided1_He 30526Wks 3 Days Hemiplegia: Right sided1_He 33727Wks 4 Days Hemiplegia: Right sided1_He 40327Wks 2 Days Hemiplegia: Right sided1_He 39032Wks 1 Days Hemiplegia: Left sided1_He 16727Wks Days Hemiplegia: Left sided1_He 41324Wks Days Hemiplegia: Left sided1_He7(53%) 6028Wks Days Spastic bilateral: 2 limb involvement2_Di 49331Wks Days Spastic bilateral: 2 limb involvement2_Di 41929Wks 6 Days Spastic bilateral: 2 limb involvement2_Di 16530Wks 1 Days Spastic bilateral: 2 limb involvement2_Di4(31%) 3730Wks 2 Days Spastic bilateral: 4 limb involvement4_Qu 43027Wks Days Spastic bilateral: 4 limb involvement4_Qu2(15%)

Dr Chrisantha Halahakoon Progress in 2014 Parents and carers Questionnaire DNA Parents and carers Questionnaire Forming Links with Health Visitors

Good outcome in Majority Difficult to draw conclusion (Sample size) Data Quality issues (missing data/ Participation of all Hospitals)/Deaths Feedback for neonatologists Dr Chrisantha Halahakoon

Way Forwards Implementation of Parent carer Questionnaires To obtain information from health Visitors

Dr Chrisantha Halahakoon