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

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

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

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 done @ two years if subtle developmental problems are identified Dr Chrisantha Halahakoon

Dr Chrisantha Halahakoon What do we know already Epicure-Trial @ 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 impairment@ 2 years. Dr Chrisantha Halahakoon

Dr Chrisantha Halahakoon What do we know already Epicure-Trial @ 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 impairment@ 2 years. Dr Chrisantha Halahakoon

Dr Chrisantha Halahakoon Inclusion Criteria / Training Babies born in SSBCNN < 31 weeks or birth weight < 1250 gms. Follow up group assessment record Parent information leaflet Letter to send over to other Trusts Assessors were trained for Bayley III Dr Chrisantha Halahakoon

Dr Chrisantha Halahakoon About Bayley III Widely used standardised developmental test- Gold Std. Test mental (MDI) & psychomotor (PDI) development – aged 1- 42 months Consists of three administered scales Cognitive scale Language scale: Receptive & expressive Motor scale: Fine & Gross Caregiver questionnaires Dr Chrisantha Halahakoon

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

Dr Chrisantha Halahakoon Analysis Criteria Relation of Scaled Scores to standard deviations Std Range of Score State of Performance -3SD: 1 Severe Impairment -2SD: 2-4 Moderate Impairment -1SD: 5-7 Mild Impairment Mean & above 8-19 Good Good Validity and Reliability -3SD – Best @ predicting later Severe Disability & impaired IQ -3SD to -2SD should also be identified as an at risk group Dr Chrisantha Halahakoon

Data corresponding to: Newborns 2006- 61 Babies 2009- 99 Babies General Statistics WkRange Gender Number of Baby Count By Gestation 24Wks TO 25Wks Female 2 3 Male 1 25Wks TO 26Wks 5 26Wks TO 27Wks 11 Not Recorded 27Wks TO 28Wks 6 14 28Wks TO 29Wks 9 20 8 29Wks TO 30Wks 16 40 18 30Wks TO 31Wks 19 45 7 31Wks TO 32Wks 32Wks TO 33Wks 4 33Wks TO 34Wks 34Wks TO 35Wks Data corresponding to: Newborns 2006- 61 Babies 2009- 99 Babies Summary Baby Boys 66 Baby Girls Gender Not Recorded 28 Total Babies 160 Total Babies not Assessed 8 Total Babies Assessed & Analysed 152 Total number of Records

Dr Chrisantha Halahakoon Cognitive Scaled Statistics Cognitive Category of Progress Number of Cases 1. Severe Cognitive Impairment 7 (4.61%) 2. Moderate Cognitive Impairment 4 (2.62%) 3. Mild Cognitive Impairment 20 (13.17%) 4. Good Cognitive Progress 121 (79.60%) Dr Chrisantha Halahakoon

Dr Chrisantha Halahakoon Fine Motor Scale Fine Motor Scaled No. Of Cases 1. Severe Fine Motor Impairment 6 (4%) 2. Moderate Fine Motor Impairment 3. Mild Fine Motor Impairment 30 (20%) 4. Good Fine Motor Progress 108 (72%) Not Recorded 2 Gross Motor Scale Gross Motor Scaled No Of Cases 1. Severe Gross Motor Impairment 15 (10.27%) 2. Moderate Gross Motor Impairment 11 (7.53%) 3. Mild Gross Motor Impairment 26 (17.81%) 4. Good Gross Motor Progress 94 (64.39%) Not Recorded 6 Dr Chrisantha Halahakoon

Dr Chrisantha Halahakoon Expressive Language Expressive Language Scaled No Of Cases 1. Severe Expressive Impairment Language 3 (1.98%) 2. Moderate Expressive Language Impairment 17 (11.24) 3. Mild Expressive Language Impairment 31 (20.55%) 4. Good Expressive Language Progress 100 (66.23%) Not Recorded 1 Receptive Language Receptive Language Scaled No. Of Cases 1. Severe Receptive Language Impairment 3 (1.98%) 2. Moderate Receptive Language Impairment 10 (6.62%) 3. Mild Receptive Language Impairment 33 (21.86%) 4. Good Receptive Language Progress 105 (69.54%) Not Recorded 1 Dr Chrisantha Halahakoon

Dr Chrisantha Halahakoon Summary of Other Disabilities (25 Babies) of the total of analysed 152 cases Child No. GestWksDays Gender Gastro special diet Neurology seizures Neuromotor neurological diagnosis Vision blind Vision visual problems Gastro Special Diet Text 160 31 Wks 0 Days Female 1   156 29 Wks 0 Days 154 30 Wks 0 Days Male under investigation for gastroaesophageal reflux 139 28 Wks 5 Days 135 110 29 Wks 5 Days 109 30 Wks 3 Days Unrecorded 101 27 Wks 5 Days 100 26 Wks 3 Days 99 31 Wks 5 Days 87 30 Wks Days 81 30 Wks 5 Days 80 29 Wks 6 Days 79 26 Wks 0 Days Lactose free 78 70 27 Wks 1 Days 67 25 Wks 0 Days 55 54 26 Wks 5 Days 25 17 8 24 Wks 5 Days Severe Gastro-oesophageal 6 5 27 Wks 4 Days Has Nissan Fundoplication for sliding hiatus hernia, has severe oesophagitis requiring oesophageal dilation 3-4 weekly 3 Total 4 11 15 Dr Chrisantha Halahakoon

Dr Chrisantha Halahakoon BAPM Data SET Link to the Analysis Results File Dr Chrisantha Halahakoon

Dr Chrisantha Halahakoon Conclusions… Lessons……. Issues……. Suggestions ……Changes…..Requests Coming this far is a great Achievement Team work Good outcome in Majority Difficult to draw conclusion (Sample size) Data Quality issues (missing data/ Participation of all Hospitals)/Deaths DNAs for assessments – Suggestions for improvement Feedback for neonatologists Instigate actions to get information of transferred babies to other hospitals Dr Chrisantha Halahakoon

Dr Chrisantha Halahakoon Thank you Questions???? Dr Chrisantha Halahakoon