1. Bayley Assessment Results Analysis for Prematurely Born BabiesBy
Dr Chrisantha Halahakoon
Lead – Long term follow up group

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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

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

11. 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
Babies
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

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

13. Dr Chrisantha Halahakoon
Fine Motor Scale
Fine Motor Scaled
No. Of Cases
1. Severe Fine Motor Impairment
(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
(10.27%)
2. Moderate Gross Motor Impairment
(7.53%)
3. Mild Gross Motor Impairment
(17.81%)
4. Good Gross Motor Progress
(64.39%)
Not Recorded 6
Dr Chrisantha Halahakoon

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

15. 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

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

17. 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

18. Dr Chrisantha Halahakoon
Thank you
Questions????
Dr Chrisantha Halahakoon