Screen infants at risk for developmental delay or neurological impairment. Abstract. Objective: To examine the utility of the Bayley Infant Neurodevelopmental Screener (BINS) as a screening technique for premature, low birth weight. Objective To determine predictive validity of the Bayley Infant Neurodevelopmental. Screener (BINS) during the first 2 years of life with a group of children at risk.
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The BINS is a satisfactory screening tool for low birth weight infants when used in conjunction with other known biologic and social risk factors.
Although some disabilities, such as specific learning disabilities, may be subtle and not apparent until school age, other deficits such as cerebral palsy and significant developmental delay appear earlier. Early diagnosis can lead to interventions, such as physical therapy, occupational therapy, and infant stimulation programs, designed to facilitate optimal development.
Screening and assessments in the first year of life are complicated because some infants may have transient tone differences that resolve by one year, and they may be going through periods of reorganization following their hospitalization as a newborn.
The developmental course of the low birth weight infant is affected by these many factors. Several techniques can determine if the infant is making normal developmental progress: The utility of developmental screening measures is affected by many factors: Full assessments such bsyley the BSID-II Scales require 45 minutes to an hour to administer and require an advanced level of training and expertise in administration. In high-risk clinics set up to follow the growth and development of low birth weight infants, infants may receive either a neurological examination or a developmental assessment; or both examinations which have overlap in items that might be administered, particularly in assessing gross and fine motor skills.
Neuroedvelopmental items in the age ranges under study include reaching for and transferring blocks, looking for fallen items, types of vocalizations, and prewalking progression scooting, stepping movements.
The BINS also includes items that measure neurological intactness, such as ratings of active and passive tone in the upper and lower extremities, and baylfy of quality of movement of the upper and lower extremities.
The BINS was validated on a high-risk nerodevelopmental population as well as normal infants in test construction. One study has reported on its concurrent validity with two other instruments in a mixed high-risk infant term and pre-term population Macias et al.
This study examines the relationship of the BINS scores at 6 months to later development as measured by the Bayley Scales at 1 year. The longitudinal study of the outcome of these infants is approved by the university Committee on Human Research. The mean gestational age of the infants was Table I presents characteristics of the study group.
Following attendance at a BINS training workshop for providers and practice in administration and scoring neurodvelopmental by a psychologist, the BINS was routinely administered by the physician or nurse in the program at the 6-month visit, and the BSID-II was administered by the psychologist at 1 year or soon thereafter.
Ages were adjusted for prematurity. The mean age of testing on the BINS was 6. Five infants had their PDI scores deferred due to late arrival for appointments or in one case, an infant who was casted for club feet. All five infants were seen by the physician for a neurodevelopmental examination and were considered to have normal neurologic development.
The BINS consists of items for different age levels. The total number of items wcreener places the infant in a category of low, moderate, or high risk for developmental delay. Within the moderate risk range, a cut score is indicated at which optimal sensitivity and specificity are reached. Scores below this cut line are considered high moderate scores, indicating that the infant is approaching a high-risk range.
Bayley Infant Neurodevelopmental Screen
Scores above the cut line are considered low-moderate scores, indicating that the infant is closer to neurodevelopmetnal low-risk range.
Although traditional cut-offs of one and two standard deviations below the mean are often utilized, we included a third category of 1. We chose to do categorical analyses that are consistent with the noncontinuous form of the original data set.
Positive predictive value PPV is a measure of the ability of the screening test to accurately identify low scoring infants, as measured by a later criteria.
We used the Bayley Scales of Infant Development at 1 year as our criteria for development. We looked at positive predictive value comparing and contrasting the different categories of performance on both tests. One infant had a diagnosis of cerebral palsy.
Based on review of test reports commenting on performance for each infant in the areas of gross motor skills, fine motor skills, language skills, problem-solving skills and behavior, the reasons for poor scores on the MDI fell into three patterns: These three infants showed a similar pattern of failed items on the BINS, failing items primarily in the Expressive and Cognitive categories.
A fourth false positive infant showed the same pattern, but although this infant improved on the MDI, his PDI of 84 fell in a borderline range. The fifth false positive infant had a different pattern: There were 34 infants who had BINS scores in the moderate risk range.
There was a slightly wider distribution of MDI scores for those infants obtaining high-moderate risk scores Figure 1. Infants obtaining a high-moderate risk score on the BINS had fairly even distribution later on their PDI scores, with similar numbers of infants falling at 1, 1.
By definition a screening test casts a wide net to select those children who may need closer monitoring. Any screening test will make classification errors; both in identifying infants as abnormal who were later found to be normal and in underidentifying infants who presented later with deficits. The Bayley Scales of Infant Development, as with other infant tests, does not predict long-term outcome.
Infant tests are measures of present developmental status and are intant utilized as formal indicators of need for timely intervention services.
This study examined the predictive value of using baykey BINS at a typical 6-month adjusted age examination of low birth weight infants to screen for emerging disabilities, as a lower cost measure than administering a full Bayley assessment at 6 months, and as able to be incorporated in the physician’s examination of the infant.
This represents cost efficiency in staff time and length of visit for the patient. The BINS was moderately effective in correctly predicting as low risk those infants at 6 months who later had a normal developmental assessment on the BSID-II and in identifying abnormal infants who remained abnormal at 12 months.
Consideration of the efficacy of any screening measure depends on the base rate in the population being screened. The BINS manual is clear in acknowledging the moderate risk range as one requiring clinical judgment in deciding whether to further assess or refer infants obtaining a moderate risk score.
In the age ranges in this study, infants had to miss only two or three items to fall in the moderate risk range. If an infant is at the lower end of the age range, failure of items may be more likely than at the upper end of the age range.
The best clinical practice may be to report scores in the moderate risk range as low-moderate risk or high-moderate risk, utilizing the cut score on the record form, and to monitor those infants obtaining high-moderate scores more frequently than those obtaining low-moderate scores. In the total group of infants, some infants in each BINS risk range were receiving services from infant programs by 1 year of age.
The BINS at 6 months would not be expected to accurately identify subtle aspects of development emerging at 1 year of age: The BINS at 6 months may also not accurately identify developmental delay that is not neurologically based but may reflect subtle aspects of behavioral organization and attention span that are expected to emerge by 1 year of age.
Many aspects of development are affected by factors in the social environment, such as adequacy of parenting, levels of parental education, and cultural differences in child rearing practices, among others. Medical risk factors such as significant intracranial hemorrhage, periventricular leukomalacia, and maternal substance abuse in the high risk infant’s medical history may place him or her at risk for development.
Extremely low gestational age may be a biological risk for later cognitive skills. Our finding of the preponderance of infants at weeks gestational age who had low risk BINS scores but who gave a poor performance on the BSID-II at 1 year may indicate a medical risk factor of very early gestational age, which has been reported elsewhere Piecuch et al.
Serial evaluations may reveal a pattern of change related to biological risk, similar to those observed by Liaw and Brooks-Gunn in low birth weight infants. Prediction of developmental outcome at 1 year from a 6-month screening for a high-risk infant is a complicated issue. In addition to social factors and medical risk factors, there is the physical recovery from the neonatal hospitalization and the resilience of the infant, which affects the trajectory of developmental outcome.
No screening tool at 6 months is likely to accommodate to a perfect degree the multitudinous effects on an infant’s development at 1 year. Social or biologic risk factors, and perhaps their additive effects, as discussed by Aylwardcontinue to be an important aspect of the assessment of developmental risk to be considered in conjunction with test scores in initiating referral for services.
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Our clinical experience with the BINS and this study suggest that it is a scrrener tool. Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, sxreener, and education by publishing worldwide.
Sign In or Create an Account. Close mobile search navigation Article navigation. All correspondence should be sent to Carol H. Low and moderate vs. Low and low-moderate Vs. View large Download slide. Bayley Infant Neurodevelopmental Screener.
Bayley Infant Neurodevelopmental Screener™ (BINS™) | Pearson Assessment
Gesell and Amatruda’s developmental diagnosis: The evaluation and management of normal and abnormal neuropsychologic development in infancy and early childhood. Patterns of low-birthweight childrens’ cognitive development.
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