NMH

NMH | 2024 56 Neonatology Language Delay while 19.4% showed Mild Delay indicating that Language Delay is still a risk factor for this cohort of children. Only 57% performed within the Average /Advanced Range in comparison to 80.6% for Cognitive Outcomes. Last year the Language outcome figure for Average performance was 55% for Language Development and 77.5% for Cognitive Development. Again, while the Covid-19 pandemic may have been a factor, these results reflect previous pre-Covid outcomes and are more likely representative of the impact of prematurity. When the Motor Outcomes were examined, it was very encouraging to see that 74% of the children were performing within the Average/Advanced Range, an improvement of 4% on last year's outcomes. In all, 13.9% showed Mild Motor Delay, 2.8% showed Moderate Delay and 9.7% showed Extreme Delay. Last year Extreme Delay was measured at 11.3%. For children to score well on this scale they need to be running with good coordination, kicking a small ball well and be able to ascend/ descend steps independently. Children who perform well on this scale engage in prompt performances, listen well to follow the task commands well. in-person assessment is the preferred assessment especially as these babies are more vulnerable in terms of developmental delay. All babies assessed using the PARCA-R were performing within the Superior / Average Range for both the Cognitive and Language Scales. All had Normal Motor Outcomes as assessed using the Ages and Stages Questionnaire. The Bayley Outcomes in the table above represent the Composite Scores. Composite scores are a transformation of a distribution of scores and have a given mean and standard deviation showing how far an individual's score is from the mean or average score. These give a general overview of the results and are the scores that are used when reporting outcomes for most audit reviews and research studies. However, valuable information can be lost. The Composite Scores can sometimes mask Expressive Speech Delay and Gross Motor Delay if the Receptive Scores and Fine Motor Scores are high. When examining these results, it is also important to look at the Scaled Scores that make up these Composite Scores. For example, the Receptive and Expressive Communication Scales make up the Composite Language Score and the Fine Motor and Gross Motor Scales make up the Composite Motor Score. Please see below the classification for the scaled scores. Bayley Scaled Scores are divided into the following ranges: • 16-19: Superior Performance • 13-15: High Average Performance • 8-12: Average Performance • 5-7: Mild Delay • 1-4: Moderate-Severe Delay Looking at Table 2, using the scaled scores to interpret outcomes, there was a very slight improvement in terms of Average score outcomes for Expressive Communication Skills at 55.5% compared with 52% in 2023. This year's outcomes have maintained a much-improved outcome compared to 31% in 2022. Receptive Communication Skills showed a lower Average outcome score at 48.6% compared to 53.5% in 2023 but similar to outcomes for 2022 measured at 49%. Expressive Speech Delay was similar in outcome to Receptive Language Delay at 34.7% compared to 33.3%. A total of 12.5% showed Moderate - Extreme Receptive compared to 9.7% for Expressive Speech Delay respectively. These figures indicate that a total of 33-34% of children were performing below average for both the Receptive and Expressive Communication Scales. If it is recommended that any preterm infant who is performing below average at 2 years of age would benefit from intervention, then 34% of our preterm cohort in 2024 meet the criteria for access to speech and language therapy. In terms of Motor Outcomes, Gross Motor Outcome was very good with 66.6% of the children performing within the Average Range and 59.7% for Fine Motor Outcomes. Fine Motor Skills were represented as an area of strength within the Motor scale with 28% of children performing within the Superior /Very Superior Range for Fine Motor performance compared with 2.7% for Gross Motor performance. There was more Mild - Moderate Gross Motor Delay than Mild- Moderate Fine Motor Delay (20.8% vs 4.2%). A total of 9.7% of infants showed Moderate-Severe Gross Motor Delay compared with 8.3% for Severe Fine Motor Delay. In summary, by analysing the scaled scores, it is evident that delays in gross motor skills were more prevalent than delays in fine motor skills in our preterm population. Language delay continues to be a concern although the difference between the two scales is not as marked as previously with similar delay noted for each scale Receptive and Expressive. The welcomed improvement in Expressive Speech could be attributed to the ACORN programme. In time we will be able to present more specific data to determine "When the Motor Outcomes were examined, it was very encouraging to see that 74% of the children were performing within the Average/Advanced Range, an improvement of 4% on last year's outcomes..." The PARCA-R being a questionnaire is avoided, if possible, for the earlier gestational age babies as the Bayley

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