1694 Comparison of two-year neurodevelopmental assessments of infants born <32 weeks gestation by Bayley-III and PARCA-R, pre and during the COVID-19 pandemic

Background NICE guideline 'Developmental follow-up of children and young people born preterm' recommended a twoyear face-to-face developmental visit for very preterm infants and the use of the Parent Report of Children's Abilities- Revised (PARCA-R) questionnaire for developmental screening. We offer all infants born below 32 weeks gestation a two-year assessment using Bayley Scales of Infant and Toddler Development (Bayley-III). In September 2018, we implemented the PARCA-R questionnaire alongside Bayley-III assessments. During the COVID-19 pandemic, video consultations and PARCAR questionnaires were used instead of Bayley-III assessments. Objectives 1. To assess the concordance of two-year developmental status through Bayley-III and PARCA-R assessments. 2. To evaluate the impact of practice change during the COVID- 19 pandemic. Methods PARCA-R questionnaires were posted to parents before clinic appointments. Pre-COVID-19, completed questionnaires were collected at the face-to-face visit. During the pandemic, PARCA-R questionnaires were reviewed during the video consultation. A Bayley-III trained doctor conducted all two-year assessments. We extracted Bayley-III and PARCA-R scores for infants born below 32 weeks gestation who completed assessments between September 2018 and January 2021 from clinical notes. A standardised Bayley-III or PARCA-R score below 85 (one standard deviation below mean) was used to categorise children 'at risk of developmental delay'. We compared the concordance of Bayley-III and PARCA-R scores and evaluated the proportions of children with scores below 85 before and during the pandemic. Results Pre-COVID-19 (September 2018 - March 2020) 42/46 (91.3%) eligible children had a Bayley-III assessment. 34 (73.9%) also had PARCA-R completed. Two PARCA-R questionnaires were completed outside the age window and standardised scores could not be ascertained. Bayley-III and PARCA-R scores showed good concordance although more children received scores below 85 with PARCA-R than Bayley- III, particularly in cognition (tables). COVID-19 (April 2020 - January 2021) 22/27 (81.5%) eligible children had a video consultation. PARCA-R scores were available on 15 (55.6%). Compared with pre-COVID-19, a larger proportion of children had language development standardised scores below 85 during the pandemic (table 2). We did not have sufficient power in our sample size to perform formal statistical testing. Conclusions Pre-COVID-19, PARCA-R was concordant with Bayley-III scores and was considered a valid alternative assessment. During the pandemic, questionnaire completion rates fell and lower standardised scores were achieved. Our cohort is small and the reasons for this require further investigation.