To the Editor.—

We applaud the recent article by Hack et al, who make 2 very important points that cannot be overemphasized. The first point, that the Bayley scales are a poor predictor of eventual cognitive outcome, has been known to evaluators of normal populations. Thus, overly pessimistic predictions can arise when early cognitive performance is used as the sole marker of outcome.

In contrast, the second point, that low Bayley scores combined with severe abnormalities on cranial ultrasound are reliable early markers of poor cognitive outcome, is demonstrated by the data from Hack et al. Severe abnormalities were defined as grade 3 to 4 intraventricular hemorrhage (IVH), ventriculomegaly (VM), or periventricular leukomalacia (PVL). In contrast to PVL, the incidence of grade 3 to 4 IVH has not changed during the past 10 years. Review of data for infants of <1500-g birth weight from both the Vermont Oxford Network...

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