The purpose is to determine the value of preoperative evaluation on developmental levels using Gesell score in predicting the postoperative outcome in pediatric cochlear implantation (CI) recipients. 78 children who underwent CI were included in our study. Age at the time of CI ranged from 6 to 67 months. The Gesell score including adaptability, fine motor, gross motor, language, and social skill was used for evaluating the patients' developmental levels before the CI, and a developmental quotient (DQ) was calculated by the following formula: (developmental age/actual age) x 100. The auditory perception and speech production abilities were evaluated using the categories of auditory performance (CAP) and speech intelligibility rating (SIR) before CI and at 1 year after CI. The associations between the preoperative Gesell score/DQ and the improvement of postoperative CAP/SIR outcomes were analyzed. Preoperative developmental evaluation of CI candidates suggested that the developmental delay was common in children with profound hearing loss. The mean of language DQ (46.72 +/- 17.59) was significantly decreased than the mean of others' ability DQ in the enrolled children. The older the pediatric CI candidates were, the lower the DQ were. Age/adaptability DQ and improvement of postoperative CAP/SIR 1 year after CI were related. Age was negative correlation with the CI outcome and adaptability DQ was positive correlation with the CI outcome. The mean of CAP 1 year after CI was 4.16, and the mean of SIR 1 year after CI was 2.03. The first logistics regression equation was Y1 = exp (-18.123 + 0.199 x adaptability DQ - 0.163 x age), and Y1 was the possibility which CAP was lower than 5 1 year after CI. The sensitivity of first regression equation was 84.2% and specificity was 70.8%. The second logistics regression equation was Y2 = exp (-23.347 + 0.268 x adaptability DQ - 0.164 x age), and Y2 was the possibility which SIR was lower than 3 1 year after CI. The sensitivity of second regression equation was 85.7% and specificity was 72.7%. Preoperative Gesell score may be value in predicting the postoperative outcome in pediatric CI recipients. The older children are more serious developmental delay occur, so the CI operation should be finished as early as possible. Adaptability DQ combined with age has predictive effect on the postoperative outcome of cochlear implantation in children.