Does preterm birth increase a child's risk for language impairment?

Multilingualism was associated with lower cognitive outcomes in children who were born very and extremely preterm

Aim

This study determined whether cognitive outcomes differed between very preterm (VPT) and extremely preterm (EPT) children who were monolingual or multilingual when they reached the corrected ages of two and five years.

Methods

The data were collected at the Emma Children's Hospital, Amsterdam, The Netherlands, as part of our national neonatal follow‐up programme and comprised 325 VPT/EPT children born between January 1, 2007 and January 1, 2012. The study used the Third Editions of the Bayley Scales of Infant and Toddler Development and the Wechsler Preschool and Primary Scale of Intelligence.

Results

We compared 234 monolingual children, 65 multilingual children who spoke Dutch and at least one foreign language at home and 26 multilingual children who didn't speak Dutch at home. The best performers on the cognitive scale at two years of age and the verbal subscales at five years of age were the monolingual children, followed by the children who spoke Dutch and at least one foreign language at home, then the children who only spoke foreign languages at home.

Conclusion

In our study cohort from The Netherlands, multilingualism lowered the cognitive and verbal outcomes of VPT/EPT children at the corrected ages of two and five years.

Predictors for delayed linguistic skills in very preterm infants

BACKGROUND

Preterm-born children are at higher risk for impaired linguistic abilities than are their term-born peers. The aim of the current study was to determine early predictors for delayed linguistic skills in very preterm-born preschool children.

METHODS

Between January 2005 and November 2010 all very preterm infants born at < 32 weeks gestation in Tyrol were prospectively enrolled (n = 421); 248 of them had a detailed examination at the age of five years including cognitive assessment (Wechsler Preschool and Primary Scale of Intelligence, third edition (WPPSI-III) or Snijders-Oomen Nonverbal Intelligence Tests (SON-R)) as well as a screening test for language skills (Bielefelder screening for early diagnosis of reading problems and weak spelling (BISC)). The association between pre-and postnatal factors and poor performance on the BISC assessment was analyzed by means of logistic regression analysis.

RESULTS

Of the 248 children 79 (31.8%) showed delayed literacy precursor skills. Male sex, gestational age, retinopathy of prematurity (ROP) grades 3-4 and low maternal education were predictive for delayed linguistic skills at 5 years of age in the multivariate analysis.

CONCLUSION

This study identified predictors for delayed literacy precursor skills. These data support the finding that in very preterm infants pre-and perinatal as well as sociodemographic factors account for linguistic skills in the preschool period.

Language Network Function in Young Children Born Very Preterm

Language deficits are reported in preterm born children across development. Recent neuroimaging studies have found functional alterations in large-scale brain networks underlying these language deficits, but the early childhood development of the language network has not been investigated. Here, we compared intrinsic language network connectivity in 4-year-old children born VPT and term-born controls, using defined language regions (Broca's area, Wernicke's areas, and their homologues in the right hemisphere). Resting-state functional magnetic resonance imaging (fMRI) was obtained, and the group differences in whole-brain connectivity were examined from each seed as well as correlations with language outcomes. We found significantly decreased functional connectivity in almost all language regions in children born VPT compared to their term controls. Notably, Broca's area homologue in the right hemisphere emerged as a functional hub of decreased connectivity in VPT group, specifically to bilateral inferior frontal and supramarginal gyri; connectivity strength between Broca's area homologue with the right supramarginal and the left inferior frontal gyri was associated with better language outcomes at 4 years of age. Wernicke's area and its homologue also showed decreased inter-hemispheric connections to bilateral supramarginal gyri in the VPT group. Decreased intra- and inter-hemispheric connectivity among primary language regions suggests immature and altered function in the language network in children born VPT.

Language Trajectories of Children Born Very Preterm and Full Term from Early to Late Childhood

OBJECTIVE

To identify distinct language trajectories of children born very preterm and full term from 2 to 13 years of age and examine predictors for the identified trajectories.

STUDY DESIGN

A cohort of 224 children born very preterm and 77 full term controls recruited at birth were followed up at ages 2, 5, 7, and 13 years. The number of distinct language trajectories was examined using latent growth mixture modeling allowing for linear and quadratic time trends. Potential predictors in the neonatal period (eg, birth group, sex, and medical risk) and at 2 years (ie, social risk and use of allied health services) for the language trajectories were tested using multinomial logistic regression.

RESULTS

Five distinct language trajectories were identified across childhood: stable normal (32% of study cohort), resilient development showing catch-up (36%), precocious language skills (7%), stable low (17%), and high-risk (5%) development. The very preterm group was 8 times more likely to have a language trajectory that represented poorer language development compared with full term controls (very preterm, 40%; full term, 6%). Greater social risk and use of allied health services were associated with poorer language development.

CONCLUSIONS

Variable language trajectories were observed, with a substantial proportion of children born very preterm exhibiting adverse language development. These findings highlight the need for monitoring language skills in children born very preterm before school entry and across middle childhood.

Nonword Repetition and Language Outcomes in Young Children Born Preterm

Purpose

The aims of this study were to examine phonological short-term memory in children born preterm (PT) and to explore relations between this neuropsychological process and later language skills.

Method

Children born PT (n = 74) and full term (FT; n = 60) participated in a nonword repetition (NWR) task at 36 months old. Standardized measures of language skills were administered at 36 and 54 months old. Group differences in NWR task completion and NWR scores were analyzed. Hierarchical multiple regression analyses examined the extent to which NWR ability predicted later performance on language measures.

Results

More children born PT than FT did not complete the NWR task. Among children who completed the task, the performance of children born PT and FT was not statistically different. NWR scores at 36 months old accounted for significant unique variance in language scores at 54 months old in both groups. Birth group did not moderate the relation between NWR and later language performance.

Conclusions

These findings suggest that phonological short-term memory is an important skill underlying language development in both children born PT and FT. These findings have relevance to clinical practice in assessing children born PT.

Ventricular shape and relative position abnormalities in preterm neonates

Recent neuroimaging findings have highlighted the impact of premature birth on subcortical development and morphological changes in the deep grey nuclei and ventricular system. To help characterize subcortical microstructural changes in preterm neonates, we recently implemented a multivariate tensor-based method (mTBM). This method allows to precisely measure local surface deformation of brain structures in infants. Here, we investigated ventricular abnormalities and their spatial relationships with surrounding subcortical structures in preterm neonates. We performed regional group comparisons on the surface morphometry and relative position of the lateral ventricles between 19 full-term and 17 preterm born neonates at term-equivalent age. Furthermore, a relative pose analysis was used to detect individual differences in translation, rotation, and scale of a given brain structure with respect to an average. Our mTBM results revealed broad areas of alterations on the frontal horn and body of the left ventricle, and narrower areas of differences on the temporal horn of the right ventricle. A significant shift in the rotation of the left ventricle was also found in preterm neonates. Furthermore, we located significant correlations between morphology and pose parameters of the lateral ventricles and that of the putamen and thalamus. These results show that regional abnormalities on the surface and pose of the ventricles are also associated with alterations on the putamen and thalamus. The complementarity of the information provided by the surface and pose analysis may help to identify abnormal white and grey matter growth, hinting toward a pattern of neural and cellular dysmaturation.

Language and cognitive outcome for high-risk neonates at the age of 2-3 years - experience from an Arab Country

AIM

To investigate the effect of different neonatal risk factors on different language parameters as well as cognitive abilities among Arabic speaking Egyptian children at the age of two to three years of life and to find out which risk factor(s) had the greatest impact on language and cognitive abilities.

METHODS

This retrospective cohort study was conducted on 103 children with age range of 2-3 years (median age 31 mo). They were 62 males and 41 females who were exposed to different high-risk factors in the perinatal period, with exclusion of metabolic disorders, sepsis/meningitis, congenital anomalies and chromosomal aberrations. The studied children were subjected to a protocol of language assessment that included history taking, clinical and neurological examination, audiological evaluation, assessment of language using modified preschool language scale-4, IQ and mental age assessment and assessment of social age.

RESULTS

The studied children had a median gestational age of 37 wk, median birth weight of 2.5 kg. The distribution of the high-risk factors in the affected children were prematurity in 25 children, respiratory distress syndrome in 25 children, hypoxic-ischemic encephalopathy in 15 children, hyperbilirubinemia in 10 children, hypoglycemia in 13 children, mixed risk factors in 15 children. The results revealed that high-risk neonatal complications were associated with impairment of different language parameters and cognitive abilities (P < 0.05). The presence of prematurity, in relation to other risk factors, increases the risk of language and cognitive delay significantly by 3.9 fold.

CONCLUSION

Arabic-speaking children aged 2-3 years who were exposed to high-risk conditions in the perinatal period are likely to exhibit delays in the development of language and impairments in cognitive abilities. The most significant risk factor associated with language and cognitive impairments was prematurity.

Using Eye Movements to Assess Language Comprehension in Toddlers Born Preterm and Full Term

OBJECTIVE

To assess language skills in children born preterm and full term by the use of a standardized language test and eye-tracking methods.

STUDY DESIGN

Children born ≤32 weeks' gestation (n = 44) were matched on sex and socioeconomic status to children born full term (n = 44) and studied longitudinally. The Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) were administered at 18 months (corrected for prematurity as applicable). The Looking-While-Listening Task (LWL) simultaneously presents 2 pictures and an auditory stimulus that directs the child's attention to one image. The pattern of eye movements reflects visual processing and the efficiency of language comprehension. Children born preterm were evaluated on LWL 3 times between 18 and 24 months. Children born full term were evaluated at ages corresponding to chronological and corrected ages of their preterm match. Results were compared between groups for the BSID-III and 2 LWL measures: accuracy (proportion of time looking at target) and reaction time (latency to shift gaze from distracter to target).

RESULTS

Children born preterm had lower BSID-III scores than children born full term. Children born preterm had poorer performance than children born full term on LWL measures for chronological age but similar performance for corrected age. Accuracy and reaction time at 18 months' corrected age displaced preterm-full term group membership as significant predictors of BSID-III scores.

CONCLUSIONS

Performance and rate of change on language comprehension measures were similar in children born preterm and full term compared at corrected age. Individual variation in language comprehension efficiency was a robust predictor of scores on a standardized language assessment in both groups.

Neonatal diffusion tensor brain imaging predicts later motor outcome in preterm neonates with white matter abnormalities

BACKGROUND

White matter (WM) abnormalities associated with prematurity are one of the most important causes of neurological disability that involves spastic motor deficits in preterm newborns. This study aimed to evaluate regional microstructural changes in diffusion tensor imaging (DTI) associated with WM abnormalities.

METHODS

We prospectively studied extremely low birth weight (ELBW; <1000 g) preterm infants who were admitted to the Neonatal Intensive Care Unit of Hanyang University Hospital between February 2011 and February 2014. WM abnormalities were assessed with conventional magnetic resonance (MR) imaging and DTI near term-equivalent age before discharge. Region-of-interests (ROIs) measurements were performed to examine the regional distribution of fractional anisotropy (FA) values.

RESULTS

Thirty-two out of 72 ELBW infants underwent conventional MR imaging and DTI at term-equivalent age. Ten of these infants developed WM abnormalities associated with prematurity. Five of ten of those with WM abnormalities developed cerebral palsy (CP). DTI in the WM abnormalities with CP showed a significant reduction of mean FA in the genu of the corpus callosum (p = 0.022), the ipsilateral posterior limb of the internal capsule (p = 0.019), and the ipsilateral centrum semiovale (p = 0.012) compared to normal WM and WM abnormalities without CP. In infants having WM abnormalities with CP, early FA values in neonatal DTI revealed abnormalities of the WM regions prior to the manifestation of hemiparesis.

CONCLUSIONS

DTI performed at term equivalent age shows different FA values in WM regions among infants with or without WM abnormalities associated with prematurity and/or CP. Low FA values of ROIs in DTI are related with later development of spastic CP in preterm infants with WM abnormalities.

Language outcomes at 36 months in prematurely born children is associated with the quality of developmental care in NICUs

OBJECTIVE

The aim of this study was to examine the relationship between the quality levels of NICU developmental care (DC) and language skills at 36 months in very preterm (VPT) children.

STUDY DESIGN

Language skills of 78 VPT children from 19 NICUs and 90 full-term controls was assessed using a standardized language test. We compared children' language task performance by splitting NICUs into units with high- and low-quality of DC according to two main factors: (1) infant centered care (ICC), and (2) infant pain management (IPM).

RESULTS

VPT children from low-care units with respect to ICC obtained lower scores in sentence comprehension, compared to children from high-care units. No differences were found between preterm children from high-quality ICC NICUs and full-term children.

CONCLUSIONS

Findings suggest that higher quality of DC related to infant centered care can mitigate delays in language skills at 36 months in children born VPT.

Linguistic features in children born very preterm at preschool age

AIM

This cross-sectional study focused on the effect of very preterm (VPT) birth on language development by analysing phonological, lexical, grammatical, and pragmatic skills and assessing the role of cognitive and memory skills.

METHOD

Sixty children (29 males, 31 females) born VPT (<32wks) aged 5 years were compared with 60 children with typical development. The linguistic assessment was performed by administering a battery of Italian tests for the evaluation of language; cognitive and memory skills were assessed by Raven's coloured progressive matrices and digit span subtest (Wechsler Intelligence Scale for Children [WISC-III]).

RESULTS

Children born VPT showed delays in lexical (comprehension: z-score difference -1.18; 95% confidence interval [CI] -1.60 to -0.77; naming: -0.88; 95% CI -1.19 to -0.58) and pragmatic skills (comprehension: -0.76; 95% CI -1.02 to -0.49; narrative production: -0.47; 95% CI -0.72 to -0.23). Delays in phonology and grammar were less diffuse, involving productive skills (-1.09; 95% CI -1.64 to -0.54; -0.48; 95% CI -0.85 to -0.12, respectively), and were dependent by cognitive and memory skills. Lexical delays were more specific.

INTERPRETATION

The linguistic profile of children born preterm is characterized by some abilities more impaired than others. This highlights the need of a linguistic assessment at the end of preschool age in order to plan a focused intervention aimed at improving lexical and pragmatic skills.

The Emergence of Tool Use in Preterm Infants

Preterm born children without neurological impairments have been shown to present some visual-manual coordination deficits, more or less depending on their tonicity and the degree of prematurity. In this paper, we compare the development of tool use in 15-23-month-old preterm infants born after 33-36 weeks of gestation without neurological complications with that of full-term infants according to corrected age. Understanding the affordance of a tool is an important cognitive milestone in early sensorimotor period. Using a tool to bring within reach an out-of-reach object, for instance, has been shown to develop during the 2nd year in full-term infants. Here we presented preterm infants with an attractive toy out of reach and with a rake-like tool within reach in five conditions of spatial relationships between the toy and the tool. Like full-terms, preterm infants used the tool with success in conditions of spatial contiguity around 15-17 months. In conditions of a spatial gap between tool and toy, i.e., the only conditions which shows without ambiguity that the infant understands the affordance of the tool, preterm infants as a group showed no delay for tool use: the frequency of spontaneous successes started to increase after 18 months, and demonstration became effective after that age. However, further analyses showed that only the preterm infants without hypotonia and born after 36 weeks of pregnancy developed tool use without delay. Hypotonic preterm infants were still largely unsuccessful in the conditions of spatial gap, even at the end of the study. The degree of prematurity also influenced the performance at tool use. These results, following the observation of a delay in the development of bimanual coordination and of handedness in the same infants at 10-12 months in a previous study, show that low risk preterm infants can still be impaired for the development of new manual skills beyond the 1st year. Thus, hypotonic preterm infants and infants born before 36 weeks of pregnancy should be followed and might benefit from early intervention programs.

Receptive language and intellectual abilities in preterm children

OBJECTIVE

The aim of this study was to examine the association between receptive vocabulary performance and intellectual quotient (IQ) in preterm born children compared to children born at term.

METHOD

A total of 72 preschool-age children participated in the study. Participants were divided in four groups: EG-I, including 20 moderate to late preterm born children; EG-II, comprehending 16 extremely preterm born children; CG-I and CG-II with correspondingly 20 and 16 children born at term. EG-I and CG-I as well as EG-II and CG-II groups were matched according to gender, chronological age, and family SES. The mean age of children in each group was: EG-I and CG-I: 30.3months; EG-II and CG-II: 29.1months. The assessment information was collected using an anamnesis protocol, the Brazilian criterion of economic classification, the Peabody Picture Vocabulary Test, and the Stanford-Binet Intelligence Scale.

RESULTS

Mean scores for receptive vocabulary were significantly lower in both preterm groups (EG-I and EG-II) than in the corresponding matched groups (CG-I and CG-II). However, no significant differences were found among the preterm groups. Moreover, high correlations between vocabulary and IQ scores were found in both preterm groups (EG-I and EG-II). In contrast, no significant correlations were found when analyses considered each group of full-term born children (CG-I and CG-II).

CONCLUSION

Our findings indicate that prematurity status has an impact on receptive language performance and on the pattern of relationships between receptive vocabulary and general intellectual functioning.

Neonatal pain and reduced maternal care: Early-life stressors interacting to impact brain and behavioral development

Advances in neonatal intensive care units (NICUs) have drastically increased the survival chances of preterm infants. However, preterm infants are still exposed to a wide range of stressors during their stay in the NICU, which include painful procedures and reduced maternal contact. The activation of the hypothalamic-pituitary-adrenal (HPA) axis, in response to these stressors during this critical period of brain development, has been associated with many acute and long-term adverse biobehavioral outcomes. Recent research has shown that Kangaroo care, a non-pharmacological analgesic based on increased skin-to-skin contact between the neonate and the mother, negates the adverse outcomes associated with neonatal pain and reduced maternal care, however the biological mechanism remains widely unknown. This review summarizes findings from both human and rodent literature investigating neonatal pain and reduced maternal care independently, primarily focusing on the role of the HPA axis and biobehavioral outcomes. The physiological and positive outcomes of Kangaroo care will also be discussed in terms of how dampening of the HPA axis response to neonatal pain and increased maternal care may account for positive outcomes associated with Kangaroo care.

Do the early development of gestures and receptive and expressive language predict language skills at 5;0 in prematurely born very-low-birth-weight children?

It is unclear what the predictive value of very early development of gestures and language is on later language ability in prematurely born very-low-birth-weight (VLBW; birth weight ≤1500g) children. The aim of the present study was to analyse the predictive value of early gestures and a receptive lexicon measured between the ages of 0;9 and 1;3, as well as the predictive value of receptive and expressive language ability at 2;0 for language skills at 5;0 in VLBW children. The subjects were 29 VLBW children and 28 full-term children whose language development has been followed intensively between the ages of 0;9 and 2;0 using the Finnish version of the MacArthur Developmental Inventory and the Reynell Developmental Language Scales (RDLS III). At 5;0, five selected verbal subtests of the Nepsy II test and the Boston Naming Test (BNT) were used to assess children's language skills. For the first time in VLBW children, the development of gestures measured between the ages of 0;9 and 1;3 was shown to correlate significantly and positively with language skills at 5;0. In addition, both receptive and expressive language ability measured at 2;0 correlated significantly and positively with later language skills in both groups. Moreover, according to the hierarchical regression analysis, the receptive language score of the RDLS III at 2;0 was a clear and significant predictor for language skills at 5;0 in both groups. The findings particularly underline the role of early receptive language as a significant predictor for later language ability in VLBW children. The results provide evidence for a continuity between early language development and later language skills.

LEARNING OUTCOMES

After reading this article, readers will understand the associations between the very early (≤2 years of age) development of gestures and language (i.e. early receptive lexicon, expressive lexicon at 2;0, receptive and expressive language ability at 2;0) and the language skills at 5;0 in prematurely born very-low-birth-weight (VLBW) children. In addition, readers will understand the heterogeneity of the group of VLBW children. The information presented in this article is informative for those who work in a clinical context and who want to be able to identify those VLBW children who need support for their language development at an early age.

Desempenho linguístico de prematuros de 2 anos, considerando idade cronológica e idade corrigida

RESUMO Introdução O nascimento prematuro acarreta problemas que não se restringem à mortalidade perinatal. Alguns prematuros, mesmo na ausência de lesões cerebrais, apresentam consequências negativas em diversos aspectos do desenvolvimento, como dificuldades em adquirir linguagem. Objetivo O objetivo deste estudo foi verificar o desempenho linguístico de prematuros, na faixa etária de 2 anos, considerando a idade cronológica e a idade corrigida. Métodos Participaram do estudo 23 sujeitos prematuros e para verificar as habilidades linguísticas foi aplicado o Test of Early Language Development – TELD-3. Resultados Os sujeitos prematuros apresentaram desempenho total alterado no TELD-3 em 39,13% dos casos. Os prematuros também foram analisados considerando o atraso para a idade cronológica e a corrigida e não houve diferença no desempenho para os subtestes receptivo (p = 0,250) e expressivo (p = 1,000). Conclusão O grupo de prematuros aos 2 anos de idade constitui população de risco para alterações de linguagem que não podem ser compensadas com a correção da idade.

Visuo-manual coordination in preterm infants without neurological impairments

The extent of and reasons for visuo-manual coordination deficits in moderate and late preterm born infants without neurological impairments are not well known. This paper presents a longitudinal study on the visuo-manual development of twelve preterm infants, born after 33-36 weeks of gestation without neurological complications, between the ages of 6 and 12 months. Visuo-manual integration and grasping were assessed using the Peabody Developmental Motor Scales, along with bimanual coordination and handedness tests. Visual function was examined once prior to the beginning of the study. Gross motor development was also evaluated every month. Preterm infants were compared to a control group of ten full-term infants according to corrected age. Compared to full-terms, the visual perception of preterm infants was close to normal, with only a measure of visual fixation lower than in full-terms. In contrast, preterm infants had delayed development of visuo-manual integration, grasping, bimanual coordination, and handedness even when compared using corrected age. Tonicity and gestational age at birth were the main variables associated to the delays. These results are discussed in terms of the possible factors underlying such delays. They need to be confirmed on a larger sample of preterm born children, and to be correlated with later development. This would allow developing markers of future neuropsychological impairments during childhood.

Early communicative behaviors and their relationship to motor skills in extremely preterm infants

Despite the predictive value of early spontaneous communication for identifying risk for later language concerns, very little research has focused on these behaviors in extremely low-gestational-age infants (ELGA<28 weeks) or on their relationship with motor development. In this study, communicative behaviors (gestures, vocal utterances and their coordination) were evaluated during mother-infant play interactions in 20 ELGA infants and 20 full-term infants (FT) at 12 months (corrected age for ELGA infants). Relationships between gestures and motor skills, evaluated using the Bayley-III Scales were also examined. ELGA infants, compared with FT infants, showed less advanced communicative, motor, and cognitive skills. Giving and representational gestures were produced at a lower rate by ELGA infants. In addition, pointing gestures and words were produced by a lower percentage of ELGA infants. Significant positive correlations between gestures (pointing and representational gestures) and fine motor skills were found in the ELGA group. We discuss the relevance of examining spontaneous communicative behaviors and motor skills as potential indices of early development that may be useful for clinical assessment and intervention with ELGA infants.

Does temperament influence language development? Evidence from preterm and full-term children

The aims of this study are: (1) to describe language and temperament characteristics of one group of low risk preterm (PR) children and a group of full-term (FT) children and (2) to identify those factors which can predict language outcomes at 30 months of age, with special attention on temperament. There is evidence of differences between very or extremely PR and FT children in relation to characteristics of temperament and language development. However, not many studies have been carried out with healthy PR children. The participants were 142 low risk PR children (mean gestational age (GA): 32.60 weeks) and 49 FT children (mean GA 39.84 weeks). The temperament of the children was assessed at 10 months of age through the Infant Behavior Questionnaire-Revised (IBQ-R). At 22 months of age the cognitive development of the children was assessed through the Spanish adaptation of the Batelle Developmental Inventory (BDI). In order to assess the children's language development the Galician adaptation of the MacArthur-Bates CDI was applied at 30 months of age. In addition, socio-demographic information about the children and their families was gathered at birth. The results indicate that there were no significant differences in the language measures of interest (word production, MLU3, and sentence complexity) between groups. The only differences found between the PR and the FT children in the IBQ-R were restricted to the smiling and laughter and the fear subscales. Hierarchical regression analyses performed indicate that GA did not have any predictive effect on language measures taken at 30 months. Cognitive scores were an important predictor of language measures, although certain temperament subscales contributed in a significant way to the variance of language measures, particularly low intensity pleasure, approach, high intensity pleasure, sadness, and vocal reactivity. Therefore, extroverted (positive affectivity) temperament seems to be beneficial for language development.

Noun and predicate comprehension/production and gestures in extremely preterm children at two years of age: Are they delayed?

Extremely low gestational age (ELGA, GA<28 weeks) preterm children are at high risk for linguistic impairments; however, their lexical comprehension and production as well as lexical categories in their early language acquisition have not been specifically examined via direct tools. Our study examines lexical comprehension and production as well as gestural production in ELGA children by focusing on noun and predicate acquisition. Forty monolingual ELGA children (mean GA of 26.7 weeks) and 40 full-term (FT) children were assessed at two years of corrected chronological age (CCA) using a test of noun and predicate comprehension and production (PiNG) and the Italian MB-CDI. Noun comprehension and production were delayed in ELGA compared with FT children, as documented by the low number of correct responses and the large number of errors, i.e., incorrect responses and no-response items, and by the types of incorrect responses, i.e., fewer semantically related responses, in noun production. Regarding predicate comprehension and production, a higher frequency of no responses was reported by ELGA children and these children also presented a lower frequency of bimodal spoken-gestural responses in predicate production than FT children. A delayed vocabulary size as demonstrated by the MB-CDI, was exhibited by one-fourth of the ELGA children, who were also unable to complete the predicate subtest. These findings highlight that noun comprehension and production are delayed in ELGA children at two years of CCA and are the most important indexes for the direct evaluation of their lexical abilities and delay. The types of incorrect responses and bimodal spoken-gestural responses were proven to be useful indexes for evaluating the noun and predicate level of acquisition and to plan early focused interventions.

LEARNING OUTCOMES

After reading this manuscript, the reader will understand (a) the differences in noun and predicate comprehension and production between ELGA and FT children and the indexes of lexical delays exhibited by ELGA children at 2;0 (CCA); (b) the relevance of evaluating errors (incorrect response and no response), the types of incorrect responses (semantically related and unrelated) and the modality of the responses (unimodal spoken and bimodal spoken-gestural) in noun and predicate production to understand the difficulties experienced by ELGA children in representing and expressing meanings; and (c) the need to plan specific interventions to support spoken and gestural modalities in lexical comprehension and production in ELGA children by focusing on noun and predicate acquisition.

[Language acquisition in preterm infants during the first year of life]

Previous studies have shown that preterm children are at a higher risk for cognitive and language delays than full-term children. Most of these studies have concentrated on the effects of prematurity during the preschool or school years, while the effect of preterm birth on the early development of language, much of which occurs during the first year of life, remains very little explored. This article focuses on this crucial period and reviews the studies that have explored early phonological and lexical development in preterm infants. The results of these studies show uneven proficiency in different language subdomains in preterm infants. This raises the possibility that different constraints apply to the acquisition of different linguistic subcomponents in this population, in part as a result of a complex interaction between maturation, experience, and language subdomains.

Academic outcomes of very low birth weight infants: the influence of mother-child relationships

It is commonly accepted that parent-child interactions are bidirectional and complex and are influenced by many different factors. The current study examined the academic and behavioral skills in the early elementary years of preterm infants and the influence of their early mother-child interactions on these skills. Using a sample of 21 premature infants and their mothers, this study found that positive early interactions during feeding were related to later mutual enjoyment during a teaching task at school age, but early maternal depression was not. Early risk factors of premature infants, specifically the number of days spent on a ventilator, were positively related to maternal perceptions of hassle associated with feeding and negatively related to maternal sensitivity during feeding. Finally, mutual enjoyment was strongly associated with language, cognitive, and behavioral skills at school age. These results suggest that it is not only the infant risk factors following a premature birth that influence later development but also the parent-child relationship and emphasize the importance of understanding and promoting these early positive parent-child interactions for premature infants.

Language development of children born following intracytoplasmic sperm injection (ICSI) combined with assisted oocyte activation (AOA)

BACKGROUND

The effect of assisted reproduction technology (ART) on language development is still unclear. Moreover, different techniques are introduced at rapid pace and are not always accompanied by extensive follow-up programmes.

AIMS

To investigate the language development of 3-10-year-old children born following ART using intracytoplasmic sperm injection (ICSI) combined with assisted oocyte activation (AOA), which is a highly specialized technique applied in cases with a history of fertilization failure following conventional ICSI. Secondly, a comparison is made between the language development of singletons and twins.

METHODS & PROCEDURES

Twenty children, six boys and 14 girls, born following ICSI combined with AOA and older than 3 years were included in the study. The mean age of the children was 5;4 years (range = 3;1-10;4 years; SD = 1;8 years). Expressive and receptive language development were assessed using the Clinical Evaluation of Language Fundamentals (CELF-IV-NL) for children older than 5 years and the Reynell Developmental Language Scales (RTOS) for children younger than or equal to 5 years.

OUTCOMES & RESULTS

The mean total score for language ability (in percentiles) was 56.8 (SD = 33.6), which corresponds to normal language skills. Significantly higher scores were found for AOA singletons compared with twins. For the general language, none of the children scored within the clinical zone for language disability corresponding with a percentile lower than 5.

CONCLUSION & IMPLICATIONS

This study presents the first data concerning language outcome in 3-10-year-old children born following AOA. General language scores of the AOA children in this study are located within the normal ranges. The language development of singletons was significantly better compared with twins. Although the results are reassuring for language development, in future long-term follow-up studies in this population are necessary.

Characterizing early detection of language difficulties in children born preterm

BACKGROUND

The optimal age for assessing language difficulties in premature children remains unclear.

AIMS

To determine the most predictive and earliest screening tool for later language difficulties on children born preterm.

STUDY DESIGN

A prospective population-based study in the Loire Infant Follow-up Team LIFT SUBJECTS: All children born <35weeks of gestation between 2003 and 2005 were assessed at corrected ages by four screening tools: the Ages & Stages Questionnaire (ASQ) communication scale at 18 and 24months, the language items of Brunet Lezine test at 24months, and the "Epreuves de Repérage des Troubles du Langage" (ERTL) at 4years.

OUTCOME MEASURES

After 5years, the kindergarten teacher evaluated the vocabulary, grammar and pronunciation capacities of the child in comparison with the classroom performances.

RESULTS

Among 1957 infants enrolled at discharge, 947 were assessed by their teacher with 12.2% (n=116) of language difficulties. Full data at all time points were available for 426 infants. The area under curve of the receiver operator characteristic curve obtained for the ASQ communication scale at 18months was significantly lower (0.65±0.09) than that obtained at 24months (0.77±0.08) and the languages items of Brunet Lezine test at 24months (0.77±0.08), and the ERTL at 4years (0.76±0.09). The optimal cut-off value for ASQ communication at 24months is ≤45 [sensitivity of 0.79 (95%CI: 0.70-0.86); specificity of 0.63 (95%CI: 0.59-0.66)].

CONCLUSIONS

The Ages & Stages Questionnaire communication scale at 24 corrected months appears as an acceptable test at an early time point to identify preterm children at risk of later language difficulties.

The prevalence and predictive value of weak language skills in children with very low birth weight--a longitudinal study

AIM

Previous findings regarding the prevalence and predictive value of weak language skills in preterm children with very low birth weight (VLBW) are unclear. This study analysed the prevalence of weak language skills, the predictive value of early weak language skills on later weak language skills, and the sensitivity and specificity of cognitive scores for identifying concurrent weak language skills in a longitudinal sample of VLBW children (n = 141) and their full-term controls (n = 146).

METHODS

Data on language skills and cognitive development were gathered at two and five years of age. Weak language skills were defined by the 10th percentile value of the controls.

RESULTS

In VLBW children, the prevalence of weak language skills varied between 16% and 18% at 2 years of age (controls: 8 to 10%) and between 20% and 27% at 5 years of age (controls: 10%). Early weak language skills predicted later weak language skills in VLBW children. Cognitive scores were specific, but their sensitivity for identifying concurrent weak language skills was low.

CONCLUSION

The prevalence of weak language skills in VLBW children increased during the follow-up period and was higher than the controls. Language-sensitive methods should be used in the clinical follow-up of VLBW children.

Habilidades comunicativas de crianças prematuras e prematuras extremas

Objetivo comparar o desempenho das habilidades comunicativas, de crianças nascidas prematuras, prematuras extremas e típicas de idade cronológica entre dois e três anos. Métodos participaram do estudo 72 crianças distribuídas em quatro grupos: 20 prematuros (GE-I), 16 prematuros extremos (GE-II) e 36 crianças com desenvolvimento típico (GC-I e GC-II), de idade cronológica entre dois a três anos. Houve pareamento quanto à idade cronológica e sexo. A avaliação constou da aplicação do Protocolo de Anamnese e Observação do Comportamento Comunicativo. O tratamento estatístico constou do Teste “t” Student e do Teste de Mann-Whitney (p ≤ 0,05). Resultados na comparação entre os grupos de prematuros e típicos (GE-I e GC-I e GEII e GC-II), quanto às habilidades comunicativas verificou-se diferenças significantes, apesar da heterogeneidade no desempenho dos prematuros e prematuros extremos. Na comparação entre os prematuros (GE-I e GE-II) não foram observadas diferenças significantes, entretanto, GE-I obteve desempenho superior em todas as categorias, exceto para a categoria uso de gestos. As categorias de menor ocorrência para GE-I foram: respeitar troca de turno, participar e manter atividade dialógica. Para o GE-II foram: participar e manter atividade dialógica, realizar ordens complexas, iniciar e respeitar troca de turno, funções de informar, oferecer e produzir frases. Conclusão houve diferenças significantes no desempenho comunicativo das crianças prematuras e prematuras extremas, quanto comparadas às crianças típicas, mas não houve diferenças significantes na comparação entre os prematuros. Apesar dos resultados indicarem que os grupos de prematuros tendem ao atraso no desenvolvimento das habilidades comunicativas, os grupos não demonstraram ser homogêneos.

Early relations between language development and the quality of mother-child interaction in very-low-birth-weight children

BACKGROUND

It is not clearly understood how the quality of early mother-child interaction influences language development in very-low-birth-weight children (VLBW).

AIMS

We aim to analyze associations between early language and the quality of mother-child interaction, and, the predictive value of the features of early mother-child interaction on language development at 24 months of corrected age in VLBW children.

STUDY DESIGN

A longitudinal prospective follow-up study design was used.

METHODS

The participants were 28 VLBW children and 34 full-term controls. Language development was measured using different methods at 6, 12 and at 24 months of age. The quality of mother-child interaction was assessed using PC-ERA method at 6 and at 12 months of age.

RESULTS

Associations between the features of early interaction and language development were different in the groups of VLBW and full-term children. There were no significant correlations between the features of mother-child interaction and language skills when measured at the same age in the VLBW group. Significant longitudinal correlations were detected in the VLBW group especially if the quality of early interactions was measured at six months and language skills at 2 years of age. However, when the predictive value of the features of early interactions for later poor language performance was analyzed separately, the features of early interaction predicted language skills in the VLBW group only weakly.

CONCLUSIONS

The biological factors may influence on the language development more in the VLBW children than in the full-term children. The results also underline the role of maternal and dyadic factors in early interactions.

Language, motor and cognitive development of extremely preterm children: modeling individual growth trajectories over the first three years of life

Survival rate of extremely low gestational age (ELGA) newborns has increased over 80% in the last 15 years, but its consequences on the short- and longer-term developmental competencies may be severe. The aim of this study was to describe growth trajectories of linguistic, motor and cognitive skills among ELGA children, compared to full-term (FT) peers, from the first to the third year of life, a crucial period for development. Growth curve analysis was used to examine individual and group differences in terms of initial status at 12 months and rate of growth through the second and the third year of life with five points of assessment. Twenty-eight monolingual Italian children, of whom 17 were ELGA (mean GA 25.7 weeks) and 11 were FT children, were assessed through the BSID-III at 12, 18, 24, 30 and 36 months for language skills and at 12, 24 and 30 months for motor and cognitive skills. ELGA children presented significantly lower scores than FT peers in language, motor and cognitive skills and they did not overcome their disadvantage by 3 years, even if their corrected age was taken into account. Concerning growth curves, in motor development a significant increasing divergence was found showing a Matthew effect with the preterm sample falling further behind the FT sample. In linguistic and cognitive development, instead, a stable gap between the two samples was found. In addition, great inter-individual differences in rate of change were observed for language development in both samples. Our findings highlight the theoretical and clinical relevance of analyzing, through growth curve analyses, the developmental trajectories of ELGA children in language skills taking into account their inter-individual variability also across motor and cognitive domains.

LEARNING OUTCOMES

After reading this article, the reader will interpret: (a) characteristics and growth trajectories of ELGA children from the first to the third year of life with respect to FT children in language, motor and cognitive development; (b) the method of growth curve analyses to describe group as well as inter-individual trajectories; (c) the rate of inter-individual variability in language as well as motor and cognitive skills, which gives useful indications for early interventions.

Desempenho nas habilidades da linguagem em crianças nascidas prematuras e com baixo peso e fatores associados

Objetivo: Analisar as habilidades do desenvolvimento da linguagem em crianças de 2 a 3 anos de idade, nascidas prematuras e com baixo peso e os fatores de risco associados. Métodos Estudo transversal com aplicação do teste de Denver II (Denver Developmental Screening Test) e escala ELM (Early Language Milestone Scale). Foi utilizado o teste de Qui-quadrado e todas variáveis com p<0,20 entraram no modelo de regressão logística binária, nível de significância (p<0,05). Resultados: Das 77 crianças avaliadas, 36,4% apresentaram desempenho global alterado no teste de Denver II, considerando os quatro setores, e 37,6% apresentaram cautelas e atrasos no setor da linguagem, especificamente na avaliação da habilidade de linguagem pela escala ELM, 32,5% das crianças apresentaram alterações. O desempenho alterado, considerando os quatro setores do teste de Denver II e da linguagem na escala ELM, após regressão logística, permaneceu associado com: suspeita dos pais de alterações no desenvolvimento (Denver II e ELM); peso <1500 g e cesariana (Denver II somente); hemorragia intracraniana e renda familiar mensal per capita ≤1/2 salário mínimo (ELM somente). Conclusão Crianças nascidas prematuras e com baixo peso apresentaram atraso na aquisição de habilidades no desenvolvimento da linguagem, com maior comprometimento da função auditiva expressiva, associado a fatores de risco socioeconômicos e de histórico.

The effect of socioeconomic status on the language outcome of preterm infants at toddler age

BACKGROUND

Independently, both prematurity and low socioeconomic status (SES) compromise language outcome but less is known regarding the effects of low SES on outcome of prior preterm infants at toddler age.

AIM

To assess SES effects on the language outcome of prior preterm infants at toddler age.

STUDY DESIGN

Retrospective chart review of infants born at ≤32 weeks, matched for gestational age (GA), birth weight (BW), chronic lung disease (CLD), periventricular leukomalacia (PVL), right and left intraventricular hemorrhage (IVH-R, L), and age at Bayley Scales of Infant Development III (BSID-III) testing.

SUBJECTS

Using insurance status as a proxy for SES, 65 children with private insurance (P-Ins) were matched with 65 children with Medicaid-type insurance (M-Ins).

OUTCOME MEASURES

Bayley Scales of Infant Development-III Language Composite.

RESULTS

M-Ins vs. P-Ins were similar in GA, BW, and age at BSID-III testing (mean 22.6 months adjusted), as well as other matched characteristics (all p ≥ 0.16). BSID-III Language Composite scores were lower in M-Ins than P-Ins (87.9 ± 11.3 vs. 101.9 ± 13.6) with a clinically significant effect size of 0.93 (p < 0.001). Overall, 45% of M-Ins exhibited mild to moderate language delay compared to 8% of P-Ins. Receptive and Expressive subscale scores also were lower in M-Ins than in P-Ins (both p < 0.001).

CONCLUSIONS

In this preterm cohort, by toddler age, M-Ins was associated with lower scores on measures of overall language as well as receptive and expressive language skills. Our findings, showing such an early influence of SES on language outcome in a cohort matched for biomedical risk, suggest that very early language interventions may be especially important for low SES preterm toddlers.

Preterm birth and developmental problems in infancy and preschool age Part II: cognitive, neuropsychological and behavioural outcomes

Few studies focus on the neuropsychological and behavioural outcomes of preterm children at preschool age. This article reviews the most recent and relevant contributions on cognitive, neuropsychological and behavioural outcomes, and the neuroradiological findings in extremely and very preterm infants. In the first 2 years of life, cognitive impairment is common: it has an incidence of 30-40% and a higher prevalence than neuromotor and neurosensorial impairments. Recent studies report that even preterm infants with no major disabilities at preschool age perform more poorly than term peers in multiple neuropsychological domains, such as language, attention, memory, visuomotor and visuospatial processing and executive functions. The incidence and severity of problems increase with decreasing gestational age. A delayed acquisition of neuropsychological functions and/or the occurrence of behavioural problems at preschool age are likely to be predictive of the high rate of cognitive deficits at school age and in adolescence. Neuropsychological functions across multiple developmental domains should be assessed longitudinally during routine follow-up checks.

Very Early Language Skills of Fifth-Grade Poor Comprehenders

This study tested the theory that future poor comprehenders would show modest but pervasive deficits in both language comprehension and production during early childhood as compared with future poor decoders and typical readers. Using an existing database (NICHD ECCRN), fifth-grade students were identified as having poor comprehension skills (n = 516), poor decoding skills (n = 511) or typical reading skills (n = 535) based on standardized assessments of word recognition and reading comprehension. Language comprehension and production during the toddler and preschool years were retrospectively compared across these subgroups. Compared with future typical readers and poor decoders, poor comprehenders had the lowest abilities on language assessments at 15, 24, 36 and 54 months. For nearly all contrasts, the difference between poor comprehenders and the other groups of readers exceeded .5 standard deviation in magnitude, indicating that the early language skills of poor comprehenders exhibit appreciable lags.

Preterm birth: neuropsychological profiles and atypical developmental pathways

Preterm birth is characterized by multiple interacting atypical constraints affecting different aspects of neuropsychological development. In the first years of life, perceptual, motor, and communicative-linguistic abilities, as well as attention, processing speed, and memory are affected by preterm birth resulting in cascading effects on later development. From school age to adolescence, a catch-up of simpler competencies (i.e., receptive lexicon) along with a more selective effect on more complex competencies (i.e., complex linguistic functions, math, motor, and executive functions) are observed, as well as a relevant incidence of behavioral outcomes. A wide heterogeneity in preterm children's neuropsychological profiles is described depending on the interaction among the degree of neonatal immaturity, medical complications, neurological damages/alterations, environmental and social factors. Severe neuromotor and sensory damages are not frequent, while low severity impairments are common among preterm children. It is argued that developmental pathways of preterm children are atypical, and not merely delayed, and are characterized by different developmental patterns and relationships among competencies.

Neuropsychological Evaluation of High-Risk Children from Birth to Seven Years of Age

High Risk Children (HRC) are those with an increased risk of abnormal development due to any factor affecting neurological growth. Those factors have been the focus of most studies in this area. However, little is known about their long-term consequences over the course of child development. Objectives: the goal was to study the cognitive, emotional and academic outcomes of 7-year-old children diagnosed as HRC at birth. Method: We compared 14 HRC and 20 healthy children using the WISC-IV, BASC and Brunet-Lezine tests. Results: HRC showed cognitive, emotional and academic deficits compared with healthy children. However, Brunet-Lezine scores obtained over the course of development (6, 12, 18 and 24 months) were not predictive of the children's' current psychological status. Conclusions: long-term follow-up with HRC should be maintained until 7 years of age, at which point an appropriate treatment should be implemented.

Word recognition and phonological representation in very low birth weight preterms

BACKGROUND

Several studies have shown impaired neurocognitive development in infants born very preterm. Language is one of the areas that may be affected. Early lexical development measurements have revealed possible delays associated with low gestational age, but no studies have analyzed lexical processing using real-time measures in this at-risk population.

AIMS

To explore the effects of preterm birth on the robustness of phonological representations and lexical processing speed.

SUBJECTS AND METHODS

Eighteen two-year-old VLBW healthy preterms (≤32weeks of gestation; ≤1500g) and a matched group of at term infants, equivalent in age, gender, SES, linguistic environment and expressive lexicon were compared in a 'looking-while-listening' task, using correctly pronounced and mispronounced known words involving a vowel change. Percentage of target fixation, longest look duration, shift rate and orientation latency measures were used to analyze possible between-group differences in phonological representation and familiar word recognition processes.

RESULTS

Based on the percentage of fixation time measure both groups succeeded at word recognition and responded similarly to mispronunciations. However, preterms significantly differed from full-terms in processing speed measures, showing longer look duration, lower shift rate and slower orientation latencies to target from distracter.

CONCLUSIONS

Preterm birth negatively affects lexical processing speed. Birth weight and gestational age are two critical variables in these results. Slower language processing in preterms can compromise the acquisition of more complex lexical and grammatical representations later in development and may underlie poor language outcomes frequently observed in children born very prematurely.

Interhemispheric temporal lobe connectivity predicts language impairment in adolescents born preterm

Although language difficulties are common in children born prematurely, robust neuroanatomical correlates of these impairments remain to be established. This study investigated whether the greater prevalence of language problems in preterm (versus term-born) children might reflect injury to major intra- or interhemispheric white matter pathways connecting frontal and temporal language regions. To investigate this, we performed a comprehensive assessment of language and academic abilities in a group of adolescents born prematurely, some of whom had evidence of brain injury at birth (n = 50, mean age: 16 years, mean gestational age: 27 weeks) and compared them to a term-born control group (n = 30). Detailed structural magnetic resonance imaging and diffusion-tractography analyses of intrahemispheric and interhemispheric white matter bundles were performed. Analysis of intrahemispheric pathways included the arcuate fasciculus (dorsal language pathway) and uncinate fasciculus/extreme capsule (ventral language pathway). Analysis of interhemispheric pathways (in particular, connections between the temporal lobes) included the two major commissural bundles: the corpus callosum and anterior commissure. We found language impairment in 38% of adolescents born preterm. Language impairment was not related to abnormalities of the arcuate fasciculus (or its subsegments), but was associated with bilateral volume reductions in the ventral language pathway. However, the most significant volume reduction was detected in the posterior corpus callosum (splenium), which contains interhemispheric connections between the occipital, parietal and temporal lobes. Diffusion tractography showed that of the three groups of interhemispheric fibres within the splenium, only those connecting the temporal lobes were reduced. Crucially, we found that language impairment was only detectable if the anterior commissure (a second temporal lobe commissural pathway) was also small. Regression analyses showed that a combination of anatomical measures of temporal interhemispheric connectivity (through the splenium of the corpus callosum and anterior commissure) explained 57% of the variance in language abilities. This supports recent theories emphasizing the importance of interhemispheric connections for language, particularly in the developing brain.

Development and predictive value of early vocalizations in very-low-birth-weight children: a longitudinal study

The aim of the present study was to analyze early vocalization development, the predictive value of this development in terms of later language skills, and possible gender difference in early vocalization development in a selected cohort of 32 very-low-birth-weight (VLBW) children and 35 full-term controls. The data on early vocalization development were gathered using a structured maternal report method. Language skills were assessed at 2.0. No significant difference was found between the groups in the rate of early vocalization development when corrected age was used for the VLBW children. The rate of early vocalization development correlated significantly with later language performance in VLBW children. Only weak correlations were detected in the control group. We found no gender difference in early vocalization development in either of the groups. The findings suggest that the rate of early vocalization development can be used as a clinical predictor of later linguistic performance in VLBW children.

Electrophysiological auditory responses and language development in infants with periventricular leukomalacia

This study presents evidence suggesting that electrophysiological responses to language-related auditory stimuli recorded at 46weeks postconceptional age (PCA) are associated with language development, particularly in infants with periventricular leukomalacia (PVL). In order to investigate this hypothesis, electrophysiological responses to a set of auditory stimuli consisting of series of syllables and tones were recorded from a population of infants with PVL at 46weeks PCA. A communicative development inventory (i.e., parent report) was applied to this population during a follow-up study performed at 14months of age. The results of this later test were analyzed with a statistical clustering procedure, which resulted in two well-defined groups identified as the high-score (HS) and low-score (LS) groups. The event-induced power of the EEG data recorded at 46weeks PCA was analyzed using a dimensionality reduction approach, resulting in a new set of descriptive variables. The LS and HS groups formed well-separated clusters in the space spanned by these descriptive variables, which can therefore be used to predict whether a new subject will belong to either of these groups. A predictive classification rate of 80% was obtained by using a linear classifier that was trained with a leave-one-out cross-validation technique.

Evidence for catch-up in cognition and receptive vocabulary among adolescents born very preterm

BACKGROUND

Very preterm adolescents display persistent deficits in neuropsychological functions.

OBJECTIVE

To compare cognitive and language outcomes at 16 years and cognitive and receptive vocabulary trajectories throughout school years between very preterm and term children and to determine child and family factors associated with better developmental trajectories.

DESIGN AND METHODS

At 8, 12, and 16 years, 322 very preterm children with birth weights of 1250 g or less and 41 term children had cognitive and language testing. Hierarchical growth-curve modeling was used to delineate the differences in cognitive and receptive vocabulary development between participants. Cluster analyses allowed for the characterization of very preterm children with different patterns of cognitive and receptive vocabulary development.

RESULTS

At 16 years, very preterm adolescents had deficits in general cognition and higher-order language skills (phonological awareness and phonemic decoding) compared with term peers. Although the between-group difference in cognitive scores remained stable from 8 to 16 years, very preterm children demonstrated catch-up gains in receptive vocabulary during the same period. Moreover, subgroups of very preterm children displayed developmental trajectories in cognition similar to term children (55% on the vocabulary and 46% on the block-design subtests). These children had lower rates of neurosensory impairment and mothers with higher education and were from an ethnic nonminority.

CONCLUSIONS

Significant catch-up in receptive vocabulary is observed by the age of 16 years among very preterm children compared to term peers. The absence of neurosensory impairment and residing in a favorable socioeconomic milieu are associated with the most optimal developmental trajectories.

Preverbal skills as mediators for language outcome in preterm and full term children

Language delay is a well documented problem that occurs on a higher rate in preterm children compared to full term children. Preverbal social skills, such as the ability to share attention to an object with another person (i.e., triadic interaction), are suggested to reflect part of the processes through which children learn language. This longitudinal study examined preverbal and verbal skills in 25 preterm and 35 full term children in order to investigate if birth status affects language development through the proposed mediating processes of preverbal dyadic and triadic skills. Dyadic initiatives during the still-face episode were assessed at 6 months. Triadic responsiveness (gaze following) was examined at 9 and 14 months. Triadic initiatives (joint attention and behavioral request) were also assessed at 14 months. At 30 months, receptive and expressive language was examined. The data showed group differences in 6-month dyadic initiatives, 9-month triadic responsiveness, 14-month triadic behavioral request initiatives and 30-month receptive and expressive language skills at the expense of the preterm children, confirming their risk for a less favorable preverbal and verbal development. Multiple mediation analyses confirmed the hypothesis that birth status affects language development partially through preverbal skills, which is important for clinical practice.

Formula milk and neurodevelopmental and cognitive outcomes: where are we now?

The hypothesis that nutrition during critical windows in fetal and early life can program long-term health is intriguing and has a potentially strong implication for public health and pediatric nutritional practice. Specifically, it has been hypothesized that there are critical periods in the differentiation and maturation of the central nervous system during which environmental and nutritional factors can produce long-term structural and/or functional changes. Many studies have focused on the relationship between nutrition during early life and long-term neurodevelopmental outcome, leading to contrasting results: in fact, although experimental data in animals and short-term follow-up studies indicate a possible relationship between nutrition during early life and neurodevelopment, the results of long-term follow-up studies are more controversial and less convincing.

Precursors to language in preterm infants: speech perception abilities in the first year of life

Language development in infants born very preterm is often compromised. Poor language skills have been described in preschoolers and differences between preterms and full terms, relative to early vocabulary size and morphosyntactical complexity, have also been identified. However, very few data are available concerning early speech perception abilities and their predictive value for later language outcomes. An overview of the results obtained in a prospective study exploring the link between early speech perception abilities and lexical development in the second year of life in a population of very preterm infants (≤32 gestation weeks) is presented. Specifically, behavioral measures relative to (a) native-language recognition and discrimination from a rhythmically distant and a rhythmically close nonfamiliar languages, and (b) monosyllabic word-form segmentation, were obtained and compared to data from full-term infants. Expressive vocabulary at two test ages (12 and 18 months, corrected age for gestation) was measured using the MacArthur Communicative Development Inventory. Behavioral results indicated that differences between preterm and control groups were present, but only evident when task demands were high in terms of language processing, selective attention to relevant information and memory load. When responses could be based on acquired knowledge from accumulated linguistic experience, between-group differences were no longer observed. Critically, while preterm infants responded satisfactorily to the native-language recognition and discrimination tasks, they clearly differed from full-term infants in the more challenging activity of extracting and retaining word-form units from fluent speech, a fundamental ability for starting to building a lexicon. Correlations between results from the language discrimination tasks and expressive vocabulary measures could not be systematically established. However, attention time to novel words in the word segmentation task yielded a significant correlation with vocabulary at both test ages. The predictive value of the behavioral measures in this research for an early identification of language delays in the preterm population was, thus, limited. However, early evidence of preterms' difficulties in speech and language processing tasks involving complex materials reveals a weakness in their initial approach to the language acquisition process that may constrain their future language skills well beyond the prelexical stage.