Language, Motor, and Cognitive Outcomes of Toddlers Who Were Born Preterm

Effect of maternal gestational diabetes mellitus on neurodevelopment in late preterm infants at the corrected age of 12 months

Previous studies have examined the associations of gestational diabetes mellitus(GDM) with autism spectrum disorder and attention deficit hyperactivity disorder. However, the associations between GDM and other neurodevelopmental domains, such as the motor and language, are rarely studied. The primary objective of this study was to examine the effect of maternal GDM on the neurodevelopmental outcomes of late preterm infants at the corrected age of 12 months. This prospective cohort study included 205 late preterm infants born between January 1, 2022, and June 30, 2023 in Jiangsu, China. These infants were grouped according to whether their mothers had GDM, and their neurodevelopment was assessed using the Gesell Developmental Schedules (GDS) at 3, 6, and 12 months of corrected age. Statistical analyses were performed to compare the differences in various parameters between the two groups. A total of 205 infants were enrolled in the study, with 61 in the GDM group and 144 in the non-GDM group. At the corrected age of 3 and 6 months, no significant differences (P > 0.05) were observed in the gross motor, fine motor, adaptability, language, and social-emotional response, nor in rates of abnormal scores, between the GDM and non-GDM groups. However, at the corrected age of 12 months, the GDM group exhibited significantly lower scores in gross motor function and fine motor function compared to the non-GDM group (P < 0.05), while the abnormal rate of language was significantly lower in the GDM group (P < 0.05). Maternal GDM may adversely affect gross motor, fine motor, and language development in late preterm infants at the corrected age of 12 months. These findings highlight the importance of early monitoring and intervention for neurodevelopmental outcomes in this population. Future research should explore the underlying mechanisms and long-term neurodevelopmental trajectories associated with maternal GDM, providing additional insights for clinical practice and public health strategies.

Impact of an early educational protocol on the oral language of children born preterm exhibiting phonological fragility: a multicenter randomized clinical trial

We conducted a six-center, prospective, randomized, open-label trial to assess whether an early standardized educational protocol provided from 42 to 48 months of age improved the progression of oral language and phonological development in children born preterm. A total of 552 children with phonological fragility were included in this study. The children were randomized to receive the educational protocol (guided arm, n = 87) or not (non-guided arm, n = 78). In the guided arm, the oral language development used a short "say and do" type educational protocol designed to maintain visual attention and train the developmental phonology/lexicon/morphosyntax structural links. In contrast, a conservative approach was used in the non-guided arm. A total of 70 guided and 73 non-guided children completed the study. After 6 months, the educated children showed a non-significant increase in their phonology score (p = 0.37), while the variations in the scores of the expressive lexicon (secondary endpoints) were significantly improved (p = 0.0008). We conclude that the short, standardized stimulation of the sensorimotor aspects of language in children born very preterm increased the expressive lexicon. This protocol improved the language of the premature children, especially those with minimal motor skills, with more significant improvement in the phonological scores.

Clinical trial registration

clinicaltrials.gov, identifier NCT01426659.

Investigating parental perspectives of the enablers and barriers to communication with their preterm infants: A narrative study

Learning to communicate with infants in a neonatal unit setting is challenging. Parents need time and support to feel confident and acquire skills that enable them to care for, be close to, and communicate with their infant. This qualitative, narrative-based study sought to investigate parents' understanding of factors that enhance or prevent the development of early communication and interaction between preterm infants and parents within a neonatal setting. Our study used a narrative interview approach with eight parents of premature infants, to explore the enablers and challenges to communication. Reflexive thematic analysis revealed four main themes: Impact of being in the neonatal unit, different communication strategies, communication barriers and an ongoing need for support at home. Our findings provide parental insight into communication between themselves and their premature infants. Overall, parents spoke highly of communication strategies that they were taught but it was clear they received varying advice and support, in the neonatal unit and post-discharge. There is a need for clear, consistent, and culturally appropriate communication strategies with greater awareness of how to facilitate them. Since failure to enable parent-infant interactions may potentially mean delayed language development, there is an essential need for tailored parent-accessible resources.

Perinatal influences on academic achievement and the developing brain: a scoping systematic review

Introduction and methods

In this PRISMA-compliant systematic review, we identify and synthesize the findings of research in which neuroimaging and assessments of achievement have been used to examine the relationships among aspects of developmental programming, neurodevelopment, and achievement in reading and mathematics.

Results

Forty-seven studies met inclusion criteria. The majority examined the impact of prematurity (n = 32) and prenatal alcohol exposure (n = 13). Several prematurity studies reported a positive correlation between white-matter integrity of callosal fibers and executive functioning and/or achievement, and white matter properties were consistently associated with cognitive and academic performance in preterm and full-term children. Volumetric studies reported positive associations between academic and cognitive abilities and white and gray matter volume in regions such as the insula, putamen, and prefrontal lobes. Functional MRI studies demonstrated increased right-hemispheric language processing among preterm children. Altered activation of the frontoparietal network related to numerical abilities was also reported. Prenatal alcohol exposure studies reported alterations in white matter microstructure linked to deficits in cognitive functioning and academic achievement, including mathematics, reading, and vocabulary skills. Volumetric studies reported reductions in cerebral, cerebellar, and subcortical gray matter volumes associated with decreased scores on measures of executive functioning, attention, working memory, and academic performance. Functional MRI studies demonstrated broad, diffuse activation, reduced activation in canonical regions, and increased activation in non-canonical regions during numeric tasks.

Discussion

A preponderance of studies linked prematurity and prenatal alcohol exposure to altered neurodevelopmental processes and suboptimal academic achievement. Limitations and recommendations for future research are discussed.

Systematic review registration

Identifier: DOI 10.17605/OSF.IO/ZAN67.

Application of the Adverse Childhood Experiences Framework to the NICU

BACKGROUND

Infants and families requiring neonatal intensive care unit (NICU) care often experience significant stress and trauma during the earliest period of the infant's life, leading to increased risks for poorer infant and family outcomes. There is a need for frameworks to guide clinical care and research that account for the complex interactions of generational stress, pain, toxic stress, parental separation, and lifelong health and developmental outcomes for infants and families.

PURPOSE

Apply the Adverse Childhood Experiences (ACEs) framework in the context of the NICU as a usable structure to guide clinical practice and research focused on infant neurodevelopment outcomes and parental attachment.

METHODS

An overview of ACEs is provided along with a detailed discussion of risk at each level of the ACEs pyramid in the context of the NICU. Supportive and protective factors to help mitigate the risk of the ACEs in the NICU are detailed.

RESULTS

NICU hospitalization may be considered the first ACE, or potentially an additional ACE, resulting in an increased risk for poorer health outcomes. The promotion of safe, stable, and nurturing relationships and implementation of trauma-informed care and individualized developmental care potentially counter the negative impacts of stress in the NICU.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Nurses can help balance the negative and positive stimulation of the NICU through activities such as facilitated tucking, skin-to-skin care, mother's milk, and active participation of parents in infant care. Future research can consider using the ACEs framework to explain cumulative risk for adverse health and well-being in the context of NICU care.

Word usage as measured by parental checklists and language samples: trends, comparisons, and implications

Background

Although parental checklists are well-known for their potential in indexing young children's lexicon size, they can also be used to track children's acquisition of individual words. Word-level data can be used to identify the checklist words most and least commonly employed across groups of children. Like parent-completed vocabulary checklists, samples of spontaneous language use collected from multiple children can also generate measures of word commonality, concerned with the numbers of children producing individual words. To our knowledge, comparisons of word usage as determined by parental checklist and language sample data obtained in parallel from the same children have not been carried out. Also scarce in the empirical literature are item-level analyses of early bilingual lexicons that explore word usage across two emerging languages. The present study aimed to contribute toward bridging both gaps through the analysis of data generated by a bilingual Maltese-English adaptation of the vocabulary checklist of the MacArthur Communicative Development Inventories: Words and Sentences (CDI: WS) and spontaneous language samples for the same children. An additional objective was to derive implications for revising the current version of the vocabulary checklist, in preparation for its eventual standardization.

Materials and methods

For 44 Maltese children aged 12, 18, 24, and 30 months, the words reported by their main caregivers on the vocabulary checklist were identified, along with their respective semantic categories. For the same children, 20-min language samples obtained during free play with the caregiver were transcribed orthographically. Words identified through parental report and language sampling were analyzed for commonality, i.e., the number of children producing each word.

Results

Comparison of the word usage patterns obtained through both methods indicated differences in the words most commonly sampled and those most commonly reported, particularly in relation to grammatical categories. Notwithstanding these differences, positive and significant correlations emerged when considering all grammatical categories and languages across commonality levels.

Discussion

The commonality scores based on parental checklist data have implications for reconsidering the length and language balance of the Maltese-English adaptation of the CDI: WS vocabulary checklist. Sampled word usage patterns can contribute additional objectivity in updating the reporting instrument in preparation for its eventual standardization.

Risk Factors of Language Delay at Two Years of Corrected Age among Very-Low-Birth-Weight Preterm Infants: A Population-Based Study

Language delays are often underestimated in very-low-birth-weight (VLBW) preterm infants. We aimed to identify the risk factors of language delay at two years of corrected age in this vulnerable population. VLBW infants, who were assessed at two years of corrected age using the Bayley Scale of Infant Development, third edition, were included using a population-based cohort database. Language delay was defined as mild to moderate if the composite score was between 70 and 85 and severe if the score was < 70. Multivariable logistic regression analysis was used to identify the perinatal risk factors associated with language delay. The study comprised 3797 VLBW preterm infants; 678 (18%) had a mild to moderate delay and 235 (6%) had a severe delay. After adjusting for confounding factors, low maternal education level, low maternal socioeconomic status, extremely low birth weight, male sex, and severe intraventricular hemorrhage (IVH) and/or cystic periventricular leukomalacia (PVL) were found to be significantly associated with both mild to moderate and severe delays. Resuscitation at delivery, necrotizing enterocolitis, and patent ductus arteriosus requiring ligation showed significant associations with severe delay. The strongest factors predicting both mild to moderate and severe language delays were the male sex and severe IVH and/or cystic PVL; thus, early targeted intervention is warranted in these populations.

Speech sound production, speech intelligibility, and oral-motor outcomes of preterm children: Are they different from full term children?

We studied the speech sound abilities of preterm (PT) children. Thirty-one PT and twenty-nine full term (FT) children were recruited. Speech abilities were assessed in single word, story retelling, oral-motor, and intelligibility. PT group had poorer outcomes (Mean = 25.77, SD = 17.19) than FT ones (Mean = 5.9, SD = 4.97) for single word (p < 0.001). They obtained poorer results (Mean = 9.65, SD = 7.85) than FT peers (Mean = 2.95, SD = 3.34) in story retelling (p = 0.002) and intelligibility (Man-Whitney U = 89.50, p = 0.02). They obtained lower values for diadochokesis/patuku/(p < 0.001), isolated (p = 0.001), and sequenced movements (p = 0.02) but not for diadochokesis/patukejk/(p = 0.12). Significant values of correlation were found among single word scores with birth weight (r = -.54, p < .001) and gestational age (r = -0.67, p < .001) and story retelling scores with birth weight (r = -0.40, p = .013) and gestational age (r = -0.64, p < .001). The associations of single word score and maternal (r = -0.02, p = .85) and paternal education (r = -0.10, p = .41) were not significant. No significant relationships were obtained between story retelling score and maternal (r = 0.16, p = .34) and paternal education (r = 0.09, p = .59). The significant values were obtained for associations of intelligibility with isolated (r = 0.54, p = .001), sequenced movements (r = 0.59, p < .001), and diadochokesis/patukejk/(r = 0.39, p = .016) but not significant for intelligibility and diadochokesis/patuku/(r = 0.25, p = .13). Findings implied that speech abilities are weaker in PT children.

Impact of Differing Language Background Exposures on Bayley-III Language Assessment in a National Cohort of Children Born Less than 29 Weeks' Gestation

Preterm infants are at risk for adverse neurodevelopmental outcomes, especially language delay. Preterm infants < 29 weeks’ gestational age, cared for in Canadian Neonatal Follow-Up Network affiliated hospitals, were assessed between 18 to 21 months corrected age using the Bayley-III. Bayley-III Language Composite Scores were compared using univariate and multivariate analyses for children in three primary language groups: English, French and other. 6146 children were included. The primary language at home was English, French or another language for 3708 children (60%), 1312 children (21%) and 1126 children (18%), respectively, and overall, 44% were exposed to two or more languages at home. Univariate analysis showed that primary language was associated with lower Bayley-III Language scores; however, multivariate analyses demonstrated that neither primary language nor language of administration were significantly associated with lower language scores when adjusted for gestational age, other developmental delays and sociodemographic factors, but multiple language exposure was. Sociodemographic and other factors are more important in determining language development than primary language at home. Further studies are needed to examine the association between exposure to multiple languages and lower Bayley-III language scores in preterm infants.

Reliability Study of the Items of the Alberta Infant Motor Scale (AIMS) Using Kappa Analysis

Purpose: We evaluated the interrater and intrarater reliabilities of the Korean version of the Alberta Infant Motor Scale (K-AIMS). Methods: For the interrater reliability test, six raters participated in the K-AIMS evaluation using video clips of 70 infants (aged between 0 and 18 months). One rater participated in an intrarater reliability test. Among 70 infants, 46 were born preterm and 24 were born full term. A total of 58 AIMS items were evaluated for supine, prone, sitting, and standing positions. A reliability analysis was conducted using ICC and Fleiss’ kappa. Results: The highest Fleiss’ kappa was found for the 4–7 months group for sitting (K = 0.701–1.000) and standing (K = 0.721–1.000), while the lowest K was the 3 months or under group for standing (K = 0.153–1.000). We found higher Fleiss’ kappa statistics when all infants were evaluated without grouping for the three positions (K = 0.727–1.000), except standing (K = 0.192–1.000), for the interrater analysis. Conclusion: Our results demonstrate the good reliability for the Korean version of the AIMS for Korean infants (preterm and full term).

Neurodevelopmental outcomes of infants of diabetic mothers

With the increase of the incidence of pre-pregnancy diabetes mellitus and gestational diabetes mellitus, the number of infants of diabetic mothers (IDMs) are increasing year by year. IDMs may be associated with poor perinatal outcomes and may have a negative impact on neurodevelopment, but there are relatively few studies on the neurodevelopmental outcomes of IDMs. This article reviews the relevant literature and summarizes the neurodevelopmental outcomes of IDMs from the aspects of sensory and perception, motor, language, intellectual development, neuropsychiatric disorders, neurological examination and drug effect, so as to provide reference for clinical work. Citation.

Language Profiles and Their Relation to Cognitive and Motor Skills at 30 Months of Age: An Online Investigation of Low-Risk Preterm and Full-Term Children

Purpose Wide interindividual variability characterizes language development in the general and at-risk populations of up to 3 years of age. We adopted a complex approach that considers multiple aspects of lexical and grammatical skills to identify language profiles in low-risk preterm and full-term children. We also investigated biological and environmental predictors and relations between language profiles and cognitive and motor skills. Method We enrolled 200 thirty-month-old Italian-speaking children-consisting of 100 low-risk preterm and 100 comparable full-term children. Parents filled out the Italian version of the MacArthur-Bates Communicative Development Inventories Infant and Toddler Short Forms (word comprehension, word production, and incomplete and complete sentence production), Parent Report of Children's Abilities-Revised (cognitive score), and Early Motor Questionnaire (fine motor, gross motor, perception-action, and total motor scores) questionnaires. Results A latent profile analysis identified four profiles: poor (21%), with lowest receptive and expressive vocabulary and absent or limited word combination and phonological accuracy; weak (22.5%), with average receptive but limited expressive vocabulary, incomplete sentences, and absent or limited phonological accuracy; average (25%), with average receptive and expressive vocabulary, use of incomplete and complete sentences, and partial phonological accuracy; and advanced (31.5%), with highest expressive vocabulary, complete sentence production, and phonological accuracy. Lower cognitive and motor scores characterized the poor profile, and lower cognitive and perception-action scores characterized the weak profile. Having a nonworking mother and a father with lower education increased the probability of a child's assignment to the poor profile, whereas being small for gestational age at birth increased it for the weak profile. Conclusions These findings suggest a need for a person-centered and cross-domain approach to identifying children with language weaknesses and implementing timely interventions. An online procedure for data collection and data-driven analyses based on multiple lexical and grammatical skills appear to be promising methodological innovations. Supplemental Material https://doi.org/10.23641/asha.14818179.