Predictive Validity of the Bayley-III Cognitive Scores at 6 Months for Cognitive Outcomes at 24 Months in Very-Low-Birth-Weight Infants

Motor skills as early indicators for cognitive development in preterm infants with very low birth weight

BACKGROUND

Preterm babies born with very low birth weight (VLBW, birth weight <1500 g) have inferior long-term neurodevelopmental outcomes to term babies. This study aimed to identify early predictive neurodevelopmental factors for future cognitive outcomes that could serve as indicators for early intervention strategies.

METHODS

This longitudinal cohort study enrolled 146 VLBW preterm infants, identified between 2011 and 2020. Each child underwent four neurodevelopmental assessments (at ages 6,12, 24, and 60 months) using the Bayley-III and Wechsler Preschool and Primary Scale of Intelligence-IV examinations. Correlation and linear regression analyses were performed to determine the correlation between early neurodevelopmental status and late cognitive outcomes. We concurrently considered neonatal medical complications and socioeconomic variables as risk factors to develop a prediction model of cognitive outcomes at five years old.

RESULTS

A total of 146 VLBW children, born with a mean weight of 1090.4 ± 229.6 g and a mean gestational age of 28.2 ± 2.0 weeks, were evaluated. At 6 months of age, motor outcome was the only factor that exhibited a significant correlation with cognitive development at 5 years of age (p < 0.01, r = 0.242). The strength of the correlation between motor and cognitive function increased with age, reaching greater significance at 12 and 24 months (p < 0.001, r = 0.409 and 0.472, respectively). The linear regression model demonstrated that neonatal medical conditions and Bayley motor score at six months old predicted 26% of the variance in the Full-Scale Intelligence Quotient (FSIQ) at five years old.

CONCLUSION

The results of the present study show that motor function was the earliest and persistent predictor of FSIQ. This underscores the importance of prioritizing motor development in interventions as early as six months of age, which could substantially advance the timing of early intervention programs.

Exploring word-referent mapping in Mandarin-speaking late-talkers at 33 months and its language predictors at 27 months: An eye-tracking study

BACKGROUND AND AIMS

This longitudinal study investigated the language skills, phonological working memory and lexical-tone perception of Mandarin-speaking late-talkers (LTs) and those with typical language development (TLD) at 27 months, while also examining their connections with novel word-referent mapping (W-R mapping) through eye-tracking at 33 months.

METHODS AND PROCEDURES

Participants included 22 Mandarin-speaking 27-month-old LTs and 22 toddlers with TLD. Data on expressive and receptive language abilities, as well as phonological working memory and lexical-tone perception, were collected when participants were 27 months old. An eye-tracking paradigm was further employed during the word-learning tasks, which included W-R mapping and word-identification test (W-I test) phases at 33 months. Multilevel models were used to analyse participants' gaze pattern trajectories.

OUTCOMES AND RESULTS

At 27 months, LT toddlers exhibited poorer language skills (receptive: p = 0.015, expressive: p < 0.001), lexical-tone perception (p < 0.001) and phonological working memory (p < 0.001) compared to those with TLD, even after considering maternal educational level and participants' fine motor ability. During the W-I test phase, we observed that LT toddlers showed a slower increase in fixations on the novel target image while listening to the corresponding novel word over time, compared to TLD toddlers (linear: p = 0.011, quadratic: p = 0.007) after adding confounders. Further, expressive language ability at 27 months old was a predictor of their newly established W-R mappings at 33 months old (p = 0.016). Additionally, the toddler's phonological working memory and lexical-tone perception were associated with their expressive language ability (p = 0.001 and < 0.001).

CONCLUSIONS AND IMPLICATIONS

These findings indicate that the novel W-R mapping is not as robust in LTs as in TLDs, and the skills necessary for word learning share similarities with a wide range of expressive language abilities. Moreover, poor expressive language abilities were associated with deficits in lexical processing abilities; that is, phonological working memory and lexical-tone perception. These findings suggest the need for interventions aimed at improving LTs' lexical processing abilities to strengthen their lagging word-learning skills at toddlerhood.

WHAT THIS PAPER ADDS

What is already known on this subject Late-talkers (LTs) exhibit delays in expressive vocabulary development. Furthermore, they also perform poorly in word learning. What this paper adds to existing knowledge The eye-tracking paradigm was employed and found that novel word-referent mapping (W-R mapping) is not as robust in LTs as in those with typical language development. Toddlers' early expressive language ability could predict their ability to establish novel W-R mappings. Furthermore, the better the phonological working memory and lexical-tone perception of LTs are, the better their early expressive language ability is. What are the clinical implications of this work? Interventions might consider incorporating strategies to improve phonological working memory and lexical-tone perception to help Mandarin-speaking LTs enhance linguistic capacities and build robust novel W-R mapping.

Sustained acute kidney injury as an independent risk factor for neurodevelopmental and growth outcomes in a single NICU center

PURPOSE

Acute kidney injury (AKI) is commonly seen in neonatal intensive care units (NICUs) and is potentially associated with adverse prognoses in later stages of life. Our study evaluated the impact of sustained AKI (SAKI) on both neurodevelopmental impairment (NDI) and early growth restriction (EGR) in neonates.

METHODS

This case-control study retrospectively analyzed the medical records of neonates diagnosed with SAKI in the NICU of a tertiary medical center during the period from January 2007 to December 2020. Cases without subsequent follow-up and those resulting in death were excluded. We analyzed demographic, biochemical, and clinical outcome data.

RESULTS

Of the 93 neonates with SAKI, 51 cases (54.8%) were included in this study, while 42 cases (45.2%) were excluded due to a lack of follow-up or death. An age-matched control group comprised 103 neonates, who had never experienced AKI or SAKI, were selected at random. In total, 59 (38.3%) cases were identified as NDI and 43 (27.9%) as EGR. Multivariate analysis revealed that patients with SAKI had significantly higher risks of developing NDI (odds ratio, [OR] = 4.013, p = 0.001) and EGR (OR = 4.894, p < 0.001). The AKI interval had an area under the receiver operating characteristic curve of 0.754 for NDI at 9.5 days and 0.772 for EGR at 12.5 days.

CONCLUSIONS

SAKI is an independent risk factor for both NDI and EGR in neonates. Consequently, regular monitoring, neurological development assessments, and appropriate nutritional advice are crucial to these infants who have experienced renal injury.

Effects of caffeine therapy for apnea of prematurity on sleep and neurodevelopment of preterm infants at 6 months of corrected age

STUDY OBJECTIVES

To determine the differences in sleep patterns between preterm infants who received caffeine and those who did not and to evaluate the effects of caffeine therapy on early neurodevelopment. Secondarily, actigraphy and polysomnography were compared to evaluate the sleep of preterm infants.

METHODS

Twenty-eight preterm infants ages 28-34 weeks admitted to a single-center Level III neonatal intensive care unit between May 2020 and May 2021 were included. Sleep was assessed by actigraphy for 72 hours with Respironics Mini-Mitter® Actiwatch-2 and Brief Infant Sleep Questionnaire at 6 months corrected age. On the first day of actigraphy, infants underwent polysomnography between 10:00 am and 3:00 pm. Neurodevelopment was evaluated by the Bayley Scales of Infant and Toddler Development-III, the Ages & Stages Questionnaire, and the Hammersmith Infant Neurological Examination.

RESULTS

There were no significant differences in sleep parameters measured by actigraphy, the Brief Infant Sleep Questionnaire, and polysomnography between infants in the caffeine group (n = 12) and no-caffeine group (n = 16). Sensitivity (91.07%) and agreement rate (77.21%) for the actigraphy against polysomnography were highest at the automatic threshold. No significant differences were observed in the neurodevelopment of infants in the caffeine group compared to the no-caffeine group.

CONCLUSIONS

Sleep parameters and neurodevelopmental outcomes were not different in infants at 6 months of corrected age with regard to caffeine therapy. Actigraphy at the automatic threshold can be used in infants for sleep pattern assessment.

CLINICAL TRIAL REGISTRATION

Registry: ClinicalTrials.gov; Name: Influence of Caffeine Therapy in Preterm Infants; URL: https://www.clinicaltrials.gov/ct2/show/NCT04376749; Identifier: NCT04376749.

CITATION

Atalah YEY, Barış HE, Akdere SK, et al. Effects of caffeine therapy for apnea of prematurity on sleep and neurodevelopment of preterm infants at 6 months of corrected age. J Clin Sleep Med. 2023;19(12):2075-2085.

Early Neurodevelopmental Assessments of Neonates Discharged From the Neonatal Intensive Care Unit: A Physiatrist's Perspective

The survival rate of children admitted in the neonatal intensive care unit (NICU) after birth is on the increase; hence, proper evaluation and care of their neurodevelopment has become an important issue. Neurodevelopmental assessments of individual domains regarding motor, language, cognition, and sensory perception are crucial in planning prompt interventions for neonates requiring immediate support and rehabilitation treatment. These assessments are essential for identifying areas of weakness and designing targeted interventions to improve future functional outcomes and the quality of lives for both the infants and their families. However, initial stratification of risk to select those who are in danger of neurodevelopmental disorders is also important in terms of cost-effectiveness. Efficient and robust functional evaluations to recognize early signs of developmental disorders will help NICU graduates receive interventions and enhance functional capabilities if needed. Several age-dependent, domain-specific neurodevelopmental assessment tools are available; therefore, this review summarizes the characteristics of these tools and aims to develop multidimensional, standardized, and regular follow-up plans for NICU graduates in Korea.

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.

Enteral Zinc Supplementation in Preterm or Low Birth Weight Infants: A Systematic Review and Meta-analysis

BACKGROUND AND OBJECTIVES

Evidence on the effect of zinc supplementation on health outcomes in preterm or low birth weight (LBW) infants is unclear. We estimated the effect of enteral zinc versus no zinc supplementation in human milk fed preterm or LBW infants on mortality, growth, morbidities, and neurodevelopment.

METHODS

Data sources include PubMed, Cochrane Central and Embase databases through March 24, 2021. Study selection was randomized or quazi-experimental trials. Two reviewers independently screened, extracted data, and assessed quality. We reported pooled relative risks (RR) for categorical outcomes, and mean differences (MD) for continuous outcomes.

RESULTS

Fourteen trials with 9940 preterm or LBW infants were included. Moderate to low certainty evidence showed that enteral zinc supplementation had little or no effect on mortality (risk ratio 0.73, 95% confidence interval [CI] 0.46 to 1.16), but increased weight (MD 378.57, 95% CI 275.26 to 481.88), length (MD 2.92, 95% CI 1.53 to 4.31), head growth (MD 0.56, 95% CI 0.23 to 0.90), and decreased diarrhea (RR 0.81; 95% CI 0.68 to 0.97). There was no effect on acute respiratory infections, bacterial sepsis, and psychomotor development scores. The effect of zinc supplementation on mental development scores is inconclusive. There was no evidence of serious adverse events. Eight trials had some concerns or high risk of bias, small-sized studies, and high heterogeneity between trials led to moderate to very low certainty of evidence.

CONCLUSIONS

Zinc supplementation in preterm or LBW infants have benefits on growth and diarrhea prevention. Further research is needed to generate better quality evidence.

The predictive value of the ages and stages questionnaire in late infancy for low average cognitive ability at age 5

Aim

This retrospective, longitudinal study examined the predictive value of the ages and stages questionnaire (ASQ) in late infancy for identifying children who progressed to have low cognitive ability at 5 years of age.

Methods

The ASQ was performed on 755 participants from the Irish BASELINE birth cohort at 24 or 27 months of age. Intelligence quotient was measured at age 5 with the Kaufmann Brief Intelligence Test, Second Edition, and low cognitive ability was defined as a score more than 1 standard deviation below the mean. The ASQ’s predictive value was examined, together with other factors associated with low cognitive ability at 5 years.

Results

When the ASQ was performed at 24 or 27 months, the overall sensitivity for identifying low cognitive ability at 5 years was 20.8% and the specificity was 91.1%. Using a total score cut‐off point increased the sensitivity to 46.6% and 71.4% at 24 and 27 months, but specificity fell to 74.1% and 67.2%, respectively. After adjusting for ASQ performance, maternal education and family income were strongly associated with cognitive outcomes at 5 years.

Conclusion

The ASQ did not detect the majority of children with low cognitive ability at age 5. Alternative methods need investigation.

Impact of early term and late preterm birth on infants' neurodevelopment: evidence from a cohort study in Wuhan, China

Background

The incidences of early term and late preterm birth have increased worldwide during recent years. However, there is a lack of prospective study about the influence of early term and late preterm birth on infants’ neurodevelopment, especially at the early stage. Therefore, we conducted this cohort study to investigate the impact of early term and late preterm birth on infants’ neurodevelopment within 6 months.

Methods

This cohort study was conducted in Wuhan, China, between October 2012 and September 2013. A total of 4243 singleton infants born within 34-41 weeks of gestation at Wuhan Children’s Hospital were included. The Gesell Developmental Scale (GDS) was utilized to evaluate the neurodevelopment of infants.

Results

Among the 4243 included participants, 155 (3.65%) were late preterm infants, 1288 (30.36%) were early term infants, and 2800 (65.99%) were full term infants. After adjusted for potential confounders, significant negative relationship was shown between late preterm birth and development quotient (DQ) in all domains of neurodevelopment: gross motor (β = − 17.42, 95% CI: − 21.15 to − 13.69), fine motor (β = − 23.61, 95% CI: − 28.52 to − 18.69), adaptability (β = − 10.10, 95% CI: − 13.82 to − 6.38), language (β = − 6.28, 95% CI: − 9.82 to − 2.74) and social behavior (β = − 5.99, 95% CI: − 9.59 to − 2.39). There was a significant negative trend for early term birth in DQ of fine motor (β = − 2.01, 95% CI: − 3.93 to − 0.09). Late preterm infants had a significantly elevated risk of neurodevelopmental delay in domains of gross motor (adjusted OR = 3.82, 95% CI: 2.67 to 5.46), fine motor (adjusted OR = 3.51, 95% CI: 2.47 to 5.01), and adaptability (adjusted OR = 1.60, 95% CI: 1.12 to 2.29), whereas early term birth was significantly associated with neurodevelopmental delay of fine motor (adjusted OR = 1.22, 95% CI: 1.05 to 1.42).

Conclusions

This study suggested that late preterm birth mainly elevated the risk of neurodevelopmental delay of gross motor, fine motor, and adaptability, whereas early term birth was associated with the developmental delay of fine motor within 6 months. Further research is needed to determine the effectiveness and necessity of the interventions at the early stage for early term and late preterm infants who had suspected neurodevelopmental delay.