Attention problems and language development in preterm low-birth-weight children: cross-lagged relations from 18 to 36 months

Living in a box: Understanding acoustic parameters in the NICU environment

Background

In the last years, a significant body of scientific literature was dedicated to the noisy environment preterm-born infants experience during their admission to Neonatal Intensive Care Units (NICUs). Nonetheless, specific data on sound characteristics within and outside the incubator are missing. Therefore, this study aimed to shed light on noise level and sound characteristics within the incubator, considering the following domain: environmental noise, incubator handling, and respiratory support.

Methods

The study was performed at the Pediatric Simulation Center at the Medical University of Vienna. Evaluation of noise levels inside and outside the incubator was performed using current signal analysis libraries and toolboxes, and differences between dB_A and dB_SPL values for the same acoustic noises were investigated. Noise level results were furthermore classed within previously reported sound levels derived from a literature survey. In addition, sound characteristics were evaluated by means of more than 70 temporal, spectral, and modulatory timbre features.

Results

Our results show high noise levels related to various real-life situations within the NICU environment. Differences have been observed between A weighted (dB_A) and unweighted (dB_SPL) values for the same acoustic stimulus. Sonically, the incubator showed a dampening effect on sounds (less high frequency components, less brightness/sharpness, less roughness, and noisiness). However, a strong tonal booming component was noticeable, caused by the resonance inside the incubator cavity. Measurements and a numerical model identified a resonance of the incubator at 97 Hz and a reinforcement of the sound components in this range of up to 28 dB.

Conclusion

Sound characteristics, the strong low-frequency incubator resonance, and levels in dB_SPL should be at the forefront of both the development and promotion of incubators when helping to preserve the hearing of premature infants.

Relationship of withdrawn, anxious/depressed and attention problems to cognitive performance in preterm children at 18 months and 36 months of age

OBJECTIVE

A positive significant association has been found between behavior problems and lower cognition in very low birthweight (VLBW) preterm children at school age, but there is relatively little information about whether such an association exists in toddlers and on the continuity of this association. The aim of this study was to assess if there is a relationship between behavior problems and cognitive performance in VLBW preterm children at 18 months post conception and 3 years old, independent of socioeconomic status and sex.

METHOD

Parents of 124 preterm children completed a behavior rating questionnaire (Child Behavior Checklist 1.5-5) to measure behavior problems characteristic of preterm children (Withdrawn, Anxious/Depressed, and Attention Problems). Children completed the Cognitive Scale of the Bayley Scales of Infant Development-III at 18 months and the Wechsler Preschool and Primary Scale (III or IV) at 36 months old. Socioeconomic status (SES), sex, and diagnoses of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) at 3 years were recorded for each child.

RESULTS

Withdrawn problems at 18 months were associated with lower cognitive scores at 18 months and both Withdrawn problems at 18 months and 36 months were associated with lower cognitive scores at 36 months. Increases in Attention Problems scores from 18 to 36 months were associated with decreases in cognitive scores over that period. Lower SES was associated with lower cognitive scores at 36 months and decreases in cognitive scores between 18 and 36 months. Sex was not related to behavior problems or cognition. Diagnoses of ASD and ADHD were significantly associated with increased Withdrawn behavior and Attention Problems, respectively.

CONCLUSIONS

The early association of Withdrawn behaviors with less favorable cognitive performance at 18 months and 36 months and the relationship between increases in Attention Problems with decreases in cognitive scores between the toddler and preschool period indicate the need for early assessment of and intervention for behavior problems, as well as concurrent cognitive delays, in VLBW preterm children.

Survey of clinical staff knowledge on the long-term outcomes of very preterm infants delivered in a tertiary referral hospital

AIM

To assess knowledge of our neonatal intensive care unit clinical staff regarding preterm neurodevelopmental outcomes using the 33-item Preterm Birth Knowledge Scale (PB-KS).

METHODS

An anonymous convenience sampling survey of clinical staff in the Neonatal Directorate was conducted between July and December 2019. PB-KS, demographic information and prior staff education on long-term outcomes in very preterm infants were collected.

RESULTS

There were 56 responses (five neonatologists, eight paediatric trainees, 41 neonatal nurses and two allied health staff). Responses were scored as correct or incorrect. The mean score on the PB-KS was 19.5 (range: 4-29 out of 40) with 50% correct answers. Accuracy was highest (96%) for rates of cerebral palsy and lowest (11%) for estimation of quality of life among preterm survivors. Staff reported training in long-term outcomes of preterm infants through attending a conference/seminar (20%) or a combination of formal training and seminars (41.1%). Over half of our clinical staff reported a lack of formal training. Formally trained clinical staff scored significantly better in this survey. Didactic seminars were indicated as preferred choice for staff education.

CONCLUSIONS

Results of our survey will assist in developing a customised educational programme to address identified gaps in the knowledge of clinical staff as our survey also showed significantly better scores among staff who were formally trained about long-term outcomes in very preterm infants. Staff responses indicated that knowledge on long-term outcomes was variable but more accurate with regard to more severe disabilities and shorter-term developmental outcomes.

Mental disorders in referred 0-3-year-old children: a population-based study of incidence, comorbidity and perinatal risk factors

The epidemiology of mental disorders in early childhood is still under-researched. We aim to explore the incidence, comorbidities and risk factors of mental disorders in 0-3-year-olds referred to hospital settings. In a national cohort of 918,280 children born in 1997-2010, we calculated incidence rates per 1,000 person-years (IR) of first-time mental and developmental disorders diagnosed in hospitals before four years of age. Data were obtained from Danish population registries. We used logistic regression to analyse co-morbidity and Cox proportional hazard models to evaluate the influence of pre- and perinatal risk factors. A total of 16,164 children (1.76%) were diagnosed with a mental (0.90%) or developmental disorder (1.05%). Pervasive developmental disorders (PDD) and disorders of hyperactivity and inattention (ADHD) were increasingly diagnosed with age. Feeding and eating disorders and disorders of social functioning were most frequent among the youngest children. Comorbidity was found in 18%, e.g., between PDD and ADHD (OR 135.8; 95% CI 112.0-164.7) or between ADHD and disorders of social functioning (OR 148.0; 95% CI 106.4-205.7). Young maternal age, old paternal age, maternal smoking in pregnancy, boy sex, premature birth and being small for gestational age were associated with highly increased risk of mental and developmental disorders. Mental and developmental disorders diagnosed within the first four years of life show increasing incidence rates and a complex pattern of comorbidities. Study findings point to the need of clinical and research attention towards the manifestations of developmental psychopathology in very young children.

Exploring predictors at toddler age of distinct profiles of attentional functioning in 6-year-old children born moderate-to-late preterm and full term

OBJECTIVE

Examining relationships of toddler abilities in attention, cognitive, motor, and language development, and behavioral problems, with distinct attention profiles at 6 years of age in children born moderate-to-late preterm and full term.

METHOD

Longitudinal study with a cohort of 88 moderate-to-late preterm and 83 full term born children. At 18 months attention abilities were assessed. At 24 months cognitive, motor, and language development was examined and behavioral problems were screened. At 6 years ten measures of attention were administered, which were used to classify children in one of four attentional functioning profiles (normal attention, overall poorer attention, poorer cognitive attention, and behavioral attention problems). Performance at 18 and 24 months was examined in relation to these four distinct attention profiles, as well as in relation to normal (first profile) versus subaverage attention (second, third, and fourth profiles) using multinomial logistic regressions.

RESULTS

Orienting and alerting attention, and receptive language were related to distinct attention profiles. Specifically, children with an overall poorer attention profile at 6 years were differentiated by lower orienting attention and receptive language scores at toddler age, while those with a poorer cognitive attention profile showed lower early alerting attention at 18 months. Children with a behavioral attention problems profile at 6 years were differentiated by lower orienting attention but higher alerting attention scores at toddler age. Orienting attention and receptive language, but not alerting attention, at toddler age were related to normal versus subaverage attention, with lower scores predicting subaverage attention.

CONCLUSIONS

Children at risk of poorer attentional functioning at school-age, expressed in distinct attention profiles, already showed differentiated functioning in attention abilities and in language comprehension as toddlers. Distinguishing distinct attention profiles could be important for future research and clinical practice, as is early monitoring of attention and language abilities in children at risk.

Associations Between Language Difficulties, Peer Victimization, and Bully Perpetration From 3 Through 8 Years of Age: Results From a Population-Based Study

Background and Purpose Schoolchildren with language difficulties experience more peer victimization compared to their typically developing (TD) peers. Whether these children also bully their peers (bully perpetration) more than TD children is unclear. Furthermore, little is known about peer victimization and bully perpetration among preschool children with language difficulties and how it may be related to different paths of language difficulties. This study aimed to investigate associations between language difficulties, peer victimization, and bully perpetration from preschool to school age as well as the risk of peer victimization and bully perpetration for children with different developmental paths of language difficulties and mild language difficulties compared to TD children. Method The sample was drawn from the Norwegian Mother, Father and Child Cohort Study. Participants with completed questionnaires at 3, 5, and 8 years of age (n = 22,628) were included. Paths between latent variables of language skills at 3, 5, and 8 years of age, peer victimization at 5 and 8 years of age, and bully perpetration at 8 years of age were examined with structural equation modeling. Logistic regression was used to investigate peer victimization and bully perpetration for predefined paths of language difficulties. Results Poor language skills at 3 and 5 years of age were associated with peer victimization at 5 years of age. Poor language skills at 5 and 8 years of age were associated with peer victimization and bully perpetration at 8 years of age. The association between poor language skills at 5 years of age and bully perpetration at 8 years of age was stronger for girls. Persistent paths of language difficulties at 3, 5, and 8 years of age showed the highest risk of peer victimization and bully perpetration. Conclusions Language difficulties are associated with peer victimization and bully perpetration. The risk of peer victimization and bully perpetration differs according to different developmental paths of language difficulties from preschool to school age.

Sustained attention across toddlerhood: The roles of language and sleep

The present study examined individual differences in the development of sustained attention across toddlerhood, as well as how these individual differences related to the development of language and sleep. Toddlers (N = 314; 54% male) were assessed at 30, 36, and 42 months using multiple measures of attention, a standardized language assessment, and actigraphic measures of sleep. Toddlers were 80% White. Family socioeconomic status (SES) was calculated using the Hollingshead Four Factor Index and ranged from 13 to 66 (M = 47.59, SD = 14.13). Aims were (a) to examine associations between measures of attention across situations, informants, and time; (b) to consider the independent and interactive effects of language and sleep on attention; and (c) to test potential bidirectional associations between sleep and attention. Findings showed attention measures were stable across time but were only weakly linked with each other at 42 months. Attention was consistently linked with language. More variable sleep and longer naps were associated with less growth in sustained attention across time. Nighttime sleep duration interacted with language in that sleep duration was positively associated with attention scores among toddlers with less advanced language, even when SES was controlled. The findings describe an understudied aspect of how sustained attention develops, involving the main effect of consistent sleep schedules and the interaction effect of amount of sleep and child language development. These findings are relevant to understanding early childhood risk for developing attention problems and to exploring a potential prevention target in family sleep practices. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Preterm birth and risk for language delays before school entry: A sibling-control study

We investigated whether children born preterm are at risk for language delay using a sibling-control design in the Norwegian Mother and Child Cohort Study (MoBa), conducted by the Norwegian Institute of Public Health. Participants included 26,769 siblings born between gestational weeks 23 and 42. Language delay was assessed when the children were 1.5, 3, and 5 years old. To adjust for familial risk factors, comparisons were conducted between preterm and full-term siblings. Pregnancy-specific risk factors were controlled for by means of observed variables. Findings showed that preterm children born before week 37 had increased risk for language delays at 1.5 years. At 3 and 5 years, only children born before week 34 had increased risk for language delay. Children born weeks 29–33 and before week 29 had increased risk for language delay at 1.5 years (RR = 4.51, 95% CI [3.45, 5.88]; RR = 10.32, 95% CI [6.7, 15.80]), 3 years (RR = 1.50, 95% CI [1.02, 2.21]; RR = 2.78, 95% CI [1.09, 7.07]), and 5 years (RR = 1.63, 95% CI [1.06, 2.51]; RR = 2.98, 95% CI [0.87, 10.26]), respectively. In conclusion, children born preterm are at risk for language delays, with familial confounders only explaining a moderate share of the association. This suggests a cause-effect relationship between early preterm birth and risk for language delay in preschool children.

A first-in-human clinical study of a new SP-B and SP-C enriched synthetic surfactant (CHF5633) in preterm babies with respiratory distress syndrome: two-year outcomes

OBJECTIVE

To assess at 24 months corrected age (CA) the neurological, respiratory, and general health status of children born prematurely from 27⁺⁰ to 33⁺⁶ weeks' gestation who were treated in a first-in-human study with a new fully synthetic surfactant (CHF5633) enriched with SP-B and SP-C proteins.

OUTCOME MEASURES

Children were assessed using Bayley Scales of Infant Development (BSID), with a score below normal defined as BSID-II Mental Development Index score <70, or BSID-III cognitive composite score <85. In addition, a health status questionnaire was used to check for functional disability including respiratory problems and related treatments, sensory and neurodevelopment assessments, communication skills as well as the number of hospitalizations.

RESULTS

35 of 39 survivors had a neurodevelopmental assessment, 24 infants being evaluated by Bayley's Scales and 11 by health status questionnaires only. 23 children had scores within normal limits and one had BSID-III <85. The remaining 11 were judged clinically to have normal development. Health status questionnaires detected only issues that would normally be expected in preterm-born children.

CONCLUSIONS

This assessment offers reassurance that treatment with CHF5633 surfactant was not associated with adverse neurodevelopmental, respiratory, or health outcomes by two years corrected age.

The Effects of the 2016 Copa América Centenario Victory on Social Trust, Self-Transcendent Aspirations and Evaluated Subjective Well-Being: The Role of Identity With the National Team and Collective Pride in Major Sport Events

Following a neo-Durkheimian perspective, major sporting events such as the World Cup or the America's Cup differ from other collective rituals because they promote interest throughout the nation due to their massiveness and international character. In order to increase the scientific knowledge related to these type of rituals, the aim of this study was to observe the effects that the Chilean victory in the 2016 Copa América Centenario had on social variables such as trust, self-transcendent aspirations, and evaluated subjective well-being (SWB) of both fans and non-fans. In addition, two longitudinal structural equation models (SEMs) were performed to estimate the effect of identity with the national team before the final match on evaluated SWB, trust, and self-transcendent aspirations post-final. A total of 648 Chilean participants (mean age = 38.58; SD = 10.96) answered the questionnaire before the final match. Out of these, 409 completed our measures after the final. The results show that fans presented higher scores in many of the studied variables before and after the final compared to non-fans. Identification with the national team (before the final) prospectively and significantly predicted pride in the national team and pride in the country (after the final). In addition, these two forms of collective pride mediated the relationship between identification with the national team (before the final) and evaluated SWB (after the final). The results are discussed emphasizing the importance of these kinds of specific massive rituals and their effects.

Toddlers' Language Development: The Gradual Effect of Gestational Age, Attention Capacities, and Maternal Sensitivity

Language development in toddlerhood forms the foundation for speech and language comprehension throughout childhood. Children born moderately preterm are at increased risk for problems in receptive and expressive language functioning, and they may need specific support or interventions. To understand the underlying mechanisms of language development, an integrated model of gestational age, attention capacities, and maternal sensitivity was examined in relation to receptive and expressive language functioning in toddlerhood. Our sample included 221 children (gestational age between 32–41 + 6 weeks; 54.7% born moderately preterm; 51.6% boys; 69.1% highly educated mothers). At 18 months (corrected age), attention capacities were measured using an eye-tracking procedure and maternal sensitivity was observed during mother-child interaction. Language was assessed at 24 months (corrected age). Results showed children with a higher gestational age scored higher on receptive language. This association was direct, as well as indirect through the child’s alerting attention. Expressive language was related to maternal sensitivity. Gestational age and alerting attention capacities specifically were related to language comprehension, whereas maternal sensitivity was related to speech. As language comprehension and speech in toddlerhood show different associations with biological, child, contextual, and regulation factors, they should be viewed as separate constructs in research and practice.

The Reciprocal Relationship Between Gratitude and Life Satisfaction: Evidence From Two Longitudinal Field Studies

Gratitude and life satisfaction are associated with several indicators of a good life (e.g., health, pro-social behavior, and relationships). However, how gratitude and life satisfaction relate to each other over time has remained unknown until now. Although a substantial body of research has tested the link from gratitude to life satisfaction, the reverse association remains unexplored. In addition, recent cross-cultural research has questioned the link between gratitude and subjective well-being in non-Western countries, suggesting that the benefits of gratitude may only prevail in Western societies. However, previous cross-cultural studies have only compared western (e.g., American) and eastern (e.g., Asian) cultures, but this simple contrast does not adequately capture the diversity in the world. To guide further theory and practice, we therefore extended previous cross-sectional and experimental studies, by testing the bi-directional longitudinal link between gratitude and life satisfaction in a Latin American context, aiming to establish temporal precedence. We assessed two adult samples from Chile, using three-wave cross-lagged panel designs with 1 month (Study 1, N = 725) and 3 months (Study 2, N = 1,841) between waves. Both studies show, for the first time, that gratitude and life satisfaction mutually predict each other over time. The reciprocal relationships suggest the existence of a virtuous circle of human well-being: higher levels of gratitude increase life satisfaction, which in turn increases gratitude, leading to a positive spiral. Key theoretical and practical implications for the dynamics of human flourishing and field of positive psychology are discussed.

Toddler skills predict moderate-to-late preterm born children's cognition and behaviour at 6 years of age

OBJECTIVE

To compare moderate-to-late preterm born (32-36 weeks' gestation) to full term born (≥37 weeks' gestation) children in cognitive and behavioural functioning at the age of 6 years and assess which toddler skills predict later cognitive and behavioural functioning.

DESIGN

A prospective longitudinal study with a cohort of 88 moderate-to-late preterm and 83 full term born Dutch children, followed from 18 months to 6 years of age. Orienting, alerting and executive attention skills were assessed at 18 months (corrected for prematurity), and cognitive, motor and language skills (Bayley-III-NL) at 24 months (corrected for prematurity). At 6 years (corrected for prematurity), cognitive (indices of IQ; WPPSI-III-NL) and behavioural functioning (CBCL/6-18) were assessed. Group differences and potential predictors were examined with MANCOVAs and hierarchical regression analyses.

RESULTS

At 6 years, moderate-to-late preterm born children performed poorer than full term born children on cognitive processing speed, and they showed more behavioural attention problems. Attention problems at 6 years were predicted by poorer orienting attention skills at 18 months, while lower performance IQ was predicted by poorer alerting attention skills at 18 months. Full Scale IQ and Verbal IQ at 6 years were predicted by language skills at 24 months. Moderate-to-late preterm and full term born children showed some differing correlational patterns in the associations between early skills and later functioning, although in further analyses predictors appeared the same for both groups.

CONCLUSIONS

Moderate-to-late preterm born children show specific vulnerabilities at primary school-age, particularly in cognitive processing speed and behavioural attention problems. Cognitive and behavioural functioning at 6 years can be predicted by differentiated attention skills at 18 months and language skills at 24 months.

Absence of neural speech discrimination in preterm infants at term-equivalent age

Children born preterm are at higher risk to develop language deficits. Auditory speech discrimination deficits may be early signs for language developmental problems. The present study used functional near-infrared spectroscopy to investigate neural speech discrimination in 15 preterm infants at term-equivalent age compared to 15 full term neonates. The full term group revealed a significantly greater hemodynamic response to forward compared to backward speech within the left hemisphere extending from superior temporal to inferior parietal and middle and inferior frontal areas. In contrast, the preterm group did not show differences in their hemodynamic responses during forward versus backward speech, thus, they did not discriminate speech from non-speech. Groups differed significantly in their responses to forward speech, whereas they did not differ in their responses to backward speech. The significant differences between groups point to an altered development of the functional network underlying language acquisition in preterm infants as early as in term-equivalent age.

Language in Preterm Born Children: Atypical Development and Effects of Early Interventions on Neuroplasticity

Predicting language performances after preterm birth is challenging. It is described in the literature that early exposure to the extrauterine environment can be either detrimental or advantageous for neurodevelopment. However, the emphasis mostly lies on the fact that preterm birth may have an unfavorable effect on numerous aspects of development such as cognition, language, and behavior. Various studies reported atypical language development in preterm born children in the preschool years but also in school-aged children and adolescents. This review gives an overview of the course of language development and examines how prematurity can lead to atypical linguistic performances. In this paper, we mainly focus on environmental and neurophysiological factors influencing preterm infant neuroplasticity with potential short- and long-term effects on language development. Further research, however, should focus on examining the possible benefits that early exposure might entail.

Association between small for gestational age and low birth weight with attention deficit and impaired executive functions in 3-6 years old children

BACKGROUND

Behavioral disorders and attention deficit hyperactivity disorder (ADHD) symptoms are frequently reported among children with history of small body size at birth and disproportionate intrauterine growth retardation. The current study aimed to investigate some factors like executive functions and attention deficit in children with history of Small for gestational age (SGA) and/or Low Birth Weight (LBW) at birth.

METHODS

A historical cohort study was done and 3-6 years old preschool children (with past history of SGA/LBW) from some kindergartens and health centers were selected. Control group was randomly selected among children with history of normal birth weight and appropriate for gestational age at birth. All children were interviewed by an expert psychologist. Variables related to their attention, development, and executive functions were assessed by ASQ, Conner's, and Wisconsin Card Sorting Test. Completed questionnaires related Attention deficit and indexes of executive functions were evaluated between children in case groups and their counterparts in controls.

RESULTS

Based on inclusion criteria, 229 preschool children entered the study. With regard to size for gestational age, 124 cases were categorized in the SGA/LBW group and the rest were assigned in the appropriate for gestational age (AGA) group. In the case group, NPE and Percent Perseverative Errors (PPE) scores were significantly lower than normal birth weight group (p = .0001, p = .015). Scores related B item of Conner's was significantly different between cases and their controls (p = .039, p = .035).

CONCLUSIONS

Our results indicated that children with past history of some risks at birth may suffer from complications related attention and executive functions in their childhood. Recommendations for further research are strongly suggested.

Long-Term Stability of Language Performance in Very Preterm, Moderate-Late Preterm, and Term Children

OBJECTIVE

To investigate whether children born very preterm, moderate-late preterm, and term differ in their average level and individual-difference stability in language performance over time.

STUDY DESIGN

Language was assessed at 5 and 20 months and 4, 6, and 8 years of age in 204 very preterm (<32 weeks' gestation), 276 moderate-late preterm (32-36 weeks' gestation), and 268 term (37-41 weeks' gestation) children from the Bavarian Longitudinal Study.

RESULTS

Very preterm children consistently performed worse than term-born children, and moderate-late preterm children scored in between. Language performance was stable from 5 months through 8 years in all gestation groups combined, and stability increased between each succeeding wave. Stability was stronger between 5 months and 4 years in very preterm than moderate-late preterm and term groups, but this differential stability attenuated when covariates (child nonverbal intelligence and family socioeconomic status) were controlled.

CONCLUSIONS

Preterm children, even moderate-late preterm, are at risk for poorer language performance than term-born children. Because individual differences in language performance are increasingly stable from 20 months to 8 years in all gestation groups, pediatricians who attend to preterm children and observe language delays should refer them to language intervention at the earliest age seen.

Influência de fatores de risco sobre o desenvolvimento da linguagem e contribuições da estimulação precoce: revisão integrativa da literatura

RESUMO O objetivo do estudo foi identificar evidências na literatura a respeito da influência dos fatores de risco sobre o desenvolvimento da linguagem da criança e as contribuições da estimulação precoce. Trata-se de uma revisão integrativa, que utilizou as bases de dados Lilacs, PubMed e SciELO e os descritores: linguagem infantil, fatores de risco, prematuro, criança pós-termo, índice de Apgar, estimulação precoce. A partir dos achados, extraíram-se os seguintes dados: autores, ano de publicação, objetivo, desenho do estudo, participantes e critérios, variáveis estudadas, principais achados. Para a organização e análise foi utilizada a técnica de Análise de Conteúdo do tipo temática. Foram identificados 1.421 artigos, 29 atenderam os critérios de inclusão. Os estudos foram categorizados por resultados afins; A maioria dos artigos selecionados trata do efeito da prematuridade sobre o desenvolvimento da linguagem. Quatro estudos investigaram a associação entre fatores de risco e problemas no desenvolvimento da linguagem. Um dos estudos avaliou crianças em idade escolar e associou valores de Apgar com DEL. Foi unanime a recomendação acerca do acompanhamento e intervenção precoce. Conclui-se que os fatores de risco elencados influenciam negativamente no desenvolvimento da linguagem. Reforça-se a recomendação do atendimento precoce e qualificado dessas crianças, evitando e/ou minimizando alterações futuras.

The agreement between two screening tests for language evaluation in premature and low weight children

Abstract Objectives: to evaluate the agreement of the results in two screening tests on children's development - Denver II and Early Language Milestone Scale (ELM) aged two to three years old, born prematurely and with low weight. Methods: two screening instruments: Denver II and ELM were applied for the development in an observational cross-sectional descriptive study. The agreement between Denver II Test and its language sector and ELM were assessed by Kappa coefficient. Results: 77 children evaluated, 36.3% had an overall loss of the development performed by Denver II and 32.5% loss of the language by ELM. The agreement between the results of Denver II test considering all sectors versus ELM showed Kappa coefficient of 0.856 (p<0.001) and considering only the language sector of Denver II versus ELM, the Kappa coefficient was 0.886 (p<0.001). Conclusions: the developmental impairment observed in the children studied by assessing Denver II and through its language sector showed agreement with changes in the language abilities observed in ELM.

Preterm delivery and risk for early language delays: a sibling-control cohort study

BACKGROUND

Studies suggest that preterm delivery is a risk factor for early language delays, but knowledge is scarce about the persistence of the delays and whether the association is of a linear kind. To resolve this, effects of confounding risk factors that are both shared within a family and pregnancy specific need to be distinguished from effects of preterm delivery. Our study examines the association between early gestational age and language outcomes, using a sibling-control design.

METHODS

The sample comprises 22,499 siblings from the Norwegian Mother and Child Birth Cohort Study, recruited between 1999 and 2008. Mothers rated child language comprehension and production at 18 and 36 months. Analyses compared siblings discordant on gestational age group (early preterm, delivery at week 22-33; late preterm, 34-36; early term, 37-38; full term, >38) and type of onset of delivery (spontaneous; provider-initiated), and compared these findings with conventional cohort analyses.

RESULTS

The findings revealed inverse linear relations between the gestational age groups, and persistent but diminishing language delays. Effects of preterm delivery were substantial on both language production and comprehension at 18 months. By 36 months, the effects of preterm delivery were weaker, but still extensive, in particular for language production in provider-initiated births. When comparing sibling-control with cohort analyses, preterm group was less important among spontaneous births, but remained important in provider-initiated births. Familial and pregnancy risk factors partly explained this.

CONCLUSIONS

Distinctive factors seem to underlie effects of preterm delivery across spontaneous and provider-initiated births.

Pathways From Toddler Information Processing to Adolescent Lexical Proficiency

This study examined the relation of 3-year core information-processing abilities to lexical growth and development. The core abilities covered four domains-memory, representational competence (cross-modal transfer), processing speed, and attention. Lexical proficiency was assessed at 3 and 13 years with the Peabody Picture Vocabulary Test (PPVT) and verbal fluency. The sample (N = 128) consisted of 43 preterms (< 1750 g) and 85 full-terms. Structural equation modeling indicated concurrent relations of toddler information processing and language proficiency and, independent of stability in language, direct predictive links between (a) 3-year cross-modal ability and 13-year PPVT and (b) 3-year processing speed and both 13-year measures, PPVT and verbal fluency. Thus, toddler information processing was related to growth in lexical proficiency from 3 to 13 years.

School children with low birth weight inserted in system of Embu's education: construction of sentences

PURPOSE

To characterize the construction of sentences in schoolchildren born with low weight.

METHODS

We selected 413 students from Embu das Artes (SP), Brazil. Application of Recreating Speech Acts of Test of Language Competence sub-test. We analyzed the number of words and the holistic score. Age group of 6-10 years old, female/male, with low birth weight (<2,500 g) in Study Group (SG; n=238), and birth weight above or equal to 2,500 g composing the Control Group (CG; n=175). Children with anomalies were excluded. The both groups' responses were considered as well as the association of the responses with variables birth weight, gender, age of child and maternal age and education, through Student's t-test, χ2test and linear regression.

RESULTS

The SG scored less on the total number of words and had worst performance in items that involved prepositions with a sense of temporality and place, with adverb functions. There was no difference between groups regarding the holistic score. It was found positive impact of the variables birth weight (p=0.002), age of child, age of mother and maternal education on standard test scores in both groups.

CONCLUSION

The SG had fewer words compared to CG. The higher the birth weight, the higher the score test pattern. It was evident the age-related changes in morpho-syntactic skills addressed in the study, and protection factors mother's schooling and age had a positive impact on language performance.

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.

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.

Gestational overgrowth and undergrowth affect neurodevelopment: similarities and differences from behavior to epigenetics

The size of an infant at birth, a measure of gestational growth, has been recognized for many years as a biomarker of future risk of morbidity. Both being born small for gestational age (SGA) and being born large for gestational age (LGA), are associated with increased rates of obesity and metabolic disorder, as well as a number of mental disorders including attention deficit/hyperactivity disorder, autism, anxiety, and depression. The common risks raise the question of what neurobiological mechanisms are altered in SGA and LGA offspring. Here we review recent findings allowing for direct comparison of neurobiological outcomes of SGA and LGA in human and animal models. We also present new data highlighting similarities and differences in behavior and neurobiology in our mouse models of SGA and LGA. Overall, there is significant data to support aberrant epigenetic mechanisms, particularly related to DNA methylation, in the brains of SGA and LGA offspring, leading to disruptions in the cell cycle in development and gene expression in adulthood.

Effects of maternal worm infections and anthelminthic treatment during pregnancy on infant motor and neurocognitive functioning

We tested the hypothesis that maternal worm infections in pregnancy affect infant motor and neurocognitive development, and that anthelminthic treatment during pregnancy can reverse these effects. We used measures which examine infant motor, cognitive and executive function, including inhibition. We assessed 983 Ugandan infants aged 15 months, using locally appropriate measures within the Entebbe Mother and Baby Study, a trial of anthelminthic treatment during pregnancy. Key exposures were maternal worm infections and anthelminthic treatment during pregnancy. Effects of other health and social factors were controlled for statistically. Of the five major worm species found in the pregnant women, two had influences on the developmental measures: Maternal Mansonella perstans and Strongyloides stercoralis infections showed negative associations with the A-not B-task, and Language, respectively. Performance on other psychomotor and cognitive measures was associated with illnesses during infancy and infants' behavior during assessment, but not with maternal worm infections. There were no positive effects of maternal anthelminthic treatment on infant abilities. Mansonella perstans and Strongyloides stercoralis infection during pregnancy seem associated with impaired early executive function and language, respectively, but single-dose anthelminthic treatment during pregnancy was not beneficial. The biological mechanisms that could underlie these neurocognitive effects are discussed.

Norway's high-quality center care reduces late talking in high- and low-risk groups

OBJECTIVES

To examine whether attendance in Norwegian high-quality center care in the first 3 years of life buffers the negative effects of biomedical risk factors on children's late talking (LT) at 3 years of age.

METHODS

Data on 75,128 children from the Norwegian Mother and Child Cohort Study were analyzed and include information on child care arrangements, LT, and a variety of covariates. A biomedical risk group (N = 6893) was constructed on the basis of information from the Medical Birth Registry of Norway on children's Apgar scores 5 minutes after birth, birth weight, and gestational age. Late talking was reported by mothers when their children were 3 years old.

RESULTS

In line with previous research, children born with biomedical risk factors were at higher risk for LT at age 3 years than children born without biomedical risk factors. Child care arrangement at age 1 was not significantly related to LT at age 3 years. At both 1.5 and 3 years of age, center care attendance was related to a reduced chance of LT, independently of whether the children were in the biomedical risk group or not. However, our main hypothesis was not confirmed. Center care attendance did not buffer the negative effects of biomedical risk factors on LT for boys or girls (all p > .05).

CONCLUSION

Although attendance in Norwegian center care is positive for children's language development in general, it does not buffer the negative effects of biomedical risk factors on children's LT.