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Coughlan S, Quigley J, Nixon E. Assessing the Language Abilities of Preterm-Born Children: An Examination of Standardized Testing and Language Sample Analysis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:2327-2343. [PMID: 38980152 DOI: 10.1044/2024_ajslp-23-00318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
PURPOSE To understand how best to assess the language abilities of preterm-born children, this study: (a) compared preterm- and term-born children's language skills using standardized testing and language sample analysis (LSA), (b) investigated how executive function skills and the language sampling context respectively affect standardized test and LSA scores, and (c) examined the pattern of associations between standardized test and LSA scores among preterm-/term-born groups. METHOD Twenty-five term-born and 23 preterm-born 2-year-old singletons were administered the language scales of the Bayley Scales of Infant and Toddler Development-Third Edition (receptive communication, expressive communication, language composite scores). Parent-child free-play recordings were used to quantify the (para)linguistic features of the children's speech. Executive function was measured via parent report. RESULTS The preterm-born group obtained significantly lower scores than the term-born group on all Bayley language measures (though differences were not consistently observed when using cutoff scores). Few preterm-term differences in LSA measures were found. The preterm-term differences in Bayley scores were not explained by between-group differences in executive function. Some preterm-term differences in LSA scores were moderated by the language sampling context. The preterm- and term-born groups exhibited different patterns of Bayley-LSA correlations. CONCLUSIONS Preterm language difficulties were more apparent on standardized test than LSA scores. Nonetheless, the Bayley-LSA correlations indicate that poor test performance (linked with preterm birth) is associated with functional communication difficulties. The discussion outlines the complementary utility of standardized tests and LSA while acknowledging the limited utility of cutoff scores and the confounding influence of the language sampling context. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.26142661.
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Affiliation(s)
| | - Jean Quigley
- School of Psychology, Trinity College Dublin, Ireland
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Nolte C, Michalska KJ, Nelson PM, Demir-Lira ӦE. Interactive roles of preterm-birth and socioeconomic status in cortical thickness of language-related brain structures: Findings from the Adolescent Brain Cognitive Development (ABCD) study. Cortex 2024; 180:1-17. [PMID: 39243745 DOI: 10.1016/j.cortex.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/31/2024] [Accepted: 05/16/2024] [Indexed: 09/09/2024]
Abstract
Preterm-born (PTB) children are at an elevated risk for neurocognitive difficulties in general and language difficulties more specifically. Environmental factors such as socio-economic status (SES) play a key role for Term children's language development. SES has been shown to predict PTB children's behavioral developmental trajectories, sometimes surpassing its role for Term children. However, the role of SES in the neurocognitive basis of PTB children's language development remains uncharted. Here, we aimed to evaluate the role of SES in the neural basis of PTB children's language performance. Leveraging the Adolescent Brain Cognitive Development (ABCD) Study, the largest longitudinal study of adolescent brain development and behavior to date, we showed that prematurity status (PTB versus Term) and multiple aspects of SES additively predict variability in cortical thickness, which is in turn related to children's receptive vocabulary performance. We did not find evidence to support the differential role of environmental factors for PTB versus Term children, underscoring that environmental factors are significant contributors to development of both Term and PTB children. Taken together, our results suggest that the environmental factors influencing language development might exhibit similarities across the full spectrum of gestational age.
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Affiliation(s)
- Collin Nolte
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Kalina J Michalska
- Department of Psychology, University of California, Riverside, Riverside, CA, United States
| | - Paige M Nelson
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Ӧ Ece Demir-Lira
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States.
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Aija A, Leppänen J, Aarnos L, Hyvönen M, Ståhlberg-Forsén E, Ahlqvist-Björkroth S, Stolt S, Toome L, Lehtonen L. Exposure to the parents' speech is positively associated with preterm infant's face preference. Pediatr Res 2024:10.1038/s41390-024-03239-8. [PMID: 38783114 DOI: 10.1038/s41390-024-03239-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 12/05/2023] [Accepted: 12/26/2023] [Indexed: 05/25/2024]
Abstract
BACKGROUND The parents' presence and involvement in neonatal care is a promising approach to improve preterm infants' neurodevelopmental outcomes. We examined whether exposure to the parents' speech is associated with the preterm infant's social-cognitive development. METHODS The study included infants born before 32 gestational weeks in two neonatal units. Each infant's language environment was assessed from 16-hour recordings using Language Environment Analysis (LENA®). Parental presence was assessed with Closeness Diary for 14 days during the hospital stay. Attention to faces and non-face patterns was measured at the corrected age of seven months using an eye-tracking disengagement test. RESULTS A total of 63 preterm infants were included. Infants were less likely to disengage their attention from faces (M = 0.55, SD = 0.26) than non-face patterns (M = 0.24, SD = 0.22), p < 0.001, d = 0.84. Exposure to the parents' speech during the neonatal period was positively correlated with the preference for faces over non-face patterns (rs = 0.34, p = 0.009) and with the preference for parents over unfamiliar faces (rs = 0.28, p = 0.034). CONCLUSION The exposure to the parents' speech during neonatal hospital care is a potential early marker for later social development in preterm infants. IMPACT The exposure to the parents' speech during neonatal intensive care is a potential early marker for optimal social-cognitive development in preterm infants. This is the first study to show an association between parental vocal contact during neonatal intensive care and early social development (i.e., face preference), measured at seven months of corrected age. Our findings suggest that we should pay attention to the parents' vocal contact with their child in the neonatal intensive care unit and identify need for tailored support for face-to-face and vocal contact.
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Affiliation(s)
- Anette Aija
- University of Turku, Turku, Finland.
- Department of Neonatal and Infant Medicine, Tallinn Children's Hospital, Tallinn, Estonia.
| | - Jukka Leppänen
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
| | | | | | - Eva Ståhlberg-Forsén
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | | | - Suvi Stolt
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Liis Toome
- Department of Neonatal and Infant Medicine, Tallinn Children's Hospital, Tallinn, Estonia
| | - Liisa Lehtonen
- University of Turku, Turku, Finland
- Department of Pediatrics, Turku University Hospital, Turku, Finland
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Barnes-Davis ME, Williamson BJ, Kline JE, Kline-Fath BM, Tkach J, He L, Yuan W, Parikh NA. Structural connectivity at term equivalent age and language in preterm children at 2 years corrected. Brain Commun 2024; 6:fcae126. [PMID: 38665963 PMCID: PMC11043656 DOI: 10.1093/braincomms/fcae126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/26/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
We previously reported interhemispheric structural hyperconnectivity bypassing the corpus callosum in children born extremely preterm (<28 weeks) versus term children. This increased connectivity was positively associated with language performance at 4-6 years of age in our prior work. In the present study, we aim to investigate whether this extracallosal connectivity develops in extremely preterm infants at term equivalent age by leveraging a prospective cohort study of 350 very and extremely preterm infants followed longitudinally in the Cincinnati Infant Neurodevelopment Early Prediction Study. For this secondary analysis, we included only children born extremely preterm and without significant brain injury (n = 95). We use higher-order diffusion modelling to assess the degree to which extracallosal pathways are present in extremely preterm infants and predictive of later language scores at 22-26 months corrected age. We compare results obtained from two higher-order diffusion models: generalized q-sampling imaging and constrained spherical deconvolution. Advanced MRI was obtained at term equivalent age (39-44 weeks post-menstrual age). For structural connectometry analysis, we assessed the level of correlation between white matter connectivity at the whole-brain level at term equivalent age and language scores at 2 years corrected age, controlling for post-menstrual age, sex, brain abnormality score and social risk. For our constrained spherical deconvolution analyses, we performed connectivity-based fixel enhancement, using probabilistic tractography to inform statistical testing of the hypothesis that fibre metrics at term equivalent age relate to language scores at 2 years corrected age after adjusting for covariates. Ninety-five infants were extremely preterm with no significant brain injury. Of these, 53 had complete neurodevelopmental and imaging data sets that passed quality control. In the connectometry analyses adjusted for covariates and multiple comparisons (P < 0.05), the following tracks were inversely correlated with language: bilateral cerebellar white matter and middle cerebellar peduncles, bilateral corticospinal tracks, posterior commissure and the posterior inferior fronto-occipital fasciculus. No tracks from the constrained spherical deconvolution/connectivity-based fixel enhancement analyses remained significant after correction for multiple comparisons. Our findings provide critical information about the ontogeny of structural brain networks supporting language in extremely preterm children. Greater connectivity in more posterior tracks that include the cerebellum and connections to the regions of the temporal lobes at term equivalent age appears to be disadvantageous for language development.
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Affiliation(s)
- Maria E Barnes-Davis
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brady J Williamson
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Julia E Kline
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Beth M Kline-Fath
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Radiology, Imaging Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Jean Tkach
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Radiology, Imaging Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Lili He
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Radiology, Imaging Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Weihong Yuan
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Cincinnati Children’s Hospital Medical Center, Pediatric Neuroimaging Research Consortium, Cincinnati, OH, USA
| | - Nehal A Parikh
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Coughlan S, Quigley J, Nixon E. The Synergistic Effects of Preterm Birth and Parent Gender on the Linguistic and Interactive Features of Parent-Infant Conversations. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:886-899. [PMID: 38284883 DOI: 10.1044/2023_jslhr-23-00389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
PURPOSE To investigate the language environments experienced by preterm-born infants, this study compared the linguistic and interactive features of parent-infant conversations involving 2-year-old preterm- and term-born infants. The study also explored how mother-infant and father-infant conversations may be differentially affected by preterm/term birth status. METHOD Twenty-two preterm-born (< 37 weeks' gestation) and 25 term-born (≥ 37 weeks' gestation) 2-year-old infants engaged in dyadic mother/father-infant free-play interactions that were transcribed to quantify the linguistic (parental volubility, speech rate, lexical diversity, and morphosyntactic complexity) and interactive (infant/parent responsiveness, turn-taking, and conversational balance) features of parent-infant conversations. Language, cognitive, socioemotional, and executive function skills were assessed via standardized tools. RESULTS Compared to the term group, the preterm group was characterized by lower maternal speech rate, parental lexical diversity, and parent-infant turn-taking, as well as greater mother-infant conversational balance. The preterm group presented poorer language and executive function skills when compared to the term group. CONCLUSIONS Both similarities and differences exist between the language environments of preterm and term groups. Similarities may be due to the partial developmental catch-up of preterm-born infants (cognitive and socioemotional skills) and parental scaffolding. Differences may partly reflect a parental adaptation to the language and executive function difficulties of preterm-born infants. These findings suggest that researchers/clinicians should appraise the language environment with respect to the unique developmental needs of preterm/term-born infants. Future research directions are provided to advance a more holistic characterization of the language environment and a deeper understanding of the developmental significance of preterm-term differences in such environments. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25021931.
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Affiliation(s)
| | - Jean Quigley
- School of Psychology, Trinity College Dublin, Ireland
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Kojima K, Kline JE, Altaye M, Kline-Fath BM, Parikh NA. Corpus Callosum Abnormalities at Term-Equivalent Age Are Associated with Language Development at 2 Years' Corrected Age in Infants Born Very Preterm. JOURNAL OF PEDIATRICS. CLINICAL PRACTICE 2024; 11:200101. [PMID: 38827483 PMCID: PMC11138257 DOI: 10.1016/j.jpedcp.2024.200101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 12/30/2023] [Accepted: 01/08/2024] [Indexed: 06/04/2024]
Abstract
We studied the effect of microstructural abnormalities in the corpus callosum on language development in 348 infants born very prematurely. We discovered that the fractional anisotropy of the corpus callosum anterior midbody was a significant predictor of standardized language scores at 2 years, independent of clinical and social risk factors.
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Affiliation(s)
- Katsuaki Kojima
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Julia E. Kline
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Mekibib Altaye
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Beth M. Kline-Fath
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Nehal A. Parikh
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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Coughlan S, Quigley J, Nixon E. Parent-infant conversations are differentially associated with the development of preterm- and term-born infants. J Exp Child Psychol 2024; 239:105809. [PMID: 37967481 DOI: 10.1016/j.jecp.2023.105809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/10/2023] [Accepted: 10/25/2023] [Indexed: 11/17/2023]
Abstract
Preterm birth is a risk factor for language difficulties. To better understand the language development of preterm-born infants, the current study investigated the concurrent associations between parent-infant conversations and the development of 22 preterm-born and 25 term-born infants at 2 years of age. Conversations occurring during mother/father-infant free-play interactions were analyzed to characterize features of parental speech (volubility, speech rate, lexical diversity, and morphosyntactic complexity) and parent-infant exchanges (parent responsiveness, turn-taking, and conversational balance). The infants' language development (receptive communication and expressive communication) and non-language development (cognitive, social-emotional, and executive function) was assessed using standardized measures. Parent-infant conversations were associated with both language and non-language development. This suggests that parent-infant conversations may support language development directly and/or through advancing non-language skills that could promote language learning. The associations between parent-infant conversations and development varied as a function of birth status (preterm or term). This finding may signal the operation of different developmental processes within preterm- and term-born groups. Finally, infant development was differentially associated with mother-infant and father-infant conversations. This may point to the distinct contributions made by mothers and fathers to the development of both preterm- and term-born infants. To optimize language outcomes, these findings indicate that families should be guided to tailor parent-infant conversations to the unique developmental needs and processes of preterm-born infants. Families should also be supported to leverage the distinct developmental contributions of mothers and fathers. Future recommendations are made regarding how to investigate the proposed preterm-term differences in language development processes and the differential developmental contribution of mothers and fathers.
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Affiliation(s)
- Sarah Coughlan
- School of Psychology, Trinity College Dublin, Dublin 2, Ireland.
| | - Jean Quigley
- School of Psychology, Trinity College Dublin, Dublin 2, Ireland
| | - Elizabeth Nixon
- School of Psychology, Trinity College Dublin, Dublin 2, Ireland
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De Leeuw S, Delens G, Vanden Brande L, Henrion E, Legros L. Socio-familial environment influence on cognitive and language development in very preterm children. Child Care Health Dev 2024; 50:e13239. [PMID: 38413377 DOI: 10.1111/cch.13239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/25/2024] [Accepted: 02/06/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Preterm children are at increased risk of cognitive and language delay compared with term-born children. While many perinatal factors associated with prematurity are well established, there is limited research concerning the influence of the socio-familial environment on the development of preterm children. This study aims to assess the relative impact of perinatal and socio-familial risk factors on cognitive and language development at 2 years corrected age (CA). METHOD This retrospective cross-sectional study included preterm infants with a gestational age <32 weeks and/or a birth weight <1500 g, who underwent neurodevelopmental assessment at 2 years CA. Cognitive and language scores were assessed using the Bayley Scales of Infant-Toddler Development, third edition. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated using a multivariable model to examine the relationship between developmental delays and perinatal and socio-familial factors. RESULT The prevalence of language delay was negatively associated with daycare attendance (aOR: 0.25, 95% CI: 0.07-0.85, p < 0.05) and high maternal educational levels (aOR: 0.24, 95% CI: 0.05-0.93, p < 0.05) and positively associated with bilingual environments (aOR: 5.62, 95% CI: 1.46-24.3, p < 0.05). Perinatal and postnatal risk factors did not show a significant impact on cognitive or language development. CONCLUSION The development of language appears to be more influenced by the socio-familial environment than by early perinatal and postnatal factors associated with prematurity. These findings highlight the importance of considering socio-familial factors in the early identification and intervention of language delay among preterm children.
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Affiliation(s)
- Stéphanie De Leeuw
- Department of Neonatal Intensive Care, CHR Sambre et Meuse, Namur, Belgium
| | - Gilda Delens
- Department of Neonatal Intensive Care, CHR Sambre et Meuse, Namur, Belgium
- Follow-up Center for Preterm Infants, CHR Sambre et Meuse, Namur, Belgium
| | - Laura Vanden Brande
- Follow-up Center for Preterm Infants, CHR Sambre et Meuse, Namur, Belgium
- Department of Pediatric Neurology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Elisabeth Henrion
- Department of Neonatal Intensive Care, CHR Sambre et Meuse, Namur, Belgium
| | - Ludovic Legros
- Follow-up Center for Preterm Infants, CHR Sambre et Meuse, Namur, Belgium
- Department of Neonatal Intensive Care, CHIREC-Delta Hospital, Brussels, Belgium
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Camerota M, Bagley J, McGowan EC, Carter BS, Check J, Dansereau LM, DellaGrotta SA, Helderman JB, Hofheimer JA, Loncar CM, Neal CR, O’Shea TM, Pastyrnak SL, Smith LM, Everson TM, Lester BM. Agreement Between Two Behavioral Rating Scales in Preschoolers Born Very Preterm. J Dev Behav Pediatr 2024; 45:e72-e78. [PMID: 38146850 PMCID: PMC10922403 DOI: 10.1097/dbp.0000000000001238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/17/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE Broadband parent rating scales are commonly used to assess behavioral problems in children. Multiple rating scales are available, yet agreement between them is not well-understood. The objective of this study was to evaluate agreement between the Behavior Assessment System for Children, Third Edition (BASC-3), and Child Behavior Checklist 1.5 to 5 years (CBCL) in a sample of children born very preterm. METHOD We assessed 73 children born < 30 weeks' gestational age whose caregivers completed the BASC-3 and CBCL at age 4. We examined correlations, within-person differences, and agreement in clinical categorization for all corresponding subscales and composites. RESULTS Comparable subscales on the BASC-3 and CBCL were significantly correlated, albeit to differing magnitudes. Subscales indexing hyperactivity and attention problems were the most comparable across the 2 measures, evidenced by strong correlations and few to no differences in mean T-scores. Composite scores indexing internalizing, externalizing, and total problems were also strongly correlated, and there were no differences in the mean T-scores for externalizing or total problems across measures. Agreement in clinical classifications were weak to moderate, though again, the highest agreement was found for hyperactivity, attention, externalizing, and total problems. CONCLUSION Agreement between BASC-3 and CBCL subscales was weak to moderate, with the exception of subscales related to attention and hyperactivity, as well as composite scores indicating overall behavior problems. Researchers and clinicians should consider these discrepancies when interpreting the results of behavior rating scales with preschool children because conclusions could differ based on the assessment that is used.
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Affiliation(s)
- Marie Camerota
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI
- Center for the Study of Children at Risk, Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI
| | - Jessica Bagley
- Center for the Study of Children at Risk, Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI
| | - Elisabeth C. McGowan
- Center for the Study of Children at Risk, Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI
- Department of Pediatrics, Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI
| | - Brian S. Carter
- Department of Pediatrics-Neonatology, Children’s Mercy Hospital, Kansas City, MO
| | - Jennifer Check
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Lynne M. Dansereau
- Center for the Study of Children at Risk, Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI
| | - Sheri A. DellaGrotta
- Center for the Study of Children at Risk, Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI
| | | | - Julie A. Hofheimer
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Cynthia M. Loncar
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI
- Center for the Study of Children at Risk, Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI
- Department of Pediatrics, Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI
| | - Charles R. Neal
- Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu, HI
| | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Steven L. Pastyrnak
- Department of Pediatrics, Spectrum Health-Helen DeVos Hospital, Grand Rapids, MI
| | - Lynne M. Smith
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA
| | - Todd M. Everson
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Barry M. Lester
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI
- Center for the Study of Children at Risk, Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI
- Department of Pediatrics, Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI
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Lugli L, Pugliese M, Bertoncelli N, Bedetti L, Agnini C, Guidotti I, Roversi MF, Della Casa EM, Cavalleri F, Todeschini A, Di Caprio A, Zini T, Corso L, Miselli F, Ferrari F, Berardi A. Neurodevelopmental Outcome and Neuroimaging of Very Low Birth Weight Infants from an Italian NICU Adopting the Family-Centered Care Model. CHILDREN (BASEL, SWITZERLAND) 2023; 11:12. [PMID: 38275433 PMCID: PMC10813860 DOI: 10.3390/children11010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Improvements in perinatal care have substantially decreased mortality rates among preterm infants, yet their neurodevelopmental outcomes and quality of life persist as a pertinent public health concern. Family-centered care has emerged as a holistic philosophy that promotes effective alliances among patients, families, and healthcare providers to improve the quality of care. AIMS This longitudinal prospective study aims to evaluate the neurodevelopmental outcomes and brain MRI findings in a cohort of preterm newborns admitted to a neonatal intensive care unit (NICU) adopting a family-centered care model. METHODS Very low birth weight (VLBW) infants admitted to the NICU of Modena between 2015 and 2020 were enrolled. Infants who underwent conventional brain magnetic resonance imaging (MRI) at term-equivalent age were included. Neurodevelopmental follow-up was performed until the age of 24 months by a multidisciplinary team using the Amiel-Tison neurological assessment and the Griffiths Mental Developmental Scales (GMDS-R). Neurodevelopmental outcomes were classified as major sequelae (cerebral palsy, DQ ≤ 70, severe sensory impairment), minor sequelae (minor neurological signs such as clumsiness or DQ between 71 and 85), and normal outcomes (no neurological signs and DQ > 85). Risk factors for severe outcomes were assessed. RESULTS In total, 49 of the 356 infants (13.8%) died before hospital discharge, and 2 were excluded because of congenital disorders. Of the remaining 305 infants, 222 (72.8%) completed the 24 month follow-up and were included in the study. Neurodevelopmental outcomes were classified as normal (n = 173, 77.9%), minor (n = 34, 15.3%), and major sequelae (n = 15, 6.8%). Among 221 infants undergoing brain MRI, 76 (34.4%) had major lesions (intraventricular hemorrhage, hemorrhagic parenchymal infarction, periventricular leukomalacia, and large cerebellar hemorrhage). In the multivariate regression model, the retinopathy of prematurity (OR 1.8; p value 0.016) and periventricular-intraventricular hemorrhage (OR 5.6; p value < 0.004) were associated with major sequelae. CONCLUSIONS We reported low rates of severe neurodevelopmental outcomes in VLBW infants born in an Italian NICU with FCC. Identifying the risk factors for severe outcomes can assist in tailoring and optimizing early interventions on an individual basis, both within the NICU and after discharge.
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Affiliation(s)
- Licia Lugli
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy; (N.B.); (L.B.); (C.A.); (I.G.); (M.F.R.); (E.M.D.C.); (T.Z.); (F.M.); (F.F.); (A.B.)
| | - Marisa Pugliese
- Psychology Unit, University Hospital of Modena, 41100 Modena, Italy;
| | - Natascia Bertoncelli
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy; (N.B.); (L.B.); (C.A.); (I.G.); (M.F.R.); (E.M.D.C.); (T.Z.); (F.M.); (F.F.); (A.B.)
| | - Luca Bedetti
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy; (N.B.); (L.B.); (C.A.); (I.G.); (M.F.R.); (E.M.D.C.); (T.Z.); (F.M.); (F.F.); (A.B.)
| | - Cristina Agnini
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy; (N.B.); (L.B.); (C.A.); (I.G.); (M.F.R.); (E.M.D.C.); (T.Z.); (F.M.); (F.F.); (A.B.)
| | - Isotta Guidotti
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy; (N.B.); (L.B.); (C.A.); (I.G.); (M.F.R.); (E.M.D.C.); (T.Z.); (F.M.); (F.F.); (A.B.)
| | - Maria Federica Roversi
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy; (N.B.); (L.B.); (C.A.); (I.G.); (M.F.R.); (E.M.D.C.); (T.Z.); (F.M.); (F.F.); (A.B.)
| | - Elisa Muttini Della Casa
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy; (N.B.); (L.B.); (C.A.); (I.G.); (M.F.R.); (E.M.D.C.); (T.Z.); (F.M.); (F.F.); (A.B.)
| | - Francesca Cavalleri
- Neuroradiology Unit, University Hospital of Modena, 41100 Modena, Italy; (F.C.); (A.T.)
| | - Alessandra Todeschini
- Neuroradiology Unit, University Hospital of Modena, 41100 Modena, Italy; (F.C.); (A.T.)
| | - Antonella Di Caprio
- Department of Medical and Surgical Sciences for Mother, Children and Adults, Postgraduate School of Pediatrics, University of Modena and Reggio Emilia, 41121 Modena, Italy; (A.D.C.); (L.C.)
| | - Tommaso Zini
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy; (N.B.); (L.B.); (C.A.); (I.G.); (M.F.R.); (E.M.D.C.); (T.Z.); (F.M.); (F.F.); (A.B.)
| | - Lucia Corso
- Department of Medical and Surgical Sciences for Mother, Children and Adults, Postgraduate School of Pediatrics, University of Modena and Reggio Emilia, 41121 Modena, Italy; (A.D.C.); (L.C.)
| | - Francesca Miselli
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy; (N.B.); (L.B.); (C.A.); (I.G.); (M.F.R.); (E.M.D.C.); (T.Z.); (F.M.); (F.F.); (A.B.)
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Fabrizio Ferrari
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy; (N.B.); (L.B.); (C.A.); (I.G.); (M.F.R.); (E.M.D.C.); (T.Z.); (F.M.); (F.F.); (A.B.)
| | - Alberto Berardi
- Neonatology Unit, Mother-Child Department, University Hospital of Modena, Via del Pozzo 71, 41100 Modena, Italy; (N.B.); (L.B.); (C.A.); (I.G.); (M.F.R.); (E.M.D.C.); (T.Z.); (F.M.); (F.F.); (A.B.)
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11
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Kojima K, Kline JE, Altaye M, Kline-Fath BM, Parikh NA. Corpus callosum abnormalities at term-equivalent age are associated with language development at two years corrected age in infants born very preterm. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.20.23295848. [PMID: 37790343 PMCID: PMC10543245 DOI: 10.1101/2023.09.20.23295848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
We studied the impact of microstructural abnormalities in the corpus callosum on language development in 348 infants born very prematurely. We discovered that the fractional anisotropy of the corpus callosum anterior midbody was a significant predictor of standardized language scores at two years, independent of clinical and social risk factors.
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Affiliation(s)
- Katsuaki Kojima
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267
| | - Julia E Kline
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039
| | - Mekibib Altaye
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039
| | - Beth M Kline-Fath
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039
- Department of Radiology, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267
| | - Nehal A Parikh
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3039
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267
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12
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Jamaluddine Z, Sharara E, Helou V, El Rashidi N, Safadi G, El-Helou N, Ghattas H, Sato M, Blencowe H, Campbell OMR. Effects of size at birth on health, growth and developmental outcomes in children up to age 18: an umbrella review. Arch Dis Child 2023; 108:956-969. [PMID: 37339859 DOI: 10.1136/archdischild-2022-324884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 05/04/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Size at birth, an indicator of intrauterine growth, has been studied extensively in relation to subsequent health, growth and developmental outcomes. Our umbrella review synthesises evidence from systematic reviews and meta-analyses on the effects of size at birth on subsequent health, growth and development in children and adolescents up to age 18, and identifies gaps. METHODS We searched five databases from inception to mid-July 2021 to identify eligible systematic reviews and meta-analyses. For each meta-analysis, we extracted data on the exposures and outcomes measured and the strength of the association. FINDINGS We screened 16 641 articles and identified 302 systematic reviews. The literature operationalised size at birth (birth weight and/or gestation) in 12 ways. There were 1041 meta-analyses of associations between size at birth and 67 outcomes. Thirteen outcomes had no meta-analysis.Small size at birth was examined for 50 outcomes and was associated with over half of these (32 of 50); continuous/post-term/large size at birth was examined for 35 outcomes and was consistently associated with 11 of the 35 outcomes. Seventy-three meta-analyses (in 11 reviews) compared risks by size for gestational age (GA), stratified by preterm and term. Prematurity mechanisms were the key aetiologies linked to mortality and cognitive development, while intrauterine growth restriction (IUGR), manifesting as small for GA, was primarily linked to underweight and stunting. INTERPRETATION Future reviews should use methodologically sound comparators to further understand aetiological mechanisms linking IUGR and prematurity to subsequent outcomes. Future research should focus on understudied exposures (large size at birth and size at birth stratified by gestation), gaps in outcomes (specifically those without reviews or meta-analysis and stratified by age group of children) and neglected populations. PROSPERO REGISTRATION NUMBER CRD42021268843.
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Affiliation(s)
- Zeina Jamaluddine
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Eman Sharara
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Vanessa Helou
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Nadine El Rashidi
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Gloria Safadi
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nehmat El-Helou
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hala Ghattas
- Center for Research On Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Miho Sato
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Hannah Blencowe
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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13
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Bowe AK, Lightbody G, Staines A, Murray DM, Norman M. Prediction of 2-Year Cognitive Outcomes in Very Preterm Infants Using Machine Learning Methods. JAMA Netw Open 2023; 6:e2349111. [PMID: 38147334 PMCID: PMC10751596 DOI: 10.1001/jamanetworkopen.2023.49111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/09/2023] [Indexed: 12/27/2023] Open
Abstract
Importance Early intervention can improve cognitive outcomes for very preterm infants but is resource intensive. Identifying those who need early intervention most is important. Objective To evaluate a model for use in very preterm infants to predict cognitive delay at 2 years of age using routinely available clinical and sociodemographic data. Design, Setting, and Participants This prognostic study was based on the Swedish Neonatal Quality Register. Nationwide coverage of neonatal data was reached in 2011, and registration of follow-up data opened on January 1, 2015, with inclusion ending on September 31, 2022. A variety of machine learning models were trained and tested to predict cognitive delay. Surviving infants from neonatal units in Sweden with a gestational age younger than 32 weeks and complete data for the Bayley Scales of Infant and Toddler Development, Third Edition cognitive index or cognitive scale scores at 2 years of corrected age were assessed. Infants with major congenital anomalies were excluded. Exposures A total of 90 variables (containing sociodemographic and clinical information on conditions, investigations, and treatments initiated during pregnancy, delivery, and neonatal unit admission) were examined for predictability. Main Outcomes and Measures The main outcome was cognitive function at 2 years, categorized as screening positive for cognitive delay (cognitive index score <90) or exhibiting typical cognitive development (score ≥90). Results A total of 1062 children (median [IQR] birth weight, 880 [720-1100] g; 566 [53.3%] male) were included in the modeling process, of whom 231 (21.8%) had cognitive delay. A logistic regression model containing 26 predictive features achieved an area under the receiver operating curve of 0.77 (95% CI, 0.71-0.83). The 5 most important features for cognitive delay were non-Scandinavian family language, prolonged duration of hospitalization, low birth weight, discharge to other destination than home, and the infant not receiving breastmilk on discharge. At discharge from the neonatal unit, the full model could correctly identify 605 of 650 infants who would have cognitive delay at 24 months (sensitivity, 0.93) and 1081 of 2350 who would not (specificity, 0.46). Conclusions and Relevance The findings of this study suggest that predictive modeling in neonatal care could enable early and targeted intervention for very preterm infants most at risk for developing cognitive impairment.
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Affiliation(s)
- Andrea K. Bowe
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Gordon Lightbody
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Electrical and Electronic Engineering, University College Cork, Cork, Ireland
| | - Anthony Staines
- School of Nursing, Psychotherapy, and Community Health, Dublin City University, Dublin, Ireland
| | - Deirdre M. Murray
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
| | - Mikael Norman
- Department of Clinical Science, Intervention, and Technology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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14
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Ruiz-González E, Lubián-López SP, Jiménez Luque N, Segado-Arenas A, Lubián-Gutiérrez M, Almagro YM, Zafra-Rodríguez P, Méndez-Abad P, Benavente-Fernández I. Relationship of early brain growth pattern measured by ultrasound with neurological outcome at two years of age in very low birth weight infants. Eur J Pediatr 2023; 182:5119-5129. [PMID: 37682341 PMCID: PMC10640451 DOI: 10.1007/s00431-023-05170-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/14/2023] [Accepted: 08/19/2023] [Indexed: 09/09/2023]
Abstract
The purpose of this study is to define the impact of early brain growth trajectory in very low birth weight infants (VLBWI) on neurological prognosis at 2 years, assessed using sequential ultrasound (US) scans. This is a prospective cohort study with consecutive inclusion of VLBWI ≤ 32 weeks gestational age and ≤ 1500 g at birth. Total brain volume (TBV) was assessed using sequential 3D-US from birth to discharge. Prognosis at 2 years (corrected age) was assessed using the Bayley Scales of Infant and Toddler Development Third Edition. TBV showed slower growth with postmenstrual age (PMA) in those VLBWI who had an adverse cognitive prognosis compared to those with good cognitive prognosis (mean difference in TBV between prognostic groups from 4.56 cm3 at 28 weeks to 42.58 cm3 at 43 weeks) as well as in those with adverse language prognosis (mean difference in TBV from 2.21 cm3 at 28 weeks to 26.98 cm3 at 43 weeks) although other variables showed more impact than TBV on language prognosis (gestational age at birth, brain injury at term, and socioeconomic status). No association was found between TBV and motor prognosis. Brain growth rate was also significantly higher in those VLBWI who presented good cognitive scores (18.78 + (0.33 × (PMA-33)) cm3/week) compared to those with adverse cognitive outcome (13.73 + (0.64 × (PMA-33)) cm3/week). Conclusion: Early altered brain growth is associated with poor cognitive prognosis at 2 years of age. Using sequential US monitoring, we can detect early brain growth deviation in patients who will have adverse cognitive outcomes. What is known: • The prediction of neurodevelopmental outcome of VLBWI is mostly based on the presence of brain injury in US and structural magnetic resonance imaging (MRI) at term. • Some studies have related brain volume measured on MRI at term with neurodevelopment outcome. What is new: • VLBWI with adverse cognitive prognosis at two years of age present smaller brain volumes detectable by sequential US during NICU admission. • Brain volume can be estimated from 2D and 3D US and has prognostic value in VLBWI.
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Affiliation(s)
- Estefanía Ruiz-González
- Department of Paediatrics, Neonatology Section, Puerta del Mar University Hospital, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Simón P Lubián-López
- Department of Paediatrics, Neonatology Section, Puerta del Mar University Hospital, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Natalia Jiménez Luque
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Antonio Segado-Arenas
- Department of Paediatrics, Neonatology Section, Puerta del Mar University Hospital, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Manuel Lubián-Gutiérrez
- Department of Paediatrics, Neonatology Section, Puerta del Mar University Hospital, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Yolanda Marín Almagro
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Pamela Zafra-Rodríguez
- Department of Paediatrics, Neonatology Section, Puerta del Mar University Hospital, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Paula Méndez-Abad
- Department of Paediatrics, Neonatology Section, Puerta del Mar University Hospital, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain
| | - Isabel Benavente-Fernández
- Department of Paediatrics, Neonatology Section, Puerta del Mar University Hospital, Cádiz, Spain.
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, Cádiz, Spain.
- Paediatrics Area, Department of Mother and Child Health and Radiology, Medical School, University of Cádiz, C/Doctor Marañon, 3, , Cádiz, Spain.
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15
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Boerma T, Ter Haar S, Ganga R, Wijnen F, Blom E, Wierenga CJ. What risk factors for Developmental Language Disorder can tell us about the neurobiological mechanisms of language development. Neurosci Biobehav Rev 2023; 154:105398. [PMID: 37741516 DOI: 10.1016/j.neubiorev.2023.105398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/03/2023] [Accepted: 09/17/2023] [Indexed: 09/25/2023]
Abstract
Language is a complex multidimensional cognitive system that is connected to many neurocognitive capacities. The development of language is therefore strongly intertwined with the development of these capacities and their neurobiological substrates. Consequently, language problems, for example those of children with Developmental Language Disorder (DLD), are explained by a variety of etiological pathways and each of these pathways will be associated with specific risk factors. In this review, we attempt to link previously described factors that may interfere with language development to putative underlying neurobiological mechanisms of language development, hoping to uncover openings for future therapeutical approaches or interventions that can help children to optimally develop their language skills.
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Affiliation(s)
- Tessel Boerma
- Institute for Language Sciences, Department of Languages, Literature and Communication, Utrecht University, Utrecht, the Netherlands
| | - Sita Ter Haar
- Institute for Language Sciences, Department of Languages, Literature and Communication, Utrecht University, Utrecht, the Netherlands; Cognitive Neurobiology and Helmholtz Institute, Department of Psychology, Utrecht University/Translational Neuroscience, University Medical Center Utrecht, the Netherlands
| | - Rachida Ganga
- Institute for Language Sciences, Department of Languages, Literature and Communication, Utrecht University, Utrecht, the Netherlands
| | - Frank Wijnen
- Institute for Language Sciences, Department of Languages, Literature and Communication, Utrecht University, Utrecht, the Netherlands
| | - Elma Blom
- Department of Development and Education of youth in Diverse Societies (DEEDS), Utrecht University, Utrecht, the Netherlands; Department of Language and Culture, The Arctic University of Norway UiT, Tromsø, Norway.
| | - Corette J Wierenga
- Biology Department, Faculty of Science, Utrecht University, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands.
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16
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Nelson PM, Demir-Lira ÖE. Parental cognitive stimulation in preterm-born children's neurocognitive functioning during the preschool years: a systematic review. Pediatr Res 2023; 94:1284-1296. [PMID: 37231307 PMCID: PMC10761195 DOI: 10.1038/s41390-023-02642-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023]
Abstract
In the United States, survival rates for preterm neonates (<37 weeks of gestation) have tripled in recent years. In parallel, preterm-born children show poorer performance in neurocognitive functioning compared to their full-term peers (≥39 weeks of gestation), and biological models predicting preterm-born children's neurocognitive performance have been met with limited success, highlighting a need to focus on environmental factors. Thus, this systematic review examines the literature on parental cognitive stimulation in relation to preterm-born children's neurocognitive outcomes. Studies were considered for inclusion if they included a sample of preterm-born children, included a measure of parental cognitive stimulation, and included a measure of child neurocognitive performance. The databases searched were PubMed, PsychINFO, CINAHL, ProQuest, and Scopus. Eight studies were included (44 unique associations). Findings suggest that preterm-born children's language skills might be open to a wide range of qualitative and quantitative features of parental cognitive stimulation. Our findings suggest that parental cognitive stimulation matters for preterm-born children's neurocognitive performance. Future experiential models should examine the mechanistic roles of cognitive stimulation in relation to narrowed neurocognitive outcomes to better inform possible prevention and intervention efforts. IMPACT: This systematic review examines the literature on parental cognitive stimulation in relation to preterm-born children's neurocognitive outcomes. Our review demonstrates that preterm-born children's language skills might be open to a wide range of qualitative and quantitative features of parental cognitive stimulation. The emphasis on environmental factors might ultimately better inform possible prevention and intervention efforts for children at risk as they transition to formal schooling.
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Affiliation(s)
- Paige M Nelson
- Department of Psychological and Brain Sciences, University of Iowa, Iowa city, IA, USA.
| | - Ö Ece Demir-Lira
- Department of Psychological and Brain Sciences, University of Iowa, Iowa city, IA, USA
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
- DeLTA Center, University of Iowa, Iowa City, IA, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
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17
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Cuervo S, Creaghead N, Vannest J, Hunter L, Ionio C, Altaye M, Parikh NA. Language Outcomes of Children Born Very Preterm in Relation to Early Maternal Depression and Anxiety. Brain Sci 2023; 13:1355. [PMID: 37891724 PMCID: PMC10605035 DOI: 10.3390/brainsci13101355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
Unaddressed maternal psychological distress within the first year postpartum is known to have numerous negative consequences on the child's developmental outcomes, including language acquisition. This study examined the relationship between early maternal psychosocial factors and the language outcomes of children born very preterm (VPT; ≤32 weeks gestational age). It used data from the Cincinnati Infant Neurodevelopment Early Prediction Study, an ongoing National-Institutes-of-Health-funded prospective, multicenter cohort investigation of VPT infants. A total of 243 (125 boys; 118 girls) children born VPT (M = 29.03 weeks of gestation; SD = 2.47) and their corresponding 207 mothers (34 with multiple infants) were included in this study. We did not find an association between maternal depression or anxiety and Bayley-III (M = 92.3, SD = 18.9) language scores. Additionally, maternal grit and self-efficacy did not modify the relationship between depression and anxiety and language scores. A higher level of maternal education and infant female sex were significantly associated with higher language scores. While preterm birth typically results in higher rates of depression and anxiety for parents, the findings suggest that maternal depression, anxiety, and grit and the self-efficacy of the mothers in this sample did not relate to the language development of their children, independent of maternal education and infant female sex.
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Affiliation(s)
- Sisan Cuervo
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH 45267, USA; (S.C.); (N.C.); (J.V.)
- Communication Sciences Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Nancy Creaghead
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH 45267, USA; (S.C.); (N.C.); (J.V.)
| | - Jennifer Vannest
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH 45267, USA; (S.C.); (N.C.); (J.V.)
- Communication Sciences Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Center for Prevention of Neurodevelopmental Disorder, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (M.A.); (N.A.P.)
| | - Lisa Hunter
- Department of Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH 45267, USA; (S.C.); (N.C.); (J.V.)
- Communication Sciences Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Center for Prevention of Neurodevelopmental Disorder, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (M.A.); (N.A.P.)
| | - Chiara Ionio
- Department of Psychology, Catholic University of the Sacred Heart, 00168 Milano, Italy;
| | - Mekibib Altaye
- Center for Prevention of Neurodevelopmental Disorder, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (M.A.); (N.A.P.)
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Nehal A. Parikh
- Center for Prevention of Neurodevelopmental Disorder, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; (M.A.); (N.A.P.)
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
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18
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Romeo R, Pezanowski R, Merrill K, Hargrave S, Hansen A. Parent and staff perspectives on the benefits and barriers to communication with infants in the neonatal intensive care unit. J Child Health Care 2023; 27:410-423. [PMID: 35232268 PMCID: PMC9433464 DOI: 10.1177/13674935221076216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Exposure to high quantity and quality of language in the neonatal period is critical to neurocognitive development; however, Neonatal Intensive Care Unit (NICU) environments may contribute to language deprivation. Using qualitative thematic content analysis, this study aimed to characterize the knowledge and attitudes of NICU staff and patient families toward the importance of early language experience, the current NICU language environment, and the benefits and barriers of communication in the NICU. Results revealed that all respondents recognized the importance of communication for optimal cognitive development, though few understood why. Staff and family members alike recognized the role of nurses as coaches and role models in promoting communication at the bedside. Nurses generally felt that family members communicate less with their babies than family members themselves perceived, and that cell phone use has fewer communicative advantages than parents perceive. Respondents reported that patient illness, lack of time, and intimidating equipment all raise barriers to communication. These findings yield important considerations for developing educational interventions to improve NICU language environments, including a synergistic, dual focus on both staff and families. Communication in the NICU is a low cost, feasible, and accessible target with aims of ensuring optimal neurocognitive development for at-risk children.
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Affiliation(s)
- Rachel Romeo
- Boston Children’s Hospital, Boston MA USA
- Harvard Medical School, Boston MA USA
- Massachusetts Institute of Technology, Cambridge MA USA
| | | | | | | | - Anne Hansen
- Boston Children’s Hospital, Boston MA USA
- Harvard Medical School, Boston MA USA
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19
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Marchman VA, Ashland MD, Loi EC, Munévar M, Shannon KA, Fernald A, Feldman HM. Associations between early efficiency in language processing and language and cognitive outcomes in children born full term and preterm: similarities and differences. Child Neuropsychol 2023; 29:886-905. [PMID: 36324057 PMCID: PMC10151433 DOI: 10.1080/09297049.2022.2138304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
Associations between children's early language processing efficiency and later verbal and non-verbal outcomes shed light on the extent to which early information processing skills support later learning across different domains of function. Examining whether the strengths of associations are similar in typically developing and at-risk populations provides an additional lens into the varying routes to learning that children may take across development. In this follow-up study, children born full-term (FT, n = 49) and preterm (PT, n = 45, ≤32 weeks gestational age, birth weight <1800 g) were assessed in the Looking While Listening (LWL) task at 18 months (corrected for degree of prematurity in PT group). This eye-tracking task assesses efficiency of real-time spoken language comprehension as accuracy and speed (RT) of processing. At 4 ½ years, children were assessed on standardized tests of receptive vocabulary, expressive language, and non-verbal IQ. Language processing efficiency was associated with both language outcomes (r2-change: 7.0-19.7%, p < 0.01), after covariates. Birth group did not moderate these effects, suggesting similar mechanisms of learning in these domains for PT and FT children. However, birth group moderated the association between speed and non-verbal IQ (r2-change: 4.5%, p < 0.05), such that an association was found in the PT but not the FT group. This finding suggests that information processing skills reflected in efficiency of real-time language processing may be recruited to support learning in a broader range of verbal and non-verbal domains in the PT compared to the FT group.
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Affiliation(s)
- Virginia A. Marchman
- Department of Psychology, 450 Jane Stanford Way, Stanford University, Stanford, CA 94305, USA
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, 3145 Porter Drive, Palo Alto, CA 94304, USA
| | - Melanie D. Ashland
- Department of Psychology, 450 Jane Stanford Way, Stanford University, Stanford, CA 94305, USA
| | - Elizabeth C. Loi
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, 3145 Porter Drive, Palo Alto, CA 94304, USA
| | - Mónica Munévar
- Department of Psychology, 450 Jane Stanford Way, Stanford University, Stanford, CA 94305, USA
| | - Katherine A. Shannon
- Department of Psychology, 450 Jane Stanford Way, Stanford University, Stanford, CA 94305, USA
| | - Anne Fernald
- Department of Psychology, 450 Jane Stanford Way, Stanford University, Stanford, CA 94305, USA
| | - Heidi M. Feldman
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, 3145 Porter Drive, Palo Alto, CA 94304, USA
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20
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Lacalle L, Martínez-Shaw ML, Marín Y, Sánchez-Sandoval Y. Intelligence Quotient (IQ) in school-aged preterm infants: A systematic review. Front Psychol 2023; 14:1216825. [PMID: 37560105 PMCID: PMC10409487 DOI: 10.3389/fpsyg.2023.1216825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/30/2023] [Indexed: 08/11/2023] Open
Abstract
UNLABELLED Preterm birth (before 37 weeks of gestational age) is associated with certain risks to child development. The aim of this systematic review was to summarize available and updated empirical evidence on prematurity as a risk factor for cognitive development in school age. Thus, we attempted to identify similarities and differences with the full-term population and to point out possible risk or protective factors among the biological, psychosocial and family variables. The conceptualization and methodology of this review followed the PRISMA recommendations. The search was carried out in Web of Science, Scopus, PsycInfo, and Dialnet databases, in May 2022. The search was limited to journal articles, published between 2012 and 2022, in English and Spanish. Research articles selected were those focused on the intelligence quotient (IQ) of preterm children aged 6-12 years. The review included studies with cross-sectional or longitudinal cohorts, compared to a control group of children born at term or to standardized scales. The quality of evidence of the selected studies was verified with the Mixed Methods Appraisal Tool (MMAT). The initial search identified 1,040 articles. Forty articles met the inclusion criteria and were finally included in this review. These studies involved 5,396 preterm children from 37 different cohorts. Despite the diversity found among the results, in general, total IQ scores were within the normative mean for premature children; however, compared to their full-term peers, these scores were lower. The most studied variables in relation to IQ are perinatal (e.g., gestational age and birth weight) and family (e.g., socioeconomic level and education level of the mother). Recent studies corroborate that premature birth affects cognitive development in school age, and identify associated perinatal and family variables. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=337371; identifier: CRD42022337371.
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Affiliation(s)
- Laura Lacalle
- Department of Psychology, University of Cádiz, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - Melissa Liher Martínez-Shaw
- Department of Psychology, University of Cádiz, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - Yolanda Marín
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
| | - Yolanda Sánchez-Sandoval
- Department of Psychology, University of Cádiz, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
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21
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Tinoco Mendoza G, Stack J, Abdel-Latif ME, Raman S, Garg P. Language outcomes at 4 years of linguistically diverse children born very preterm: an Australian retrospective single-centre study. BMJ Paediatr Open 2023; 7:e001814. [PMID: 37474201 PMCID: PMC10357640 DOI: 10.1136/bmjpo-2022-001814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 06/03/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Very preterm children are at increased risk of language delays. Concerns have been raised about the utility of standardised English language tools to diagnose language delay in linguistically diverse children. Our study investigated the incidence of language delay at 4 years in linguistically diverse very preterm children. METHODS Very preterm children born in South Western Sydney, Australia, between 2012 and 2016, were assessed with the Clinical Evaluation of Language Fundamentals Preschool-2 (CELF-P2) tool at 4 years of age. We sought to determine the incidence of language delay in this cohort using language scores from the CELF-P2 assessment tool, and explore potential predictors associated with language delay. RESULTS One hundred and sixty very preterm children attended the 4-year assessment out of the included 270 long-term survivors. At 4 years, 76 (52%) very preterm children had language delay diagnosed using the CELF-P2 assessment tool. Children who preferred a language other than English had lower average core language scores on the CELF-P2 assessment tool (75.1±14.4) compared with children that preferred English (86.5±17.9); p=0.002. Very preterm children growing up in households that preferenced a language other than English and those who were born from multiple births had higher odds of language delay at 4 years (AOR 10.30 (95% CI 2.82 to 38.28); p<0.001 and AOR 2.93 (95% CI 1.20 to 7.14); p=0.018, respectively). Assessing these children using an English language tool may have affected language scores at 4 years. CONCLUSIONS In this metropolitan setting, very preterm children from linguistically diverse backgrounds were found to be vulnerable to language delays at 4 years. Further large-scale studies evaluating the language outcomes of linguistically diverse preterm children with more culturally appropriate tools are warranted. We question the utility of standardised English language tools to assess language outcomes of linguistically diverse populations.
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Affiliation(s)
- Giannina Tinoco Mendoza
- Newborn Care Centre, Royal Hospital for Women, Sydney, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jacqueline Stack
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Newborn Care Centre, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Mohamed E Abdel-Latif
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Canberra, Australian Capital Territory, Australia
- Discipline of Neonatology, School of Medicine and Psychology, Australian National University, Canberra, Australian Capital Territory, Australia
- Department of Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Shanti Raman
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Community Paediatrics, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Pankaj Garg
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Community Paediatrics, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
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22
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Jago LS, Alcock K, Meints K, Pine JM, Rowland CF. Language outcomes from the UK-CDI Project: can risk factors, vocabulary skills and gesture scores in infancy predict later language disorders or concern for language development? Front Psychol 2023; 14:1167810. [PMID: 37397291 PMCID: PMC10313203 DOI: 10.3389/fpsyg.2023.1167810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/19/2023] [Indexed: 07/04/2023] Open
Abstract
At the group level, children exposed to certain health and demographic risk factors, and who have delayed language in early childhood are, more likely to have language problems later in childhood. However, it is unclear whether we can use these risk factors to predict whether an individual child is likely to develop problems with language (e.g., be diagnosed with a developmental language disorder). We tested this in a sample of 146 children who took part in the UK-CDI norming project. When the children were 15-18 months old, 1,210 British parents completed: (a) the UK-CDI (a detailed assessment of vocabulary and gesture use) and (b) the Family Questionnaire (questions about health and demographic risk factors). When the children were between 4 and 6 years, 146 of the same parents completed a short questionnaire that assessed (a) whether children had been diagnosed with a disability that was likely to affect language proficiency (e.g., developmental disability, language disorder, hearing impairment), but (b) also yielded a broader measure: whether the child's language had raised any concern, either by a parent or professional. Discriminant function analyses were used to assess whether we could use different combinations of 10 risk factors, together with early vocabulary and gesture scores, to identify children (a) who had developed a language-related disability by the age of 4-6 years (20 children, 13.70% of the sample) or (b) for whom concern about language had been expressed (49 children; 33.56%). The overall accuracy of the models, and the specificity scores were high, indicating that the measures correctly identified those children without a language-related disability and whose language was not of concern. However, sensitivity scores were low, indicating that the models could not identify those children who were diagnosed with a language-related disability or whose language was of concern. Several exploratory analyses were carried out to analyse these results further. Overall, the results suggest that it is difficult to use parent reports of early risk factors and language in the first 2 years of life to predict which children are likely to be diagnosed with a language-related disability. Possible reasons for this are discussed.
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Affiliation(s)
- Lana S. Jago
- Department of Psychology, University of Liverpool, Liverpool, United Kingdom
| | - Katie Alcock
- Department of Psychology, Lancaster University, Lancaster, United Kingdom
| | - Kerstin Meints
- School of Psychology, University of Lincoln, Lincoln, United Kingdom
| | - Julian M. Pine
- Department of Psychology, University of Liverpool, Liverpool, United Kingdom
| | - Caroline F. Rowland
- Language Development Department, Max Planck Institute for Psycholinguistics, Nijmegen, Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Radboud, Netherlands
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23
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Novitskiy N, Chan PHY, Chan M, Lai CM, Leung TY, Leung TF, Bornstein MH, Lam HS, Wong PCM. Deficits in neural encoding of speech in preterm infants. Dev Cogn Neurosci 2023; 61:101259. [PMID: 37257249 DOI: 10.1016/j.dcn.2023.101259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/19/2023] [Accepted: 05/25/2023] [Indexed: 06/02/2023] Open
Abstract
Preterm children show developmental cognitive and language deficits that can be subtle and sometimes undetectable until later in life. Studies of brain development in children who are born preterm have largely focused on vascular and gross anatomical characteristics rather than pathophysiological processes that may contribute to these developmental deficits. Neural encoding of speech as reflected in EEG recordings is predictive of future language development and could provide insights into those pathophysiological processes. We recorded EEG from 45 preterm (≤ 34 weeks of gestation) and 45 term (≥ 38 weeks) Chinese-learning infants 0-12 months of (corrected) age during natural sleep. Each child listened to three speech stimuli that differed in lexically meaningful pitch (2 native and 1 non-native speech categories). EEG measures associated with synchronization and gross power of the frequency following response (FFR) were examined. ANCOVAs revealed no main effect of stimulus nativeness but main effects of age, consistent with earlier studies. A main effect of prematurity also emerged, with synchronization measures showing stronger group differences than power. By detailing differences in FFR measures related to synchronization and power, this study brings us closer to identifying the pathophysiological pathway to often subtle language problems experienced by preterm children.
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Affiliation(s)
- Nikolay Novitskiy
- Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China
| | - Peggy H Y Chan
- Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China; Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, China
| | - Mavis Chan
- Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China
| | - Chin Man Lai
- Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China
| | - Tak Yeung Leung
- Department of Obsterics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Ting Fan Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, China
| | - Marc H Bornstein
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, USA; UNICEF, USA; Institute for Fiscal Studies, UK
| | - Hugh S Lam
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, China.
| | - Patrick C M Wong
- Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China.
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24
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Ashorn P, Ashorn U, Muthiani Y, Aboubaker S, Askari S, Bahl R, Black RE, Dalmiya N, Duggan CP, Hofmeyr GJ, Kennedy SH, Klein N, Lawn JE, Shiffman J, Simon J, Temmerman M. Small vulnerable newborns-big potential for impact. Lancet 2023; 401:1692-1706. [PMID: 37167991 DOI: 10.1016/s0140-6736(23)00354-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/27/2023] [Accepted: 02/14/2023] [Indexed: 05/13/2023]
Abstract
Despite major achievements in child survival, the burden of neonatal mortality has remained high and even increased in some countries since 1990. Currently, most neonatal deaths are attributable to being born preterm, small for gestational age (SGA), or with low birthweight (LBW). Besides neonatal mortality, these conditions are associated with stillbirth and multiple morbidities, with short-term and long-term adverse consequences for the newborn, their families, and society, resulting in a major loss of human capital. Prevention of preterm birth, SGA, and LBW is thus critical for global child health and broader societal development. Progress has, however, been slow, largely because of the global community's failure to agree on the definition and magnitude of newborn vulnerability and best ways to address it, to frame the problem attractively, and to build a broad coalition of actors and a suitable governance structure to implement a change. We propose a new definition and a conceptual framework, bringing preterm birth, SGA, and LBW together under a broader umbrella term of the small vulnerable newborn (SVN). Adoption of the framework and the unified definition can facilitate improved problem definition and improved programming for SVN prevention. Interventions aiming at SVN prevention would result in a healthier start for live-born infants, while also reducing the number of stillbirths, improving maternal health, and contributing to a positive economic and social development in the society.
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Affiliation(s)
- Per Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Tampere, Finland.
| | - Ulla Ashorn
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Yvonne Muthiani
- Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | | | - Rajiv Bahl
- Indian Council for Medical Research, New Delhi, India
| | - Robert E Black
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Nita Dalmiya
- United Nations Children's Fund, New York, NY, USA
| | - Christopher P Duggan
- Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana; Effective Care Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Department of Obstetrics and Gynaecology, Walter Sisulu University, East London, South Africa
| | - Stephen H Kennedy
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Nigel Klein
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Jeremy Shiffman
- Paul H Nitze School of Advanced International Studies, Johns Hopkins University, Baltimore, MD, USA
| | | | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
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25
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Xing L, Zhang D, Cao M, Zhang J. The relationship between NICU stress and neurodevelopmental outcomes of preterm infants: A multi-center prospective cohort study in China. J Pediatr Nurs 2023:S0882-5963(23)00106-9. [PMID: 37142495 DOI: 10.1016/j.pedn.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE To examine the relationship between NICU stress exposure and the neurodevelopmental outcomes of preterm infants. DESIGN AND METHODS A multicenter, prospective cohort study was conducted between May 2021 and June 2022. Preterm infant participants (28-34 weeks gestational age) were recruited at birth from three NICUs of three tertiary hospitals by convenience sampling. The NICU stress includes acute NICU stress and chronic NICU stress which were measured over the total NICU hospitalization for each infant using the Neonatal Infant Stressor Scale (NISS). Neurodevelopmental outcomes of preterm infants were assessed at 3 months corrected age (CA) using the Ages and Stages Questionnaire, Third Edition (ASQ-3). RESULTS Of one hundred and thirty preterm infant participants, 108 preterm infants were included into analysis. Results showed that acute NICU stress exposure significantly predicted the neurodevelopmental abnormalities in communication function (RR: 1.001, 95%CI: 1.000-1.001, p = .011), while chronic NICU stress exposure was significantly associated with the problem-solving function (RR: 1.003, 95%CI: 1.001-1.005, p = .002) at 3 months CA. No significant associations were found between NICU stress exposure and other dimensions of neurodevelopmental outcomes, including gross motor, fine motor, and personal-social functions. CONCLUSION NICU stress exposure demonstrated a significant predicting relationship with abnormalities in communication and problem-solving functions of preterm infants at 3 months CA. PRACTICE IMPLICATIONS During the NICU hospitalization, neonatal health caregivers should systematically monitor the NICU stress exposure to prevent neurodevelopmental problems in preterm infants.
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Affiliation(s)
- Limin Xing
- Xiang Yang First People Hospital, Affiliated Hospital of Hubei University of Medicine, No. 15, Jiefang Road, Fancheng District, Xiangyang 441000, China
| | - Dan Zhang
- Wuhan University School of Nursing, No. 115, Donghu Road, Wuchang District, Wuhan 430071, China
| | - Mi Cao
- Wuhan University School of Nursing, No. 115, Donghu Road, Wuchang District, Wuhan 430071, China
| | - Jun Zhang
- Wuhan University School of Nursing, No. 115, Donghu Road, Wuchang District, Wuhan 430071, China.
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26
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Ståhlberg-Forsén E, Latva R, Aija A, Lehtonen L, Stolt S. Language environment and parent-infant close contact in neonatal care and emerging lexical abilities of very preterm children-a longitudinal study. Acta Paediatr 2023; 112:659-666. [PMID: 36567645 DOI: 10.1111/apa.16647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 12/27/2022]
Abstract
AIM This longitudinal study investigated associations between language environment and parent-infant close contact in the neonatal intensive care unit (NICU) and preterm children's lexical abilities. METHODS NICU language environment of 43 very preterm infants (born<32 gestational weeks) was measured with the Language Environment Analysis System (LENA; variables: number of adult words, conversational turns, and child vocalisations). Parent-infant close contact (holding and skin-to-skin contact) in the NICU was reported using parental closeness diaries. At 15 and 18 months' corrected age, lexical development was measured with screening methods, and eye tracking-based lexical processing was assessed at 18 months. N varied between 29 and 38 in different outcome measures. RESULTS LENA measured conversational turns and child vocalisations, and parent-infant close contact associated positively with lexical development (r = 0.35-0.57). High numbers of NICU adult words associated negatively with lexical processing (r = -0.38- -0.40). In regression models, conversational turns and parent-infant close contact explained 34%-35% of receptive development. CONCLUSION Findings suggest that adult-infant turn taking and parent-infant close contact in the NICU are positively associated with lexical development. High numbers of overheard words in the NICU may not favour later lexical processing. Further research is warranted on the significance of NICU language environment on later lexical abilities.
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Affiliation(s)
| | - Reija Latva
- Tampere University Hospital, Tampere, Finland.,Tampere University, Tampere, Finland
| | - Anette Aija
- University of Turku, Turku, Finland.,Tallinn Children's Hospital, Tallinn, Estonia
| | - Liisa Lehtonen
- University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Suvi Stolt
- University of Helsinki, Helsinki, Finland
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27
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Berdasco-Muñoz E, Biran V, Nazzi T. Probing the Impact of Prematurity on Segmentation Abilities in the Context of Bilingualism. Brain Sci 2023; 13:brainsci13040568. [PMID: 37190533 DOI: 10.3390/brainsci13040568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/09/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
Infants born prematurely are at a high risk of developing linguistic deficits. In the current study, we compare how full-term and healthy preterm infants without neuro-sensorial impairments segment words from fluent speech, an ability crucial for lexical acquisition. While early word segmentation abilities have been found in monolingual infants, we test here whether it is also the case for French-dominant bilingual infants with varying non-dominant languages. These bilingual infants were tested on their ability to segment monosyllabic French words from French sentences at 6 months of (postnatal) age, an age at which both full-term and preterm monolinguals are able to segment these words. Our results establish the existence of segmentation skills in these infants, with no significant difference in performance between the two maturation groups. Correlation analyses failed to find effects of gestational age in the preterm group, as well as effects of the language dominance within the bilingual groups. These findings indicate that monosyllabic word segmentation, which has been found to emerge by 4 months in monolingual French-learning infants, is a robust ability acquired at an early age even in the context of bilingualism and prematurity. Future studies should further probe segmentation abilities in more extreme conditions, such as in bilinguals tested in their non-dominant language, in preterm infants with medical issues, or testing the segmentation of more complex word structures.
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28
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Kvaratskhelia N, Rurua N, Vadachkoria SG. Biomedical and Psychosocial Determinants of Early Neurodevelopment After Preterm Birth. Glob Pediatr Health 2023; 10:2333794X231160366. [PMID: 36968456 PMCID: PMC10037732 DOI: 10.1177/2333794x231160366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/09/2023] [Indexed: 03/29/2023] Open
Abstract
Prematurity and them related conditions are subject of scientific discussion. From the point of view optimization of postpartum processes, timely assessment of individual biomedical and psychosocial conditions and management of preventive intervention is very important, because of its linkage to issues of preterm infants and their families in long-term perspectives. The goal of the literature review is to bring together existing body of knowledge on biomedical, psychological, and social issues of premature infants related to early neurodevelopment in order to achieve better systemic vision. For this goal scientific articles related to neurological development delay of premature children and the possibilities of their timely identification were processed using electronic scientific search systems. Diagnostic tools to identify at-risk children and early intervention programs discussed in the article, significantly improve the chances of premature child development. In the article Introduced materials are to support: Clinicians to make correct decisions regarding important components of premature infants; Healthcare policy makers to plan targeted programs and activities; Public to better understand prematurity issues, especially in case of prematurely-born family members.
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Affiliation(s)
- Natia Kvaratskhelia
- University of Georgia, Tbilisi,
Georgia
- Natia Kvaratskhelia, School of Health
Sciences and Public Health, University of Georgia, Merab Kostava Street, 77a,
Tbilisi GE 0171, Georgia.
| | - Nana Rurua
- Pediatric Clinic Babymed, Tbilisi,
Georgia
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29
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Hoberg K, Häusler M, Orlikowsky T, Lidzba K. Enhancing the Follow-up Assessment of Very Preterm Children with Regard to 5-Year IQ Considering Socioeconomic Status. Z Geburtshilfe Neonatol 2022; 226:405-415. [PMID: 35981549 DOI: 10.1055/a-1864-9895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Specifying peri- and postnatal factors in children born very preterm (VPT) that affect later outcome helps to improve long-term treatment. AIM To enhance the predictability of 5-year cognitive outcome by perinatal, 2-year developmental and socio-economic data. SUBJECTS AND OUTCOME MEASURES 92 VPT infants, born 2007-2009, gestational age<32 weeks and/or birthweight of 1500 g, were assessed longitudinally including basic neonatal, socio-economic (SES), 2-year Mental Developmental Index (MDI, Bayley Scales II), 5-year Mental Processing Composite (MPC, Kaufman-Assessment Battery for Children), and Language Screening for Preschoolers data. 5-year infants born VPT were compared to 34 term controls. RESULTS The IQ of 5-year infants born VPT was 10 points lower than that of term controls and influenced independently by preterm birth and SES. MDI, SES, birth weight and birth complications explained 48% of the variance of the MPC. The MDI proved highly predictive (r=0.6, R2=36%) for MPC but tended to underestimate the cognitive outcome. A total of 61% of the 2-year infants born VPT were already correctly classified (specificity of .93, sensitivity of .54). CHAID decision tree technique identified SES as decisive for the outcome for infants born VPT with medium MDI results (76-91): They benefit from effects associated to a higher SES, while those with a poor MDI outcome and a birth weight≤890 g do not. CONCLUSION Developmental follow-up of preterm children enhances the quality of prognosis and later outcome when differentially considering perinatal risks and SES.
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Affiliation(s)
- Kathrin Hoberg
- Department of Paediatrics, Social Paediatric Centre, Division of Neuropaediatrics and Social Paediatrics; University Hospital RWTH Aachen, RWTH Aachen University, Aachen, Germany
| | - Martin Häusler
- Department of Paediatrics, Division of Neuropediatrics and Social Pediatrics; University Hospital RWTH Aachen, RWTH Aachen University, Aachen, Germany
| | - Thorsten Orlikowsky
- Department of Paediatrics, Division of Neonatology; University Hospital RWTH Aachen, RWTH Aachen University, Aachen, Germany
| | - Karen Lidzba
- Division of Child Neurology, Department of Pediatrics, Pediatric Neurology, Inselspital University Hospital Bern, Bern, Switzerland
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30
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Bernard S, Hebert C, Katz C, Mogilner L, Weintraub A, Bragg J, Guttmann KF. Maternal and staff perceptions of shared reading in the neonatal intensive care unit. J Perinatol 2022; 43:529-531. [PMID: 36261620 DOI: 10.1038/s41372-022-01539-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Stephanie Bernard
- Division of Newborn Medicine, Department of Pediatrics, the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Camille Hebert
- Division of Newborn Medicine, Department of Pediatrics, the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cynthia Katz
- Division of General Pediatrics, Department of Pediatrics, the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leora Mogilner
- Division of General Pediatrics, Department of Pediatrics, the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrea Weintraub
- Division of Newborn Medicine, Department of Pediatrics, the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jennifer Bragg
- Division of Newborn Medicine, Department of Pediatrics, the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine F Guttmann
- Division of Newborn Medicine, Department of Pediatrics, the Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Taskila HL, Heikkinen M, Yliherva A, Välimaa T, Hallman M, Kaukola T, Kallankari H. Antenatal and neonatal risk factors in very preterm children were associated with language difficulties at nine years of age. Acta Paediatr 2022; 111:2100-2107. [PMID: 35896181 DOI: 10.1111/apa.16501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/28/2022]
Abstract
AIM This Finnish study compared language and reading abilities between schoolchildren born at a very low gestational age (VLGA) of <32 weeks and at term and analysed any associations between antenatal and neonatal risk factors and language skills in the VLGA group. METHODS We prospectively followed 76 children born at a VLGA and 50 children born at term when they reached a mean age of 9.0 (8.1-10.0) years. They attended mainstream schools and had no severe neurosensory disabilities. Receptive language ability, rapid naming and word reading were evaluated using standardised tests. RESULTS Children in the VLGA group had lower scores for receptive language abilities (median 55.0 versus 57.0, p = 0.01) and word reading (mean 4.4 versus 5.1, p = 0.03) than the children in the term group. In the VLGA group, foetal growth restriction was associated with lower scores for rapid naming, early intraventricular haemorrhage was associated with poor word reading and respiratory distress syndrome was associated with poor rapid naming (p < 0.05). CONCLUSION Schoolchildren born at a VLGA had more difficulties with receptive language abilities and word reading than children born at term. Foetal growth restriction and early neonatal morbidities were associated with language difficulties.
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Affiliation(s)
- Hanna-Leena Taskila
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Minna Heikkinen
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Research Unit of Logopedics and Child Language Research Center, University of Oulu, Oulu, Finland
| | - Anneli Yliherva
- Research Unit of Logopedics and Child Language Research Center, University of Oulu, Oulu, Finland.,Logopedics, Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Taina Välimaa
- Research Unit of Logopedics and Child Language Research Center, University of Oulu, Oulu, Finland
| | - Mikko Hallman
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Tuula Kaukola
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Hanna Kallankari
- PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
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32
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Impact of Differing Language Background Exposures on Bayley-III Language Assessment in a National Cohort of Children Born Less than 29 Weeks' Gestation. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9071048. [PMID: 35884032 PMCID: PMC9316512 DOI: 10.3390/children9071048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 06/25/2022] [Accepted: 07/09/2022] [Indexed: 11/16/2022]
Abstract
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.
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33
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Sensory-based interventions in the NICU: systematic review of effects on preterm brain development. Pediatr Res 2022; 92:47-60. [PMID: 34508227 DOI: 10.1038/s41390-021-01718-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 07/12/2021] [Accepted: 08/17/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Infants born preterm are known to be at risk for abnormal brain development and adverse neurobehavioral outcomes. To improve early neurodevelopment, several non-pharmacological interventions have been developed and implemented in the neonatal intensive care unit (NICU). Sensory-based interventions seem to improve short-term neurodevelopmental outcomes in the inherently stressful NICU environment. However, how this type of intervention affects brain development in the preterm population remains unclear. METHODS A systematic review of the literature was conducted for published studies in the past 20 years reporting the effects of early, non-pharmacological, sensory-based interventions on the neonatal brain after preterm birth. RESULTS Twelve randomized controlled trials (RCT) reporting short-term effects of auditory, tactile, and multisensory interventions were included after the screening of 1202 articles. Large heterogeneity was identified among studies in relation to both types of intervention and outcomes. Three areas of focus for sensory interventions were identified: auditory-based, tactile-based, and multisensory interventions. CONCLUSIONS Diversity in interventions and outcome measures challenges the possibility to perform an integrative synthesis of results and to translate these for evidence-based clinical practice. This review identifies gaps in the literature and methodological challenges for the implementation of RCTs of sensory interventions in the NICU. IMPACT This paper represents the first systematic review to investigate the effect of non-pharmacological, sensory-based interventions in the NICU on neonatal brain development. Although reviewed RCTs present evidence on the impact of such interventions on the neonatal brain following preterm birth, it is not yet possible to formulate clear guidelines for clinical practice. This review integrates existing literature on the effect of sensory-based interventions on the brain after preterm birth and identifies methodological challenges for the conduction of high-quality RCTs.
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van Boven MR, Henke CE, Leemhuis AG, Hoogendoorn M, van Kaam AH, Königs M, Oosterlaan J. Machine Learning Prediction Models for Neurodevelopmental Outcome After Preterm Birth: A Scoping Review and New Machine Learning Evaluation Framework. Pediatrics 2022; 150:188249. [PMID: 35670123 DOI: 10.1542/peds.2021-056052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Outcome prediction of preterm birth is important for neonatal care, yet prediction performance using conventional statistical models remains insufficient. Machine learning has a high potential for complex outcome prediction. In this scoping review, we provide an overview of the current applications of machine learning models in the prediction of neurodevelopmental outcomes in preterm infants, assess the quality of the developed models, and provide guidance for future application of machine learning models to predict neurodevelopmental outcomes of preterm infants. METHODS A systematic search was performed using PubMed. Studies were included if they reported on neurodevelopmental outcome prediction in preterm infants using predictors from the neonatal period and applying machine learning techniques. Data extraction and quality assessment were independently performed by 2 reviewers. RESULTS Fourteen studies were included, focusing mainly on very or extreme preterm infants, predicting neurodevelopmental outcome before age 3 years, and mostly assessing outcomes using the Bayley Scales of Infant Development. Predictors were most often based on MRI. The most prevalent machine learning techniques included linear regression and neural networks. None of the studies met all newly developed quality assessment criteria. Studies least prone to inflated performance showed promising results, with areas under the curve up to 0.86 for classification and R2 values up to 91% in continuous prediction. A limitation was that only 1 data source was used for the literature search. CONCLUSIONS Studies least prone to inflated prediction results are the most promising. The provided evaluation framework may contribute to improved quality of future machine learning models.
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Affiliation(s)
- Menne R van Boven
- Departments of Neonatology.,Pediatrics, Follow-Me Program, Emma Neuroscience Group, and Amsterdam Reproduction and Development
| | - Celina E Henke
- Pediatrics, Follow-Me Program, Emma Neuroscience Group, and Amsterdam Reproduction and Development.,Psychosocial Department, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Aleid G Leemhuis
- Departments of Neonatology.,Pediatrics, Follow-Me Program, Emma Neuroscience Group, and Amsterdam Reproduction and Development
| | - Mark Hoogendoorn
- Faculty of Science, Quantitative Data Analytics Group, Department Computer Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Anton H van Kaam
- Departments of Neonatology.,Pediatrics, Follow-Me Program, Emma Neuroscience Group, and Amsterdam Reproduction and Development
| | - Marsh Königs
- Pediatrics, Follow-Me Program, Emma Neuroscience Group, and Amsterdam Reproduction and Development
| | - Jaap Oosterlaan
- Pediatrics, Follow-Me Program, Emma Neuroscience Group, and Amsterdam Reproduction and Development
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Mayne J, McGowan EC, Chiem A, Nwanne O, Tucker R, Vohr BR. Randomised controlled trial of maternal infant-directed reading among hospitalised preterm infants. Acta Paediatr 2022; 111:1921-1932. [PMID: 35673850 DOI: 10.1111/apa.16445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022]
Abstract
AIM A randomised trial to study the impact of a maternal-driven, infant-directed reading intervention on preterm infant language compared with matched controls. METHODS Infants born at 22-32 weeks in Women & Infants Neonatal Intensive Care were gestationally stratified to a reading intervention (n = 33) or standard care (n = 34). At 32-, 34- and 36-weeks postmenstrual age, 16-h language recordings were obtained in the hospital. Bivariate group comparisons and regressions adjusting for gestational age and multiples were run to predict word counts and conversational turns. Longitudinal analyses were conducted by negative binomial models containing intervention, randomised gestation group, recording number (1-3), an intervention × recording number interaction term and multiple birth adjustment by generalised estimating equations. RESULTS In adjusted analyses, by 36-weeks postmenstrual age, infants in the reading group had twice the number of conversational turns as infants receiving standard care (Rate ratio 1.98, 95% CI 1.33-2.93, p < 0.05). In longitudinal analyses, only infants in the reading group had a significant increase in the conversational turns between 32- and 36-weeks postmenstrual age (Rate ratio 2.45, 95% CI 1.45-4.14, p < 0.05). CONCLUSIONS A maternal infant-directed reading curriculum in the hospital demonstrated a positive impact on interactive conversations by 36-weeks postmenstrual age.
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Affiliation(s)
- Julia Mayne
- Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island, USA
| | - Elisabeth C McGowan
- Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island, USA
| | - Adrian Chiem
- Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ogochukwu Nwanne
- Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island, USA
| | - Richard Tucker
- Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island, USA
| | - Betty R Vohr
- Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island, USA
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Stipdonk LW, Boon RM, Franken MCJP, van Rosmalen J, Goedegebure A, Reiss IK, Dudink J. Language lateralization in very preterm children: associating dichotic listening to interhemispheric connectivity and language performance. Pediatr Res 2022; 91:1841-1848. [PMID: 34408271 DOI: 10.1038/s41390-021-01671-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Language difficulties of very preterm (VPT) children might be related to weaker cerebral hemispheric lateralization of language. Language lateralization refers to the development of an expert region for language processing in the left hemisphere during the first years of life. Children born VPT might not develop such a dominant left hemisphere for language processing. A dichotic listening task may be a functional task to show the dominance of the left hemisphere during language processing. During this task, different acoustic events are simultaneously presented to both ears. Due to crossing fibers in the brain, right ear stimuli are transferred directly to the left hemisphere, and left ear stimuli are transferred first to the right hemisphere and then, through the corpus callosum (CC), to the left hemisphere. Dichotic listening typically shows a right ear advantage, assuming to reflect left hemispherical language dominance. The CC, in particular the splenium, is associated with auditory processing and is considered important for language lateralization. The objective of this work was to explore whether dichotic listening performance in school-aged VPT children are associated with language performance and interhemispheric connectivity. METHODS This is a cross-sectional study of 58 VPT children and 30 full term controls at age 10 years. Language performance and dichotic digit test (DDT) were assessed. In 44 VPT children, additionally diffusion weighted imaging (DWI) was performed using a 3 T MRI scanner. Fractional anisotropy (FA) and mean diffusivity (MD) values of the splenium of the CC were extracted. RESULTS Poorer right ear DDT scores were associated with poorer language performance in VPT children only (p = 0.015). Association between right ear DDT scores and MD of the splenium approached the level of significance (p = 0.051). CONCLUSIONS These results support the hypothesis that poor language performance in VPT children may be a consequence of weaker lateralized language organization, due to a poorly developed splenium of the CC. Dichotic listening may reflect the level of language lateralization in VPT children. IMPACT Poor language performance in VPT children may be a consequence of weaker lateralized language organization, due to a poorly developed splenium of the CC. Dichotic listening performance may reflect the level of language lateralization in VPT children and right ear scores of a dichotic listening task are associated with both the splenium of the corpus callosum and language performance. If our results could be validated in future research, it suggests that poor CC development may indicate VPT children at risk for long-term language problems.
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Affiliation(s)
- Lottie W Stipdonk
- Department of Otorhinolaryngology at Erasmus Medical University Centre-Sophia Children's Hospital, Rotterdam, Netherlands.
| | - Rianne M Boon
- Division of Neonatology, Department of Pediatrics at UMCU-Wilhelmina Children's Hospital, Utrecht, Netherlands.,Faculty of Science at Vrije Universiteit, Amsterdam, Netherlands
| | - Marie-Christine J P Franken
- Department of Otorhinolaryngology at Erasmus Medical University Centre-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical University Centre, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus Medical University Centre, Rotterdam, Netherlands
| | - André Goedegebure
- Department of Otorhinolaryngology at Erasmus Medical University Centre-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Irwin K Reiss
- Division of Neonatology, Department of Pediatrics at Erasmus Medical University Centre-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Jeroen Dudink
- Division of Neonatology, Department of Pediatrics at UMCU-Wilhelmina Children's Hospital, Utrecht, Netherlands
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Cebeci B, Alderliesten T, Wijnen JP, van der Aa NE, Benders MJNL, de Vries LS, van den Hoogen A, Groenendaal F. Brain proton magnetic resonance spectroscopy and neurodevelopment after preterm birth: a systematic review. Pediatr Res 2022; 91:1322-1333. [PMID: 33953356 DOI: 10.1038/s41390-021-01539-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 03/31/2021] [Accepted: 04/05/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Preterm infants are at risk of neurodevelopmental impairments. At present, proton magnetic resonance spectroscopy (1H-MRS) is used to evaluate brain metabolites in asphyxiated term infants. The aim of this review is to assess associations between cerebral 1H-MRS and neurodevelopment after preterm birth. METHODS PubMed and Embase were searched to identify studies using 1H-MRS and preterm birth. Eligible studies for this review included 1H-MRS of the brain, gestational age ≤32 weeks, and neurodevelopment assessed at a corrected age (CA) of at least 12 months up to the age of 18 years. RESULTS Twenty papers evaluated 1H-MRS in preterm infants at an age between near-term and 18 years and neurodevelopment. 1H-MRS was performed in both white (WM) and gray matter (GM) in 12 of 20 studies. The main regions were frontal and parietal lobe for WM and basal ganglia for GM. N-acetylaspartate/choline (NAA/Cho) measured in WM and/or GM is the most common metabolite ratio associated with motor, language, and cognitive outcome at 18-24 months CA. CONCLUSIONS NAA/Cho in WM assessed at term-equivalent age was associated with motor, cognitive, and language outcome, and NAA/Cho in deep GM was associated with language outcome at 18-24 months CA. IMPACT In preterm born infants, brain metabolism assessed using 1H-MRS at term-equivalent age is associated with motor, cognitive, and language outcomes at 18-24 months. 1H-MRS at term-equivalent age in preterm born infants may be used as an early indication of brain development. Specific findings relating to NAA were most predictive of outcome.
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Affiliation(s)
- Burcu Cebeci
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands.,Department of Neonatology, Health Sciences University, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Thomas Alderliesten
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Jannie P Wijnen
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Niek E van der Aa
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Linda S de Vries
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Agnes van den Hoogen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands.
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Sundas L, Palma S, Pugliese M, Roversi MF, Apa E, Berardi A, Genovese E, Monzani D. Monitoring of Communication Precursors in Extremely Low Birth Weight (ELBW) Newborns by Video Analysis Method: Preliminary Results. CHILDREN (BASEL, SWITZERLAND) 2022; 9:602. [PMID: 35626779 PMCID: PMC9139730 DOI: 10.3390/children9050602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 11/16/2022]
Abstract
Background: The survival of extremely low birth weight infants (ELBW) has increased worldwide. Even in the absence of major disabilities, ELBW infants show difficulty in simple language functions. It is relevant to assess early abilities, which are the base of early linguistic skills, in order to implement customized intervention programs in ELBW infants. Aims: To evaluate communication precursors of language development in ELBW infants at 12 and 24 months of correct age (C.A). To investigate the correlation of linguistic and communicative prerequisites with mental development outcome at 24 months CA. Method: 52 ELBW neonates (mean gestational age 26.6 weeks, mean birth weight was 775 g) who were admitted to the neonatal intensive care unit of the University Hospital of Modena, were enrolled. Data were collected from archived audio-video recordings of neurodevelopmental follow-up visits. Video analysis of communicative and linguistic developmental was performed at 12 and 24 months CA. Neurodevelopmental outcome was evaluated with Mental Developmental Scales (GMDS-R). Results: The video-analysis showed that infants at 12 months CA used predominantly eye contacts and gestural turns, while vocal turns were scant. At 24 months CA, a significant change in eye contacts, vocal turns, gestural turns, and utterances (p < 0.001) occurred. The total number of utterances (p = 0.036) and eye contacts (p = 0.045) were significantly correlated to the Development Quotient (DQ) of Hearing and Language scale. Moreover, a significant correlation was found with the Personal-Social scale vocal turns (p = 0.009) and the total number of utterances (p = 0,02). Finally, the Global Quotient of the GMDS-R was related to the Vocal Turns (p = 0.034) and the total number of Utterances (p = 0.013). Conclusions: ELBW infants at 12 months CA use predominantly eye contacts and gestural turns to communicate with adults. At 24 months CA, the child’s communicative intention evolves from gestural to verbal communication. The latter is characterized by an increase in both vocal turns and the number of utterances produced during interaction. The video analysis we implement appears to be a sensitive tool for early assessment of communication and language development and to refine early intervention
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Affiliation(s)
- Laura Sundas
- Child and Adolescent Mental Health Service AUSL, 41121 Modena, Italy;
| | - Silvia Palma
- Audiology, Primary Care Dep. AUSL, 41100 Modena, Italy
| | - Marisa Pugliese
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41100 Modena, Italy; (M.P.); (M.F.R.); (A.B.)
| | - Maria Federica Roversi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41100 Modena, Italy; (M.P.); (M.F.R.); (A.B.)
| | - Enrico Apa
- Audiology, ENT Dept., University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy; (E.A.); (E.G.); (D.M.)
| | - Alberto Berardi
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41100 Modena, Italy; (M.P.); (M.F.R.); (A.B.)
| | - Elisabetta Genovese
- Audiology, ENT Dept., University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy; (E.A.); (E.G.); (D.M.)
| | - Daniele Monzani
- Audiology, ENT Dept., University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy; (E.A.); (E.G.); (D.M.)
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van Noort-van der Spek IL, Dudink J, Reiss IK, Franken MCJP. Early Speech Sound Production and Its Trajectories in Very Preterm Children From 2 to 4 Years of Age. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1294-1310. [PMID: 35263167 DOI: 10.1044/2021_jslhr-21-00388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Very preterm (VPT) children are at risk for speech and language problems throughout school age. However, little is known about early speech sound production in these children. This study aims to present a detailed description of early speech sound production and its trajectories in VPT children from 2 to 4 years of age. In addition, this study aimed to determine if early speech sound production is associated with speech production and expressive language function at 4 years of age. METHOD In 63 VPT children (< 32 weeks of gestation, 41 boys, mean gestational age = 28.8 weeks, mean birth weight = 1,135 g), speech sound production was assessed by naturalistic speech analysis at 2 years of corrected age and speech and language function by standardized tests at 4 years of age. RESULTS Speech sound production was found to be abnormal in 49% of the VPT children at 2 years of age and in 19% at 4 years of age. Four different speech production trajectories from 2 to 4 years of age could be identified: a normal trajectory, an abnormal trajectory, a catch-up trajectory, and a growing-into-deficit trajectory. Early speech production, defined by the number of acquired consonants at 2 years of age, significantly predicted the word production score at 4 years of age and the sentence production score at 4 years of age. CONCLUSIONS Compared to the general population, an alarmingly high proportion of VPT children showed speech production problems at 2 years of age. About half of these children showed persistent speech problems at 4 years of age. Moreover, these problems were associated with expressive language problems at the age of 4 years. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19310822.
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Affiliation(s)
- Inge L van Noort-van der Spek
- Department of Otorhinolaryngology, Sophia Children's Hospital, Erasmus Medical University Center, Rotterdam, the Netherlands
| | - Jeroen Dudink
- Division of Neonatology, Department of Pediatrics, Sophia Children's Hospital, Erasmus Medical University Center, Rotterdam, the Netherlands
- Division of Neonatology, Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, the Netherlands
| | - Irwin K Reiss
- Division of Neonatology, Department of Pediatrics, Sophia Children's Hospital, Erasmus Medical University Center, Rotterdam, the Netherlands
| | - Marie-Christine J P Franken
- Department of Otorhinolaryngology, Sophia Children's Hospital, Erasmus Medical University Center, Rotterdam, the Netherlands
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Gire C, Garbi A, Zahed M, Beltran Anzola A, Tosello B, Datin-Dorrière V. Neurobehavioral Phenotype and Dysexecutive Syndrome of Preterm Children: Comorbidity or Trigger? An Update. CHILDREN (BASEL, SWITZERLAND) 2022; 9:239. [PMID: 35204960 PMCID: PMC8870742 DOI: 10.3390/children9020239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/29/2022] [Accepted: 02/09/2022] [Indexed: 06/14/2023]
Abstract
Premature birth is a worldwide public health priority. One in ten children is born before 37 weeks of gestational age and, in developed countries, survival rates without major neonatal morbidity are increasing. Although severe sequelae associated with these births have decreased, their neurobehavioral difficulties, often associated in multiple fields, remain stable but still widespread. These neurobehavioral difficulties hamper the normal development of academic achievements and societal integration and intensify the children's needs for rehabilitation during their preschool and academic years. Severe sequelae increase when gestational age decreases. This is even truer if the socio-cultural background is impeded by low income, education and language skills as compared with defined averages. However, moderate and/or minor neurocognitive and/or behavioral difficulties are almost identical for a moderate or a late preterm birth. Obtaining a better clinical description of neurobehavioral characteristics of those pretermly born, once they reach preschool age, is essential to detect behavioral issues as well as early specific cognitive difficulties (working memory, planning, inhibition, language expression and reception, attention and fine motor skills, etc.). Such information would provide a better understanding of the executive functions' role in brain connectivity, neurodevelopment and neuroanatomical correlation with premature encephalopathy.
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Affiliation(s)
- Catherine Gire
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (C.G.); (A.G.); (M.Z.); (A.B.A.)
- CEReSS—Health Service Research and Quality of Life Center, Faculty of Medicine, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - Aurélie Garbi
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (C.G.); (A.G.); (M.Z.); (A.B.A.)
| | - Meriem Zahed
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (C.G.); (A.G.); (M.Z.); (A.B.A.)
| | - Any Beltran Anzola
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (C.G.); (A.G.); (M.Z.); (A.B.A.)
- CEReSS—Health Service Research and Quality of Life Center, Faculty of Medicine, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005 Marseille, France
| | - Barthélémy Tosello
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (C.G.); (A.G.); (M.Z.); (A.B.A.)
- CNRS, EFS, ADES, Aix Marseille Universite, 13915 Marseille, France
| | - Valérie Datin-Dorrière
- Department of Neonatal Medicine, Caen University Hospital, Avenue Cote De Nacre, 14000 Caen, France;
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Marques A, Santos ME. Oral language of school-aged children born pretermaturely: a population-based analysis from Madeira Island, Portugal. REVISTA DE INVESTIGACIÓN EN LOGOPEDIA 2022. [DOI: 10.5209/rlog.74670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Premature birth and low birth weight are very important factors in neurodevelopment. Current research in this population focuses on children born prematurely, with no underlying complications in the post-natal period, who are likely to develop specific disorders with their language development and consequently with their learning capabilities too. This study aims to analyse the oral language skills of prematurely born children in comparison to their school-aged peers. The children were assessed in the respective schools, 27 preterm children (16 under 32 weeks and 11 with 32 or more weeks of gestation) and 49 term paired by gender, age, and school year. Tests including simple and complex structures for assessing semantics, morphosyntax, and phonology were used, as well as a test of verbal memory. Preterm born children, regardless of their prematurity grade, showed significantly lower results than their peers, and more than a half of them, 52%, presented low scores in all language tests simultaneously, showing an important language deficit. In contrast, in the term born children group only 14% showed low scores simultaneously in all tests. Verbal memory ability proved to be lower than that of their term peers, regardless of the gestational age and birth weight of preterm children. As a result of this analysis we consider that the evaluation of the linguistic development of these children, even in cases of moderate to late prematurity, should be monitored in order to identify earlier the existence of deficits and prevent psychosocial and learning problems.
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Barnes-Davis ME, Williamson BJ, Merhar SL, Nagaraj UD, Parikh NA, Kadis DS. Extracallosal Structural Connectivity Is Positively Associated With Language Performance in Well-Performing Children Born Extremely Preterm. Front Pediatr 2022; 10:821121. [PMID: 35372163 PMCID: PMC8971711 DOI: 10.3389/fped.2022.821121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/24/2022] [Indexed: 01/29/2023] Open
Abstract
Children born extremely preterm (<28 weeks gestation) are at risk for language delay or disorders. Decreased structural connectivity in preterm children has been associated with poor language outcome. Previously, we used multimodal imaging techniques to demonstrate that increased functional connectivity during a stories listening task was positively associated with language scores for preterm children. This functional connectivity was supported by extracallosal structural hyperconnectivity when compared to term-born children. Here, we attempt to validate this finding in a distinct cohort of well-performing extremely preterm children (EPT, n = 16) vs. term comparisons (TC, n = 28) and also compare this to structural connectivity in a group of extremely preterm children with a history of language delay or disorder (EPT-HLD, n = 8). All participants are 4-6 years of age. We perform q-space diffeomorphic reconstruction and functionally-constrained structural connectometry (based on fMRI activation), including a novel extension enabling between-groups comparisons with non-parametric ANOVA. There were no significant differences between groups in age, sex, race, ethnicity, parental education, family income, or language scores. For EPT, tracks positively associated with language scores included the bilateral posterior inferior fronto-occipital fasciculi and bilateral cerebellar peduncles and additional cerebellar white matter. Quantitative anisotropy in these pathways accounted for 55% of the variance in standardized language scores for the EPT group specifically. Future work will expand this cohort and follow longitudinally to investigate the impact of environmental factors on developing language networks and resiliency in the preterm brain.
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Affiliation(s)
- Maria E Barnes-Davis
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Brady J Williamson
- Department of Radiology, University of Cincinnati, Cincinnati, OH, United States
| | - Stephanie L Merhar
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Usha D Nagaraj
- Department of Radiology, University of Cincinnati, Cincinnati, OH, United States
| | - Nehal A Parikh
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States.,Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Darren S Kadis
- Neurosciences and Mental Health, Hospital for Sick Children, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada
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Language function following preterm birth: prediction using machine learning. Pediatr Res 2022; 92:480-489. [PMID: 34635792 PMCID: PMC8503721 DOI: 10.1038/s41390-021-01779-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/04/2021] [Accepted: 09/12/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Preterm birth can lead to impaired language development. This study aimed to predict language outcomes at 2 years corrected gestational age (CGA) for children born preterm. METHODS We analysed data from 89 preterm neonates (median GA 29 weeks) who underwent diffusion MRI (dMRI) at term-equivalent age and language assessment at 2 years CGA using the Bayley-III. Feature selection and a random forests classifier were used to differentiate typical versus delayed (Bayley-III language composite score <85) language development. RESULTS The model achieved balanced accuracy: 91%, sensitivity: 86%, and specificity: 96%. The probability of language delay at 2 years CGA is increased with: increasing values of peak width of skeletonized fractional anisotropy (PSFA), radial diffusivity (PSRD), and axial diffusivity (PSAD) derived from dMRI; among twins; and after an incomplete course of, or no exposure to, antenatal corticosteroids. Female sex and breastfeeding during the neonatal period reduced the risk of language delay. CONCLUSIONS The combination of perinatal clinical information and MRI features leads to accurate prediction of preterm infants who are likely to develop language deficits in early childhood. This model could potentially enable stratification of preterm children at risk of language dysfunction who may benefit from targeted early interventions. IMPACT A combination of clinical perinatal factors and neonatal DTI measures of white matter microstructure leads to accurate prediction of language outcome at 2 years corrected gestational age following preterm birth. A model that comprises clinical and MRI features that has potential to be scalable across centres. It offers a basis for enhancing the power and generalizability of diagnostic and prognostic studies of neurodevelopmental disorders associated with language impairment. Early identification of infants who are at risk of language delay, facilitating targeted early interventions and support services, which could improve the quality of life for children born preterm.
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Abstract
Extremely preterm birth is associated with increased risk for a spectrum of neurodevelopmental problems. This review describes the nature of cognitive and academic outcomes of extremely preterm survivors across childhood and adolescence. Evidence across meta-analyses and large prospective birth cohorts indicate that early developmental difficulties in children born extremely preterm do not resolve with age and are not improving over time despite advancements in neonatal care. While extremely preterm birth confers increased risk of widespread cognitive difficulties, considerable heterogeneity in outcomes is evident across individuals. There is a continued need for high-quality longitudinal studies to understand the developmental progression of cognitive and academic skills following extremely preterm birth, and greater focus on understanding contributing factors that may help to explain the individual variability in cognitive and academic outcomes of extremely preterm survivors.
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Affiliation(s)
- Leona Pascoe
- Turner Institute for Brain and Mental Health, Monash University, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Alice C Burnett
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Newborn Research, The Royal Women's Hospital, Melbourne, Australia; Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Peter J Anderson
- Turner Institute for Brain and Mental Health, Monash University, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
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van Noort-van der Spek IL, Stipdonk LW, Goedegebure A, Dudink J, Willemsen S, Reiss IKM, Franken MCJP. Are multidisciplinary neurodevelopmental profiles of children born very preterm at age 2 relevant to their long-term development? A preliminary study. Child Neuropsychol 2021; 28:437-457. [PMID: 34727843 DOI: 10.1080/09297049.2021.1991296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
To identify distinctive multidisciplinary neurodevelopmental profiles of relatively healthy children born very preterm (VPT) and describe the longitudinal course of these profiles up to age 10. At 2 years of corrected age, 84 children born VPT underwent standardized testing for cognitive, language, speech, motor, behavioral, and auditory nerve function. These data were submitted to factor and cluster analysis. Sixty-one of these children underwent cognitive, language, and behavioral assessment again at age 10. Descriptive statistics were used to analyze longitudinal trajectories for each profile. Four neurodevelopmental profiles were identified at age 2. Profile 1 children (n = 22/26%) had excellent cognitive-language-motor function, normal behavioral and auditory nerve function, but showed an unexpected severe decline up to age 10. Profile 2 children (n = 16/19%) had very low behavioral function, low cognitive-language-motor function, and accelerated auditory nerve function. Their scores remained low up until age 10. Profile 3 children (n = 17/20%) had delayed auditory nerve function, low behavioral function, and slightly lower cognitive-language-motor function. They showed the most increasing trajectory. Profile 4 children (n = 29/35%) had very low cognitive-language-motor function, normal behavioral and auditory nerve function, but showed wide variation in their trajectory. Our preliminary study showed that a multidisciplinary profile-oriented approach may be important in children born VPT to improve counseling and provide targeted treatment for at risk children. High performers at age 2 may not be expected to maintain their favorable development. Behavioral problems might negatively impact language development. Delayed auditory nerve function might represent a slow start and catch-up development.
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Affiliation(s)
- Inge L van Noort-van der Spek
- Department of Otorhinolaryngology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Lottie W Stipdonk
- Department of Otorhinolaryngology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - André Goedegebure
- Department of Otorhinolaryngology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Jeroen Dudink
- Division of Neonatology, Department of Pediatrics, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands.,Division of Neonatology, Department of Pediatrics, UMCU-Wilhelmina Children's Hospital, Utrecht, Netherlands
| | - Sten Willemsen
- Department of Biostatistics, Erasmus Medical University Center, Rotterdam, Netherlands
| | - Irwin K M Reiss
- Division of Neonatology, Department of Pediatrics, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Marie-Christine J P Franken
- Department of Otorhinolaryngology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
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46
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de Lima AMO, Cáceres-Assenço AM. What factors interfere with the performance of preschool children in the language subtest of Bayley-III? Codas 2021; 34:e20200200. [PMID: 34730745 PMCID: PMC9886127 DOI: 10.1590/2317-1782/20212020200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 03/31/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE to verify if the performance of pre-school children born prematurely and at term in the Bayley-III language subtest differs and to identify whether variables gestational age, birth weight, socioeconomic level, and maternal education are determinant in the outcome of language development. METHODS Descriptive cross-sectional case-control study in which 36 pre-school children born prematurely and 27 born at term were evaluated concerning language development by the Bayley III subtest. Preschoolers between 18 and 36 months of chronological age were considered; with no syndromes or genetic, sensory, neurological, auditory, or visual impairments; and had not previously undergone speech therapy. Mann-Whitney, Fisher's Exact, and binary logistic regression tests were used for statistical analysis. RESULTS the groups' performance did not differ either by the composite score (p = .701) or by the classification based on the percentile (p = .225). Gestational age, birth weight, and socioeconomic status did not influence the outcome of language development. However, maternal education was significant (p = .014) in the binary logistic regression model, suggesting that the mother having studied until basic education increases the chance of having a child underperforming in the Bayley III language subtest 6.31 times. CONCLUSION there was no difference between the groups in the Bayley-III language subtest and only maternal education influenced the outcome of language development.
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Affiliation(s)
- Antonio Marcos Oliveira de Lima
- Laboratório de Desenvolvimento da Linguagem, Departamento de Fonoaudiologia, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte – UFRN - Natal (RN), Brasil.
| | - Ana Manhani Cáceres-Assenço
- Laboratório de Desenvolvimento da Linguagem, Departamento de Fonoaudiologia, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte – UFRN - Natal (RN), Brasil.
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Abstract
White matter injury (WMI) represents a frequent form of parenchymal brain injury in preterm neonates. Several dimensions of WMI are recognized, with distinct neuropathologic features involving a combination of destructive and maturational anomalies. Hypoxia-ischemia is the main mechanism leading to WMI and adverse white matter development, which result from injury to the oligodendrocyte precursor cells. Inflammation might act as a potentiator for WMI. A combination of hypoxia-ischemia and inflammation is frequent in several neonatal comorbidities such as postnatal infections, NEC and bronchopulmonary dysplasia, all known contributors to WMI. White matter injury is an important predictor of adverse neurodevelopmental outcomes. When WMI is detected on neonatal brain imaging, a detailed characterization of the injury (pattern of injury, severity and location) may enhance the ability to predict outcomes. This clinically-oriented review will provide an overview of the pathophysiology and imaging diagnosis of the multiple dimensions of WMI, will explore the association between postnatal complications and WMI, and will provide guidance on the signification of white matter anomalies for motor and cognitive development.
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Affiliation(s)
- Mireille Guillot
- Department of Pediatrics (Neurology), University of Toronto and the Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Toronto M5G 1X8, Canada; Department of Pediatrics (Neonatology), Université Laval and Centre Hospitalier Universitaire de Québec, Québec, Canada
| | - Steven P Miller
- Department of Pediatrics (Neurology), University of Toronto and the Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Toronto M5G 1X8, Canada.
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48
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Abstract
The preterm birth rate in the United States is 10%, with 8% being born between 36 and 32 weeks of gestation, and the remaining 2% born less than 31 weeks of gestation. The global preterm birth rate varies from 5% to 18%, with varying survival rates. These percentages signify a population of people that will receive health care across the life course without ever being asked about a preterm birth history. With a steady rise in the survival rate of preterm infants being discharged home from the neonatal intensive care unit, with limited referrals for neonatal or developmental follow up, it is essential adult care providers ask the right questions and identify risk factors for this vulnerable population. This review describes the recently published, evidence-based recommendations for addressing preterm history across the life course. A robust review of the literature has demonstrated that the long-term sequelae of being born preterm can adversely affect health and quality of life. The following will offer preterm birth history recommendations based on assessment and diagnosis, prevention and management and referral and treatment. The goal of the recommendations is to create awareness among adult health providers in acknowledging a past medical history of preterm birth and providing appropriate preventive care, therefore shifting the paradigm of care from reactive intervention to proactive care.
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Affiliation(s)
- Michelle M Kelly
- Villanova University, Fitzpatrick College of Nursing, United States of America; University of Rhode Island, College of Nursing, Research Fellow, United States of America.
| | - Jane Tobias
- Thomas Jefferson University, Jefferson College of Nursing, United States of America
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Redd SK, Rice WS, Aswani MS, Blake S, Julian Z, Sen B, Wingate M, Hall KS. Racial/ethnic and educational inequities in restrictive abortion policy variation and adverse birth outcomes in the United States. BMC Health Serv Res 2021; 21:1139. [PMID: 34686197 PMCID: PMC8532280 DOI: 10.1186/s12913-021-07165-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/12/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND To examine racial/ethnic and educational inequities in the relationship between state-level restrictive abortion policies and adverse birth outcomes from 2005 to 2015 in the United States. METHODS Using a state-level abortion restrictiveness index comprised of 18 restrictive abortion policies, we conducted a retrospective longitudinal analysis examining whether race/ethnicity and education level moderated the relationship between the restrictiveness index and individual-level probabilities of preterm birth (PTB) and low birthweight (LBW). Data were obtained from the 2005-2015 National Center for Health Statistics Period Linked Live Birth-Infant Death Files and analyzed with linear probability models adjusted for individual- and state-level characteristics and state and year fixed-effects. RESULTS Among 2,250,000 live births, 269,253 (12.0%) were PTBs and 182,960 (8.1%) were LBW. On average, states had approximately seven restrictive abortion policies enacted from 2005 to 2015. Black individuals experienced increased probability of PTB with additional exposure to restrictive abortion policies compared to non-Black individuals. Similarly, those with less than a college degree experienced increased probability of LBW with additional exposure to restrictive abortion policies compared to college graduates. For all analyses, inequities worsened as state environments grew increasingly restrictive. CONCLUSION Findings demonstrate that Black individuals at all educational levels and those with fewer years of education disproportionately experienced adverse birth outcomes associated with restrictive abortion policies. Restrictive abortion policies may compound existing racial/ethnic, socioeconomic, and intersecting racial/ethnic and socioeconomic perinatal and infant health inequities.
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Affiliation(s)
- Sara K Redd
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA.
- Center for Reproductive Health Research in the Southeast (RISE), Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA.
| | - Whitney S Rice
- Center for Reproductive Health Research in the Southeast (RISE), Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Monica S Aswani
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, 1719 9th Ave. S, Birmingham, AL, 35233, USA
| | - Sarah Blake
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
- Center for Reproductive Health Research in the Southeast (RISE), Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Zoë Julian
- Independent Clinician Scholar, Atlanta, GA, 30322, USA
| | - Bisakha Sen
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL, 35233, USA
| | - Martha Wingate
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, Birmingham, AL, 35233, USA
| | - Kelli Stidham Hall
- Center for Reproductive Health Research in the Southeast (RISE), Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, 722 West 168th St, New York, NY, 10032, USA
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50
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Cerebellar volumes and language functions in school-aged children born very preterm. Pediatr Res 2021; 90:853-860. [PMID: 33469182 DOI: 10.1038/s41390-020-01327-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Volumes of cerebellar posterior lobes have been associated with cognitive skills, such as language functioning. Children born very preterm (VPT) often have language problems. However, only total cerebellar volume has been associated with language functioning, with contradicting results. The objective of this study was to ascertain whether total cerebellar structures or specific posterior lobular structures are associated with language ability of school-aged VPT children. METHODS This is a prospective cohort study of 42 school-aged VPT children without major handicaps. Structural MRI was performed and the cerebellum segmentation pipeline was used for segmentation of separate lobules. Narrative retelling assessment was performed and language content and language structure scores were extracted. Linear regression analyses were used to associate language scores with whole gray matter (GM) cerebellar volume and right Crus I+II GM volume. RESULTS Whole cerebellar GM volume was not significantly associated with language content nor with language structure; however, right Crus I+II GM volume was significantly associated with language content (β = 0.192 (CI = 0.033, 0.351), p = 0.020). CONCLUSIONS GM volume of Crus I+II appears to be associated with language functions in school-aged VPT children without major handicaps, while whole cerebellar volume is not. This study showed the importance of studying cerebellar lobules separately, rather than whole cerebellar volume only, in relation to VPT children's language functions. IMPACT GM volume of Crus I+II is associated with semantic language functions in school-aged very preterm children without overt brain injury, whereas whole cerebellar volume is not. This study showed the importance of studying cerebellar lobules separately, rather than whole cerebellar volume only, in relation to very preterm children's language functions. This study might impact future research in very preterm children. Lobular structures rather than whole cerebellar structures should be the region of interest in relation to language functions.
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