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

doi:10.1016/j.earlhumdev.2010.08.014

Early Human Development

Volume 86, Issue 12, December 2010, Pages 765-772

https://doi.org/10.1016/j.earlhumdev.2010.08.014 Get rights and content

Abstract

Background

Although premature birth is associated with lags in language acquisition, it is unclear whether preterms exhibit an elevated risk for language impairment (LI). This study determined whether preterms, without frank cerebral damage, at 2;6 and 3;6 exhibited a higher rate of risk for LI as compared to full-terms, and also sought to identify predictors of risk.

Method

Sixty-four Italian very immature preterms were assessed longitudinally at 2;6 and 3;6; age-matched full-terms served as controls at 2;6 (n = 22) and 3;6 (n = 40). Each completed individualized assessments of cognition and language ability. At each time point, using cut-offs specific to each of the language measures, children were differentiated into two groups (at risk for LI, not at risk).

Results

The percentage of full-terms at risk for LI at 2;6 (9.1% to 13.6%) and 3;6 (7.5%) was consistent with prior estimates of LI at these ages. The percentage of preterms at risk for LI at 2;6 (16.1% to 24.1%) and 3;6 (34.4%) was higher at both ages and statistically significant at 3;6 (difference = 26.8%, 95% CI = 12.3% to 41.4%). The best model predicting risk status at 3;6 was preterms' mean length of utterance (MLU) at 2;6, (sensitivity 72.73%, specificity 85%) when adjusting for maternal education.

Conclusion

Preterms exhibit a heightened risk for LI in the preschool years, since about one in four preterms at 2;6 and one in three preterms at 3;6 experiences significant lags in language acquisition. Findings argue the importance of early identification of language difficulties among preterms coupled with implementation of systematic language-focused interventions for these youngsters.

Section snippets

Participants

This study involved 126 Italian children (64 very immature preterms, 62 full-terms) comprising three sub-samples. A preterm sample consisting of 64 children was assessed longitudinally at 2;6 and 3;6, whereas two control samples of full-terms were ascertained to provide cross-sectional references for the preterms at 2;6 (n = 22) and 3;6 (n = 40).

Results

Descriptive information about the language abilities of preterms relative to full-terms at 2;6 and 3;6 appear in Table 1. At 2;6, independent-samples t tests showed no significant differences (all ps > 0.15) between preterms and full-terms on the language or cognition measures, as we have reported previously [17]. The effect of group was not significant for PVB Total Words, PVB Complete Sentences, PRF MLU and the Stanford-Binet IQ, when adjusting for maternal level of education [2-way MANOVA test

Discussion

An ample literature on the circumstances surrounding preterm birth shows that these youngsters face an increased risk for a number of adverse outcomes that transcend both physical (e.g., cerebral palsy) [41] and cognitive dimensions of development [1]. Of relevance to this study, a number of research findings have suggested that preterms exhibit a substantially heightened risk for LI during early childhood [14], [26]. As we discussed previously, LI refers to a specific or nonspecific impairment

Conflict of interest statement

None declared.

Acknowledgements

We would like to thank the children and parents for their participation in the research and Giulia Aquilano for help with the medical examination.

Funding: This research was supported by research grants from University of Bologna: Basic Oriented Research ex 60% 2004, 2005, 2006; Strategic Project 2007–2009 “Early communicative-linguistic and cognitive abilities: risks linked to preterm birth”. This research was also supported by a national research grant PRIN 2008 “Gestures and language in

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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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The advancement in perinatal care has significantly improved the survival of preterm infants born very low birth weight (VLBW, birth weight < 1500 g), however their vulnerability to neonatal diseases and neurodevelopmental disability remains a concern [1–4]. Preterm infants born VLBW are at a higher risk of poor motor, cognitive, language and behavioral functions from infancy to school age than their term peers [5–10]. Furthermore, analyses of developmental outcome in preterm infants during recent eras showed a decline in the risk of major developmental disability together with no change or an incline in the risk of mild to moderate developmental disabilities over time [11–14].
Although numerous studies have examined the development of preterm children born very low birth weight (VLBW, birth body weight < 1500 g), variations of developmental progress within individuals have rarely been explored. The aim of this research was to examine the cognitive and motor trajectories in preterm children born VLBW at early ages and to assess the risk factors and predictability of these trajectories.
Five hundred and eighty preterm infants born VLBW from three cohort studies (2003 to 2014) were prospectively assessed their mental and motor development using the Bayley Scales at 6, 12, 24, and 36 months, and cognitive, motor and behavioral outcomes using the Movement Assessment Battery for Children and the Child Behavior Checklist for Ages 1.5–5 at 4 years of age.
Preterm children born VLBW manifested three cognitive patterns (stably normal [64.0 %], deteriorating [31.4 %], and persistently delayed [4.6 %]) and four motor patterns (above average [6.3 %], stably normal [60.0 %], deteriorating [28.5 %], and persistently delayed [5.2 %]) during 6–36 months. Low birth body weight, stage III-IV retinopathy of prematurity and low parental socio-economic status were associated with the deteriorating patterns; prolonged hospitalization and major brain damage were additionally associated with the persistently delayed patterns. Furthermore, the cognitive and motor deteriorating pattern was each predictive of cognitive and motor impairment at 4 years of age; whereas, the persistently delayed patterns were predictive of multiple impairments.
Preterm children born VLBW display heterogeneous trajectories in early cognitive and motor development that predict subsequent developmental and behavioral outcomes.
Validity of an early parent-report questionnaire for language disorder in very preterm children from 2 to 10 years of age
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Language problems at an early age in very preterm (VP) children can have a detrimental effect on other developmental domains and often persist throughout childhood. The aim of this study was to examine the concurrent and predictive validity of an early language parent-report questionnaire for language disorder in VP children from 2 to 10 years of age.
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The Lexi-list showed acceptable concurrent validity for word production scores obtained at age 2 CA. The predictive validity was good for sentence production and acceptable for word production scores obtained at age 4, and low for language production scores obtained at age 10. A Lexi-list cut-off score of <85 (i.e., <-1 SD) was found optimal.
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Does preterm birth increase a child's risk for language impairment?

Abstract

Background

Method

Results

Conclusion

Section snippets

Participants

Results

Discussion

Conflict of interest statement

Acknowledgements

J Commun Disord

Early Hum Dev

J Am Acc Child Adol Psych

J Commun Disord

Early Hum Dev

Cognitive and behavioural outcomes of school-aged children who were born preterm. A metaanalysis

JAMA

The development of Italian low- and very-low-birthweight infants from birth to 5 years: the role of biological and social risks

Inter J Beh Dev

Educational and behavioural problems in babies of 32-35 weeks gestation

Arch Dis Child Fetal Neonatal Ed

Learning disability, attention deficit disorder and language impairment as outcomes of prematurity: a longitudinal study

J Learn Disabil

Criteria for determining disability in infants and children: low birth weight

Late language emergence at 24 months: an epidemiological study of prevalence, predictors, and covariates

J Speech Lang Hear Res

A longitudinal investigation of reading outcomes in children with language impairments

J Speech Lang Hear Res

Reading trajectories of children with specific language impairment from preschool through fifth grade

Lang Speech Hear Serv Sch

Tracking children from poverty at risk for specific language impairment: a 3-year longitudinal study

J Speech Lang Hear Res

The socioemotional behaviors of children with SLI: social adaptation or social deviance?

J Speech Lang Hear Res

Short-term memory and language outcomes after extreme prematurity at birth

J Speech Lang Hear Res

Language development in very low birth weight preterm children: a follow-up study

Folia Phoniatr Logop

Size and composition of the lexicon in prematurely born very-low-birth-weight and fullterm Finnish children at two years of age

J Child Lang

Early relations between lexical and grammatical development in very immature Italian preterms

J Child Lang

Influence of preterm birth on early lexical and grammatical acquisition

First Lang

Early delayed language development in very preterm infants: evidence from the MacArthur–Bates CDI

J Child Lang

Reynell developmental language scales

Utility of the Macarthur–Bates Communicative Development Inventory in identifying language abilities of late-talking and typically developing toddlers

Am J Speech Lang Pathol