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Effect of ethnicity and race on cognitive and language testing at age 18-22 months in extremely preterm infants
Andrea Freeman Duncan1, Kristi L Watterberg, Tracy L Nolen
1University of New Mexico Health Sciences Center, Albuquerque, NM, USA. afduncan@salud.unm.edu
Insights
Race/ethnicity impacts language development in extremely preterm toddlers. While cognitive differences were explained by medical and social factors, lower language scores persisted in Black and Hispanic white toddlers, suggesting a need for targeted early intervention.
Area of Science:
- Neonatal research
- Developmental pediatrics
- Child psychology
Background:
- Extremely preterm infants (<28 weeks' gestation) are at high risk for developmental delays.
- The Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) is a key tool for assessing early development.
- Understanding how race/ethnicity influences these scores is crucial for equitable care.
Purpose of the Study:
- To investigate the association between race/ethnicity and cognitive and language outcomes.
- To analyze these relationships in extremely preterm toddlers using the Bayley-III.
- To identify potential disparities in developmental assessments.
Main Methods:
- A cohort study of extremely preterm toddlers (gestational age <28 weeks).
- Inclusion of three race/ethnic groups: white, black, and Hispanic white.
- Multivariate regression analysis adjusting for medical and psychosocial factors.
Main Results:
- Cognitive scores did not differ significantly among race/ethnic groups after adjustment.
- Language scores showed significant differences across groups, both before and after adjustment.
- White toddlers scored higher on language than Black and Hispanic white toddlers.
Conclusions:
- Medical and psychosocial factors explained cognitive score variations among racial/ethnic groups.
- Lower language scores in Black and Hispanic white toddlers persisted post-adjustment.
- Early intervention and targeted language assessments are recommended for at-risk minority children.
Objective:
To evaluate the relationship of race/ethnicity to Cognitive and Language scores on the Bayley Scales of Infant and Toddler Development, Third Edition in extremely preterm toddlers (<28 + 0 weeks' estimated gestational age).
Study Design:
This cohort study included extremely preterm toddlers seen at Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network centers evaluated at 18-22 months adjusted age from 3 race/ethnic groups (white, black, and Hispanic white). Multivariate regression modeling was used to identify race/ethnic differences, after adjusting for medical and psychosocial factors.
Results:
The study population comprised 369 whites, 352 blacks, and 144 Hispanic whites. Cognitive scores differed among the 3 groups on unadjusted analysis (P ≤ .001), but not after adjusting for medical and psychosocial factors (P = .13). Language scores differed on adjusted and unadjusted analyses. Whites scored higher than blacks and Hispanic whites, and blacks scored higher than Hispanic whites.
Conclusions:
A combination of medical variables and primary caretaker education accounted for differences in Bayley Scales of Infant and Toddler Development, Third Edition Cognitive scores among the 3 groups. Black and Hispanic white toddlers had lower Language scores than whites, even after adjustment. Early intervention should be targeted to these identified risk factors. Assessment of early language development in minority children may be warranted.
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