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Early medical risks to language development in extremely preterm infants
Paige M Nelson1, Francesca Scheiber2, Ö Ece Demir-Lira2
1Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA. paige-nelson@uiowa.edu.
Insights
Neonatal morbidities like bronchopulmonary dysplasia significantly impact language development in extremely preterm infants. Early intervention is crucial for infants born before 25 weeks, especially those with retinopathy of prematurity or severe BPD.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Speech-Language Pathology
Background:
- Extremely preterm (EP) infants face significant risks for neurodevelopmental deficits.
- Language development is a key area of concern for EP infants.
- Understanding the mechanisms linking prematurity to language outcomes is critical.
Purpose of the Study:
- To investigate the role of neonatal morbidities in mediating the relationship between gestational age and language performance in EP infants.
- To identify specific morbidities that influence language outcomes.
- To inform targeted interventions for EP infants at high risk for language impairment.
Main Methods:
- Secondary analysis of data from extremely preterm infants (born <25 weeks gestation) at a tertiary care center.
- Assessment of language performance (expressive, receptive, composite) and cognition at 18-26 months corrected age.
- Mediation analysis to examine the role of neonatal morbidities (e.g., retinopathy of prematurity, bronchopulmonary dysplasia) in the gestational age-language association.
Main Results:
- Infants born at 25-26 weeks gestation demonstrated better language and cognitive outcomes than those born at 22-24 weeks.
- Retinopathy of prematurity (ROP) and severe bronchopulmonary dysplasia (BPD) partially mediated the effect of gestational age on language skills.
- Infants born earlier (22-24 weeks) had higher rates of severe BPD, leading to poorer cognitive and language outcomes.
Conclusions:
- Gestational age significantly impacts language development in EP infants.
- Neonatal morbidities, particularly ROP and severe BPD, play a mechanistic role in this relationship.
- Families of infants born before 25 weeks or with ROP/severe BPD require counseling regarding elevated language impairment risk and proactive support.
Objective:
To study the mechanistic role of neonatal morbidities on language performance in extremely preterm (EP) infants.
Study Design:
We conducted secondary analyses on EP infants born at a single tertiary care center, investigating whether neonatal morbidities mediated associations between gestational age and language performance at 18-26 months corrected age.
Results:
Infants born at 25-26 weeks (n = 298) outperformed those born at 22-24 weeks (n = 177) in expressive communication, receptive communication, composite language, and cognition. Retinopathy of prematurity (ROP), grade 2/3 bronchopulmonary dysplasia (BPD), and cognition partially explained gestational age effects on expressive and receptive communication. In the final sequential path models, infants born 22-24 weeks gestation were more likely to be diagnosed with grade 2/3 BPD, which was linked to diminished cognitive skills, and reduced language skills.
Conclusion:
Families of EP infants born under 25 weeks or with ROP and/or grade 2/3 BPD should be counseled about higher language impairment risk and receive proactive intervention.
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