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Motor, Cognitive, and Language Development in Preterm Infants: A Systematic Review with Meta-analysis
Sany Fernandes1, Nadia C Valentini2, Lucia Andreis1
1Department of Human Movement Sciences, Santa Catarina State University, Florianópolis, Brazil.
Insights
Preterm infants face significant risks of early neurodevelopmental delays, especially those born extremely preterm. Early monitoring and intervention are crucial for this vulnerable pediatric population.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Public Health
Background:
- Preterm birth increases the risk of early neurodevelopmental difficulties.
- Prevalence of these delays varies significantly based on prematurity levels.
- Systematic review needed to consolidate prevalence data.
Purpose of the Study:
- To estimate the prevalence of motor, language, and cognitive delays in preterm infants.
- To analyze prevalence based on the degree of prematurity.
- To provide data supporting early developmental surveillance.
Main Methods:
- Systematic review following PRISMA guidelines, registered in PROSPERO.
- Searched PubMed, VHL, SciELO, Scopus, Embase (Jan 2012-Feb 2023).
- Meta-analyses of cohort/cross-sectional studies using Bayley Scales, Brunet-Lézine, or Denver Developmental Screening Test.
Main Results:
- Pooled prevalence of mild delays: language (22.73%), motor (18.15%), cognitive (11.90%).
- Significant delays were less common.
- Extremely preterm infants exhibited the highest prevalence, particularly for mild motor and language delays.
Conclusions:
- Preterm infants, especially extremely preterm, have a high prevalence of neurodevelopmental delays in early life.
- Findings underscore the need for early developmental surveillance and targeted interventions.
- Pooled estimates require cautious interpretation due to observed heterogeneity.
Introduction/Objective:
Preterm birth is associated with an increased risk of early neurodevelopmental difficulties, but reported prevalence varies widely across studies and across degrees of prematurity. This review aimed to estimate the prevalence of motor, language, and cognitive delays in preterm infants according to the degree of prematurity.
Methods:
This review followed the PRISMA guidelines and was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42021252388). PubMed, VHL, SciELO, Scopus, and Embase were searched for cohort and cross-sectional studies published from January 2012 to February 2023 in English, Portuguese, or Spanish. Eligible studies evaluated preterm infants from birth to 24 months of corrected age using the Bayley Scales of Infant and Toddler Development (BSID/BSITD), the Brunet-Lézine Scale, or the Denver Developmental Screening Test. Randomeffects proportional meta-analyses using the Freeman-Tukey double-arcsine transformation were conducted to estimate the prevalence of mild and significant motor, language, and cognitive delays.
Results:
Twenty-two studies were included, and pooled analyses included 2,958-3,258 infants, depending on the outcome. The Bayley Scales were used in all included studies, whereas the Brunet- Lezine and Denver instruments were each reported in one study in combination with the Bayley. The pooled prevalence of mild delays was highest for language (22.73%; 95% CI: 13.92-32.93), followed by motor (18.15%; 95% CI: 10.72-26.91) and cognitive (11.90%; 95% CI: 5.80-19.71) domains. Significant delays were less frequent overall. Extremely preterm infants showed the highest prevalence across domains, especially for mild motor and language delays.
Discussion:
Considerable heterogeneity was observed across analyses, likely reflecting differences in assessment age, Bayley edition, clinical profiles, and study settings. Therefore, pooled estimates should be interpreted with caution.
Conclusion:
Preterm infants, particularly those born extremely preterm, present a substantial prevalence of neurodevelopmental delays during the first two years of life. These findings support early developmental surveillance, timely referral, and targeted intervention in this high-risk paediatric population.
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