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Language outcomes at 36 months in prematurely born children is associated with the quality of developmental care in NICUs

Journal of Perinatology volume 36, pages 768–774 (2016)Cite this article

Subjects

Abstract

Objective:

The aim of this study was to examine the relationship between the quality levels of NICU developmental care (DC) and language skills at 36 months in very preterm (VPT) children.

Study Design:

Language skills of 78 VPT children from 19 NICUs and 90 full-term controls was assessed using a standardized language test. We compared children’ language task performance by splitting NICUs into units with high- and low-quality of DC according to two main factors: (1) infant centered care (ICC), and (2) infant pain management (IPM).

Results:

VPT children from low-care units with respect to ICC obtained lower scores in sentence comprehension, compared to children from high-care units. No differences were found between preterm children from high-quality ICC NICUs and full-term children.

Conclusions:

Findings suggest that higher quality of DC related to infant centered care can mitigate delays in language skills at 36 months in children born VPT.

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References

  1. Potijk MR, de Winter AF, Bos AF, Kerstjens JM, Reijneveld SA . Higher rates of behavioural and emotional problems at preschool age in children born moderately preterm. Arch Dis Child 2012; 97: 112–117.

    Article  Google Scholar 

  2. Sansavini A, Guarini A, Savini S, Broccoli S, Justice L, Rosina A et al. Longitudinal trajectories of gestural and linguistic abilities in very preterm infants in the second year of life. Neuropsychologia 2011; 49: 3677–3688.

    Article  Google Scholar 

  3. Foster-Cohen S, Edgin JO, Champion PR, Woodward LJ . Early delayed language development in very preterm infants: evidence from the MacArthur-Bates CDI. J Child Lang 2007; 34: 655–675.

    Article  Google Scholar 

  4. Jansson-Verkasalo E, Valkama M, Vainionpää L, Pääkkö E, llkko E et al. Language development in very low birth weight preterm children: a follow-up study. Folia Phoniatr Logop 2004; 56: 108–119.

    Article  CAS  Google Scholar 

  5. Luoma L, Herrgård E, Martikainen A, Ahonen A . Speech and language development of children born at 32 weeks' gestation: a 5 year prospective follow-up. Dev Med Child Neurol 1998; 40: 380–387.

    Article  CAS  Google Scholar 

  6. Sansavini A, Guarini A, Alessandroni R, Faldella G, Giovanelli G, Salvioli GP . Early relations between lexical and grammatical development in very immature Italian preterms. J Child Lang 2006; 33: 199–216.

    Article  Google Scholar 

  7. Stolt S, Klippi A, Launonen K, Munck P, Lehtonen L, Lapinleimu H et al. 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 2007; 34: 283–310.

    Article  Google Scholar 

  8. Guarini A, Sansavini A, Fabbri C, Alessandroni R, Faldella G, Karmiloff-Smith A . Reconsidering the impact of preterm birth on language outcome. Early Hum Dev 2009; 85 (10): 639–645.

    Article  Google Scholar 

  9. Beek, van Y, Hopkins B, Hoeksma GB . The development of communication in preterm infant–mother dyads. Behaviour 1994; 129: 35–61.

    Article  Google Scholar 

  10. Reissland N, Stephenson T . Turn-taking in early vocal interaction: a comparison of premature and term infants' vocal interaction with their mothers. Child Care Health Dev 1999; 25: 447–456.

    Article  CAS  Google Scholar 

  11. Esteban F, Padilla N, Sanz-Cortés M, de Miras JR, Bargalló N, Villoslada P et al. Fractal-dimension analysis detects cerebral changes in preterm infants with and without intrauterine growth restriction. Neuroimage 2010; 53 (4): 1225–1232.

    Article  Google Scholar 

  12. Vanderveen JA, Bassler D, Robertson CMT, Kirpalani H . Early interventions involving parents to improve neurodevelopmental outcomes of premature infants: a meta-analysis. J Perinatol 2009; 29 (5): 343–351.

    Article  CAS  Google Scholar 

  13. Als H, Gilkerson L, Duffy FH, McAnulty GB, Buehler DM, Vandenberg K et al. A three-center, randomized, controlled trial of individualized developmental care for very low birth weight preterm infants: medical, neurodevelopmental, parenting, and caregiving effects. J Dev Behav Pediatr 2003; 24 (6): 399–408.

    Article  Google Scholar 

  14. Milgrom J, Newnham C, Anderson PJ, Doyle LW, Gemmill AW, Lee K et al. Early sensitivity training for parents of preterm infants: impact on the developing brain. Pediatr Res 2010; 67 (3): 330–335.

    Article  Google Scholar 

  15. Reynolds LC, Duncan MM, Smith GC, Matur A, Neil J, Inder T et al. Parental presence and holding in the neonatal intensive care unit and associations with early neurobehavior. J Perinatol 2013; 33 (8): 636–641.

    Article  CAS  Google Scholar 

  16. Als H, Duffy FH, McAnulty G, Butler SC, Lightbody L, Kosta S et al. NIDCAP improves brain function and structure in preterm infants with severe intrauterine growth restriction. J Perinatol 2012; 32 (10): 797–803.

    Article  CAS  Google Scholar 

  17. Spittle A, Orton J, Anderson P, Boyd R, Doyle LW . Early developmental intervention programmes post-hospital discharge to prevent motor and cognitive impairments in preterm infants. Cochrane Database Syst Rev. 2015; 11: CD005495.

    Google Scholar 

  18. Als H, Duffy FH, McAnulty GB, Rivkin MJ, Vajapeyam S, Mulkern RV et al. Early experience alters brain function and structure. Pediatrics 2004; 113: 846–857.

    Article  Google Scholar 

  19. Symington A, Pinelli JM . Distilling the evidence on 13 developmental care: a systematic review. Adv Neonatal Care 2002; 2: 198–22.

    Article  Google Scholar 

  20. Coughlin M, Gibbins S, Hoath S . Core measures for developmentally supportive care in neonatal intensive care units: Theory, precedence and practice. J Adv Nurs 2009; 65: 2239–2248.

    Article  Google Scholar 

  21. Als H . Program Guide: Newborn Individualized Developmental Care and Assessment Program (NIDCAP): An Education and Training Program for Health Care Professionals. Boston, MA: NIDCAP Federation International 2011.

  22. Altimier L, Kenner C, Damus K . The Wee Care Neuroprotective NICU Program (Wee Care): The Effect of a Comprehensive Developmental Care Training Program on Seven Neuroprotective Core Measures for Family-Centered Developmental Care of Premature Neonates. Newborn Infant Nurs Rev 2015; 15: 6–16 21.

    Article  Google Scholar 

  23. Byers JF . Components of developmental care and the evidence for their use in the NICU. MCN Am J Matern Child Nurs 2003; 28: 174–180.

    Article  Google Scholar 

  24. Ashbaugh JB, Leick-Rude MK, Kilbride HW . Developmental care teams in the neonatal intensive care unit: Survey on current status. J Perinatol 1999; 19: 48–52.

    Article  CAS  Google Scholar 

  25. Greisen G, Mirante N, Haumont D, Pierrat V, Pallas-Alonso CR, Warren I . Parents, siblings and grandparents in the neonatal intensive care unit. A survey of policies in eight European countries. Acta Paediatr 2009; 98: 1744–1750.

    Article  Google Scholar 

  26. Bonet M, Marchand L, Kaminski M, Fohran A, Betoko A, Charles MA EDEN Mother-Child Cohort Study Group. Breastfeeding duration, social and occupational characteristics of mothers in the French 'EDEN mother-child' cohort. Matern Child Health J 2013; 17: 714–722.

    Article  Google Scholar 

  27. Losacco V, Cuttini M, Greisen G, Haumont D, Pallás-Alonso CR, Pierrat V et al. Heel blood sampling in European neonatal intensive care units: Compliance with pain management guidelines. Arch Dis Child Fetal Neonatal Ed 2011; 96: F65–F68.

    PubMed  Google Scholar 

  28. Montirosso R, Del Prete A, Bellù R, Tronick E, Borgatti R, NEO-ACQUA Study Group. Level of NICU quality of developmental care and neurobehavioral performance in very preterm infants. Pediatrics 2012; 129: e1129–e1137.

    Article  Google Scholar 

  29. Montirosso R, Casini E, Del Prete A, Zanini R, Bellù R, Borgatti R, NEO-ACQUA Study Group. Neonatal developmental care in infant pain management and internalizing behaviours at 18 months in prematurely born children. Eur J Pain 2016 (advance online publication 5 February 2016; doi:10.1002/ejp.826).

  30. Paulson JF, Keefe HA, Leiferman JA . Early parental depression and child language development. J Child Psychol Psychiatry 2009; 50: 254–262.

    Article  Google Scholar 

  31. Pan BA, Rowe ML, Singer JD, Snow CE . Maternal correlates of growth in toddler vocabulary production in low-income families. Child Dev 2005; 76: 763–782.

    PubMed  Google Scholar 

  32. Kaiser AP, Hancock TB, Cai X, Foster EM, Hester PP . Parent-reported behavioral problems and language delays in boys and girls enrolled in head start classrooms. Behav Disord 2000; 26: 26–41.

    Article  Google Scholar 

  33. Benner GJ, Nelson JR, Epstein MH . Language skills of children with EBD. A literature review. J Emot Behave Disord 2002; 10 (1): 43–56.

    Article  Google Scholar 

  34. Montirosso R, Provenzi L, Calciolari C, Borgatti R, NEO-ACQUA Study Group. Measuring maternal stress and perceived support in 25 Italian NICUs. Acta Paediatr 2011; 101: 136–142.

    Article  Google Scholar 

  35. Montirosso R, Fedeli C, Del Prete A, Calciolari G, Borgatti R, NEO-ACQUA Study Group. Maternal stress and depressive symptoms associated with quality of developmental care in 25 Italian NICUs: a cross sectional observational study. Int J Nurs Stud 2014; 51: 994–1002.

    Article  Google Scholar 

  36. Landry SH, Smith KE, Miller-Locar CL, Swank PR . Predicting cognitive-language and social growth curves from early maternal behaviors in children at varying degrees of biological risk. Dev psychol. 1997; 33 (6): 1040–1053.

  37. Zupancic JAF, Richardson DK, Horbar JD, Carpenter JH, Lee SK, Escobar GJ et al. Revalidation of the score for neonatal acute physiology in the Vermont oxford network. Pediatrics 2007; 119: 156–163.

    Article  Google Scholar 

  38. Hollingshead AB . Four Factor Index of Social Status. Yale University: New Haven CT, 1978.

    Google Scholar 

  39. Ciachetti C, Sannio Fancello G . Test TVL. Test di valutazione del linguaggio. Livello prescolare. Edizioni Erikson: Trento, 1997.

    Google Scholar 

  40. Achenbach TM, Ruffle TM . The Child Behavior Checklist and related forms for assessing behavioral/emotional problems and competencies. Pediatr Rev 2000; 21: 265–271.

    Article  CAS  Google Scholar 

  41. Frigerio A, Cozzi P, Pastore V, Molteni M, Borgatti R, Montirosso R . La valutazione dei problemi emotivo comportamentali in un campione italiano di bambini in età prescolare attraverso la Child Behavior Checklist e il Caregiver Teacher Report Form. Infanzia e adolescenza. 2006; 5, 1 24–37.

  42. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J . Reliability of psychiatric diagnosis. A study of consistency of clinical judgements and ratings. Am J Psychiatry 1962; 119: 351–357.

    Article  CAS  Google Scholar 

  43. O’Hara MW, Rehm LP, Campbell SB . Postpartum depression. A role for social network and life stress variables. J Nerv Ment Dis 1983; 171: 336–341.

    Article  Google Scholar 

  44. Sansavini A, Guarini A, Justice LM, Savini S, Broccoli S, Alessandroni R et al. Does preterm birth increase a child’s risk for language impairment? Early Hum Dev 2010; 86 (12): 765–772.

    Article  Google Scholar 

  45. Schmider E, Ziegler M, Danay E, Beyer L, Bühner M . Is it really robust? Methodology 2010; 6 (4): 147–151.

    Article  Google Scholar 

  46. Guarini A, Sansavini A, Fabbri C, Savini S, Alessandroni R, Faldella et al. Long-term effects of preterm birth on language and literacy at eight years. J Child Lang 2010; 37 (4): 865–885.

    Article  Google Scholar 

  47. Barre N, Morgan A, Doyle LW, Anderson PJ . Language abilities in children who were very preterm and/or very low birth weight: a meta-analysis. J Peds 2011; 158: 766–774.

    Article  Google Scholar 

  48. Caskey M, Stephens B, Tucker R, Vohr B . Adult talk in the NICU with preterm infants and developmental outcomes. Pediatrics 2014; 133 (3): e578–e584.

    Article  Google Scholar 

  49. Filippa M, Devouche E, Arioni C, Imberty M, Gratier M . Live maternal speech and singing have beneficial effects on hospitalized preterm infants. Acta Paediatr 2013; 102: 1017–1020.

    Article  Google Scholar 

  50. Short MA, Brooks-Brunn JA, Reeves DS, Yeager J, Thorpe JA . The effects of swaddling versus standard positioning on neuromuscular development in very low birth weight infants. Neonatal Netw 1996; 15 (4): 25–31.

    CAS  Google Scholar 

  51. Feldman R, Eidelman AI, Sirota L, Weller A . Comparison of skin-to-skin (kangaroo) and traditional care: parenting outcomes and preterm infant development. Pediatrics 2002; 110 (1): 16–26.

    Article  Google Scholar 

  52. Dixon WE Jr, Smith PH . Links between early temperament and language acquisition. Merrill-Palmer Quarterly 2000; 46: 417–440.

    Google Scholar 

  53. Stansbury K, Zimmermann LK . Relations among child language skills, maternal socialization of emotion regulation, and child behavior problems. Child Psychiatry Hum Dev 1999 Winter 30 (2): 121–142.

    Article  CAS  Google Scholar 

  54. Grunau RE, Haley DW, Whitfield MF, Weinberg J, Yu W, Thiessen P . Altered basal cortisol levels at 3, 6, 8 and 18 months in infants born at extremely low gestational age. J Pediatr 2007; 150: 151–156.

    Article  CAS  Google Scholar 

  55. Vinall J, Miller SP, Synnes AR, Grunau RE . Parent behaviors moderate the relationship between neonatal pain and internalizing behaviors at 18 months corrected age in children born very prematurely. Pain 2013; 154: 1831–1839.

    Article  Google Scholar 

  56. Fewtrell MS, Kennedy K, Singhal A, Martin RM, Ness A, Hadders-Algra M et al. How much loss to follow-up is acceptable in long-term randomised trials and prospective studies? Arch Dis Child 2008; 93 (6): 458–461.

    Article  Google Scholar 

  57. Iacoboni M . Mirroring People. Farrar, Straus and Giroux: New York, 2008.

    Google Scholar 

  58. Iverson JM . Developing language in a developing body: the relationship between motor development and language development. J Child Lang 2010; 37 (2): 229–261.

    Article  Google Scholar 

  59. Guarini A, Sansavini A, Fabbri C, Alessandroni R, Faldella G, Karmiloff-Smith A . Reconsidering the impact of preterm birth on language outcome. Early Hum Dev 2009; 85: 639–664.

    Article  Google Scholar 

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Acknowledgements

The NEO-ACQUA project was supported by an unrestricted educational grant from Chiesi Farmaceutici S.p.A. The authors wish to thank the NEO-ACQUA Study Advisory Board whose membership consisted of the following people: Roberto Bellù, Renato Borgatti, Alberto Del Prete, Guido Calciolari, Maria Caterina Cavallo, Rosario Montirosso, Rinaldo Zanini. Thanks go to the MediData Studi e Ricerche staff in Modena for their organizational, technical, scientific support. We are very grateful to the staff of all 19 participating units. We thank Erica Casini for her support in data analysis. We are grateful to Maria Gartstein for her remarks improving the quality of the English language. We would also like to thank participating children and their parents for their involvement in this study. Finally, we are deeply indebted to Zack Boukydis for useful comments and suggestions on all aspects of the text of the earlier draft. Sadly, he has passed away during the manuscript submission to the journal. This paper is in memory of Zack.

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Author notes

  1. The NEO-ACQUA Study Group are listed before Conflict of Interest statement.

Authors and Affiliations

  1. 0-3 Centre for the at-Risk Infant, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy

    R Montirosso & L Giusti

  2. Department of Neonatal Care and Neonatal Intensive Care Unit, Manzoni Hospital, Lecco, Italy

    A Del Prete, R Zanini & R Bellù

  3. Neuropsychiatry and Neurorehabilitation Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy

    R Borgatti

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  1. R Montirosso
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Correspondence to R Montirosso.

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Additional information

Fabio Mosca, Odoardo Picciolini, NICU, Department of Maternal and Pediatric Sciences, University of Milan Fondazione IRCCS Ca’ Granda, Milan, Italy; Stefano Visentin, Nadia Battajon, Neonatology and NICU, Ca' Foncello Hospital, Treviso, Italy; Maria Lucia Di Nunzio, Fiorina Ramacciato, NICU, Cardarelli Hospital, Campobasso, Italy; Laura Barberis, Emmanuele Mastretta, Division of Neonatology and NICU, S. Anna Hospital, Turin, Italy; Giovanna Carli, Michela Alfiero Bordigato, NICU, Hospital of Camposampiero, Camposampiero Italy; Valeria Chiandotto, Cristiana Boiti, Department of Neonatology, University Hospital S. M. M., Udine, Italy; Rosangela Litta, Giovanna Minelli, Division of Neonatology and NICU, Ospedali Riuniti, Foggia, Italy; Marcello Napolitano, NICU, Evangelic Hospital Villa Betania, Napoli, Italy; Alessandro Arco, NICU, University Hospital G. Martino, Messina, Italy; Palma Mammoliti, NICU, Ospedale degli Infermi, Rimini, Italy; Cinzia Fortini, NICU, Pediatric University Hospital, Ferrara, Italy; Paolo Tagliabue, Division of Neonatology, San Gerardo Hospital, Monza, Italy; Lorenzo Quartulli, NICU, Perrino Hospital, Brindisi, Italy; Giuliana Motta, NICU, Niguarda Hospital Ca' Granda, Milan, Italy; Paola Introvini, NICU, Buzzi Hospital, Milan, Italy; Rosetta Grigorio, NICU, Umberto I Hospital, Siracusa, Italy; Paola Mussini, NICU, C. Poma Hospital, Mantova, Italy; Giulia Pomero, NICU, Santa Croce e Carle Hospital, Cuneo, Italy; Carlo Poggiani, NICU, Istituti Ospitalieri, Cremona, Italy; Ananda Bauchiero, Department of Neonatology, S. Anna University Hospital, Turin, Italy.

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Montirosso, R., Giusti, L., Del Prete, A. et al. Language outcomes at 36 months in prematurely born children is associated with the quality of developmental care in NICUs. J Perinatol 36, 768–774 (2016). https://doi.org/10.1038/jp.2016.57

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