Derbie, A. Y., Tamm, L., Kline-Fath, B., Li, H., Harpster, K., Merhar, S. L., … & Parikh, N. A. (2025). Diffuse white matter abnormality is independently predictive of neurodevelopmental outcomes in preterm infants. Archives of Disease in Childhood-Fetal and Neonatal Edition Early View https://doi.org/10.1136/archdischild-2025-328635
This multicentre prospective cohort study evaluated diffuse white matter abnormality (DWMA) in 392 preterm infants (≤32 weeks’ gestation) at term – equivalent age as an independent predictor of neurodevelopmental outcomes in infants born preterm. MRI examinations were completed, along with cognitive function measures at 3 years corrected age using the Differential Ability Scales-II General Conceptual Ability (GCA) score. In addition, the Bayley III and the GMFCS were implemented. Higher DWMA volume independently predicted lower cognitive and motor scores with increased risk of cerebral palsy after controlling for socioeconomic factors. Concluding comments suggest that DWMA quantification predicts multiple developmental outcomes at 3 years corrected age in infants born preterm. Suggestions include the necessity for targeted interventions to improve long-term outcomes.
Fraser, A., Griffiths, N., & Webb, A. (2023). Why reading matters. The development of a read-a-thon for neonatal intensive care units to encourage neonatal exposure to language. Journal of Neonatal Nursing, 29(5), 704-708 https://doi.org/10.1016/j.jnn.2023.02.003
The Australian authors of this paper acknowledge that the neonatal environment can be emotionally overwhelming for parents and families as well as noisy. Using language through reading can support parent – infant attachment and give parents a specific purpose in developing early interaction skills. A Read-a-Thon was set up whereby parents were provided with reading materials to enable them to access materials to enable reading time with their baby. Parent interviews were undertaken before the Read-a-Thon had been set up with follow-up interviews once parents had been involved in developing a reading routine with their baby. It was noted that with support and relevant materials, parents doubled the amount of time that they read to their babies. Barriers included not being able to hold an infant comfortably and read simultaneously as well as a lack of privacy.
Provera, A., Neri, E., & Agostini, F. (2024, February). Infant-Directed Speech to Preterm Infants during the First Year Postpartum: The Influence of Preterm Birth Weight and Maternal Parenting Stress. In Healthcare, 12(3), 401). https://doi.org/10.3390/healthcare12030401
This paper investigated infant – directed speech used by mothers of extremely low birth weight and very low birth weight infants in the first year of life. One hundred infant – parent dyads were investigated, comprising of 30 extremely low birth weight dyads, 30 very low birth weight dyads and 40 term infant dyads. The authors were particularly interested in the potential impact of maternal stress in relation to having experienced a preterm birth and the subsequent impact on interaction. Language analysis used the Child Language Data System (CHILDES) that provides a standardised format for computerised transcriptions of face-to-face exchanges. In addition, parenting stress was assessed using the Parenting Index -Short Form. Findings showed that at 3 months, high-risk birth conditions were associated with high levels of parent stress and language use that included reduced affect-salient speech and increased questioning. This pattern appeared to reduce at 9 months of age for all groups. Overall, low birth weight and preterm birth are risk factors for developing less facilitative language styles.
Monson, B. B., Ambrose, S. E., Gaede, C., & Rollo, D. (2023). Language exposure for preterm infants is reduced relative to fetuses. The Journal of Pediatrics, 262, 113344 https://doi.org/10.1016/j.jpeds.2022.12.042
The aims of this study were to examine the differences in language exposure consequent to preterm birth and neonatal intensive care unit settings compared with the language exposures of in-utero typically developing foetuses pre-birth. Over 23,000 hours of auditory exposure in a group of 27 typically developing foetuses compared with 24 infants born preterm were analysed. Outcomes revealed that foetuses were exposed to five times more predominantly female language (2.6 ±1.8 hours a day) compared with infants born preterm (32±12 minutes a day). In addition, infants born preterm experienced much greater daily exposure to a range of electronic sounds (5.1±2.5 vs 1.3±0.6 hours; P < .001) and noise (4.4 ± 2.1 vs 2.9 ± 2.8 hours; P < .05) with 4.7 ± 3.9 hours/day of silence. This study concludes that some preterm infants may incur deficits of over 150 hours of language exposure which the authors describe as alarming.
Nascimento, T. F., Bocchi, S. C. M., Trenado, R. M., Cerezo, M. A., & Jensen, R. (2023). Instruments to measure interaction of mothers and newborns: A systematic review. Infant Behavior and Development, 71, 101825 https://doi.org/10.1016/j.infbeh.2023.101825
Parent – infant interactions are often evaluated to understand early language and communication development and so that necessary support and advice can be given to enable the development of language rich communication environments. There are a number of tools to assess parent – infant interaction and this systematic review presents important information about the variety of scales and observational coding used to describe these interactions in the literature. The authors considered the psychometric properties of the fourteen assessment tools examined. Such tools are frequently used to predict risk behaviours, investigate interactions during challenging exchanges such as feeding times as well as observing mother-newborn neurobehavioral interactions. Only two of the cited assessment instruments reported content, construct and criterion validity as well as descriptions of internal consistency assessment and inter-rater reliability. As speech, language and communication development of infants born preterm is of significant concern, considering appropriate and robust tools to observe early infant-parent interaction so that constructive and supportive advice can be given is of the utmost importance.
Nelson, P. M., Scheiber, F., Demir-Lira, Ö. E., & Harmon, H. M. (2025). Early medical risks to language development in extremely preterm infants. Journal of Perinatology, 45(3), 378-385 https://doi.org/10.1038/s41372-024-02191-z
This study involved a secondary analysis on extremely preterm infants born at one tertiary care provision. It sought to investigate whether neonatal morbidities had an association between gestational age and language skills at 18 – 26 months corrected age. A total of 475 extremely preterm infants were included in the data analysis. The Bayley III Language and Communication scales were used to measure outcomes but children with identifiable severe and complex needs were excluded (the Bayley Language and Communication Scales are not typically a useful measure for identification od specific language and communication difficulties). Infants born at 25-26 weeks (N = 298) had better expressive language, receptive language, composite language and cognitive skills compared with infants born at 22-24 weeks (N = 177). The authors conclude that families of extremely preterm infants under 25 weeks including infants who experienced ROP and / or grade 2/3 BPD should receive help and support about how to develop speech, language and communication skills. In addition, the authors suggest that intervention should be provided to help mitigate some of the risks including speech and language therapy.
Novitskiy, N., Chan, P. H., Chan, M., Lai, C. M., Leung, T. Y., Leung, T. F., … & Wong, P. C. (2023). Deficits in neural encoding of speech in preterm infants. Developmental Cognitive Neuroscience, 61, 101259 https://doi.org/10.1016/j.dcn.2023.101259
The authors of this paper argue that brain development studies of children born preterm focus mainly on vascular and gross anatomical characteristics rather than more subtle pathophysiological processes that may identify more subtle developmental problems. They suggest that use of Electroencephalogram (EEG) recordings and Frequency Following Response (FFR) measures that examine neural encoding of speech can be predictive of future language development. This study compared EEG and FFR measures of 45 preterm (≤34 weeks of gestation) and 45 term infants 0 -12 months of (corrected) age during natural sleep. All infants lived in Chinese speaking family environments. Findings suggest that infants born preterm experience significant interruption of neural encoding of speech compared with typically developing term infants. Speculation as to these outcomes relative to synaptogenesis and myelination for preterm infants is made with the suggestion that pathological changes within neurological architecture and lead to hypomyelination. Screening for potential language difficulties is a suggested outcome in relation to the study findings, but no examples of preventative methods on the neonatal unit are mentioned.
Sanchez, K., Boyce, J. O., Mei, C., St John, M., Smith, J., Leembruggen, L., … & Morgan, A. T. (2020). Communication in children born very preterm: A prospective cohort study. Developmental Medicine & Child Neurology, 62(4), 506-512. doi.org/10.1111/dmcn.14360
Aim: To compare language, speech, and voice of children born preterm and at term, and determine relevant predictors of outcome.
Method: Three hundred infants (150 males, 150 females; 149 born at <30wks’ gestation, 151 term-born) were prospectively recruited at birth from the Royal Women’s Hospital. We administered the Preschool Language Scales, Fifth Edition, Diagnostic Evaluation of Articulation and Phonology, Grade Roughness Breathiness Asthenia Strain Scale, and Pediatric Voice Handicap Index at 3 years, and compared groups. We examined hypothesized predictors in children born preterm: gestational age at birth, birthweight, sex, chronic lung disease, high social risk, multilingualism, neurodevelopmental diagnosis, and oromotor feeding. Results: Children born preterm had poorer language than children born at term (coefficient −5.43). Speech and voice were similar between groups (coefficients −0.70 to 1.63). Chronic lung disease predicted voice (coefficient 6.05); male sex (coefficients 4.54–6.18), high social risk (coefficient −6.02 to −9.30), and neurodevelopmental diagnosis (coefficients −16.42 to −20.61) predicted language. Interpretation: Children born before 30 weeks’ gestation had poorer language than children born at term. Children born preterm with neurodevelopmental disabilities or high social risk experience poorer language outcomes and would benefit from enrichment of their language environment.
What this paper adds- Speech and voice outcomes were similar between children born preterm and at term / Male sex, high social risk, and neurodevelopmental diagnosis predicted language outcomes.
Ståhlberg‐Forsén, E., Latva, R., Aija, A., Lehtonen, L., & Stolt, S. (2023). Language environment and parent‐infant close contact in neonatal care and emerging lexical abilities of very preterm children–a longitudinal study. Acta Paediatrica, 112(4), 659-666 https://doi.org/10.1111/apa.16647
This longitudinal study investigated the association between language environment for 43 infants born <32 weeks gestation on a neonatal unit and parent – infant closeness and contact on the neonatal unit and on follow-up at 15- and 18-months corrected age. Parent – infant communication exchanges were measured using the Language Environment Analysis System (LENA). This system analyses number of words used by an adult, conversational turns and child vocalisations. Parental closeness diaries were used on the neonatal unit to report holding and skin – to- skin time. At 25-and 18-months corrected age, child lexical development was measured, and a novel eye tracking approach to measure receptive language processing was assessed at 18 months. It was interesting to note that there was a positive correlation between parent – infant close contact and lexical development of infants. The authors state that conversational turn -taking and close contact were important for lexical development. However, the authors state that high numbers of overheard words (which are not infant directed) in the neonatal unit impacted on the child’s developing lexical processing skills. The paper suggests consideration needs to be given to managing the communication environment in a neonatal unit, and that talking near an infant when not directed at it may influence how language processing skills develop.
Strandberg, E., Lieberman, M., & Lohmander, A. (2024). Babbling in extremely premature infants at 12 months corrected age. Clinical Linguistics & Phonetics, 38(1), 82-96 https://doi.org/10.1080/02699206.2022.2160658
The importance of developmental babbling as a necessary precursor to speech in early language development is investigated in this Swedish cross-sectional study. Samples of babbling were collected in homes via audio-recordings from a group of 20 infants born extremely preterm at the corrected age of 12 months. Specifically, the researchers wanted to identify the presence of canonical babbling, three oral stop variables distinctive of typical babbling and overall consonant attempts. Data obtained were compared with a group (N = 20) of typically developing 10-month-old infants. The extremely preterm group produced a significantly smaller consonant range with fewer examples of canonical babbling. Oral stops were less frequently found in the extremely preterm group although this finding was not significant. It is known that difficulties with babbling and the development of less typical babbling patterns can suggest that speech, language and communication development may be challenging. However, it is still not clear if babbling at 12 months can predict likely speech and language development in extremely preterm infants.
Suttora, C., Guarini, A., Zuccarini, M., Aceti, A., Corvaglia, L., & Sansavini, A. (2020). Speech and language skills of low-risk preterm and full-term late talkers: The role of child factors and parent input. International Journal of Environmental Research and Public Health, 17(20), 7684 https://doi.org/10.3390/ijerph17207684
This study acknowledges the increased risks of speech, language and communication problems for children who have been born preterm. Detailed analysis if child-speech during parent – infant talking when book-sharing was undertaken (61 late talkers aged 30 months old, 26 of whom were low-risk children born preterm and 35 children who were born term). In addition, parent perspectives of their child’s linguistic skills were gained using the MacArthur Bates Communication Development Inventories (MB-CDI -Short Form). The children who were born low-risk preterm and the full-term late talkers displayed similar developmental speech and language skills. Interestingly, no differences were found in the parent-language styles / language use between the two groups. Cognitive skills and abilities, chronological age and low-risk birth history were positively associated with vocabulary range and speech production, whereas family history for language and /or learning problems as well as parent vocabulary range, rate of language delivery and complexity of grammar during interactions were negatively associated with child variables. Parents of the late talkers failed to adjust their communication to support their child, e.g. range of words used, and grammatical complexity. The authors suggest that interventions to support parent language and communication input for both types of groups are important in the promotion of an enjoyable and positive language learning environments. Provision of support for parents as to the type of language and communication dynamic to use when interacting with children who require language support is essential.
Varela-Moraga, V., Diethelm-Varela, B., & Pérez-Pereira, M. (2023). Effect of biomedical complications on very and extremely preterm children’s language. Frontiers in Psychology, 14, 1163252 https://doi.org/10.3389/fpsyg.2023.1163252
This study conducted in Chile investigated use of words, sentence structure complexity and mean length of utterance of three groups of children aged 24 months of age (of which children born preterm were included at 24 months corrected age). The full-term infant group included 42 children, the second group included 60 children born preterm below 32 weeks without significant medical complications (i.e. BPD, IVH, PVL) and the third group comprised of 64 children born preterm below 32 weeks gestation with additional medical complications. Language was assessed using the Communicative Development Inventories (CDI) and other developmental skills were assessed using the Ages and Stages Questionnaire (ASQ-3). Unsurprisingly, the two groups that included children born preterm had significantly lower language measures compared with the children born term. Specifically, the children born preterm who had additional medical complications had the lowest scores. No significant differences between the groups were observed in gross-motor, fine-motor and problem-solving areas of the ASQ-3. The authors conclude that language development is seriously impacted by very or extremely low gestational age.
