Predicting the outcome of specific language impairment at five years of age through early developmental assessment in preterm infants

Patricia L Woods; Ingrid Rieger; Crista Wocadlo; Adrienne Gordon

doi:10.1016/j.earlhumdev.2014.07.010

Predicting the outcome of specific language impairment at five years of age through early developmental assessment in preterm infants

Early Hum Dev. 2014 Oct;90(10):613-9. doi: 10.1016/j.earlhumdev.2014.07.010. Epub 2014 Aug 20.

Authors

Patricia L Woods¹, Ingrid Rieger², Crista Wocadlo³, Adrienne Gordon²

Affiliations

¹ Centre for Newborn Care, Royal Prince Alfred Hospital for Mothers and Babies, Sydney, NSW 2050, Australia. Electronic address: patricia.woods@sswahs.nsw.gov.au.
² Centre for Newborn Care, Royal Prince Alfred Hospital for Mothers and Babies, Sydney, NSW 2050, Australia; The University of Sydney, NSW 2006, Australia.
³ Centre for Newborn Care, Royal Prince Alfred Hospital for Mothers and Babies, Sydney, NSW 2050, Australia.

PMID: 25239156
DOI: 10.1016/j.earlhumdev.2014.07.010

Abstract

Background: Very preterm infants (<30 weeks of gestation) are at increased risk of specific language impairment and systematic developmental follow-up is essential for the provision of targeted early intervention.

Aims: To define the predictive value of early language testing and stability of language development, and perinatal and demographic risk factors for the diagnosis of SLI at 5 years, in a cohort of preterm infants.

Study design: We used a retrospective hospital based cohort study.

Subjects: Preterm infants <30 weeks of gestation, were cared for in NICU at RPAH, between 2004 and 2007, and prospectively enrolled in developmental follow-up. Standardised developmental assessment was done at 3 years utilising the Bayley Scales of Infant and Toddler Development-III and the Wechsler Preschool and Primary Scale of Intelligence-III was done at 5 years.

Outcome measures: Predictive value and stability of early language testing were assessed with respect to SLI at 5 years, using measures of diagnostic accuracy and kappa values. Multivariate logistic regression was performed during the distribution of perinatal and demographic risk factors for SLI.

Results: One-in-five met diagnostic criteria for SLI (19%, n=24). Limited diagnostic accuracy was found with early expressive language and the stability of language scores demonstrated only fair agreement (Cohen's κ .383). Multilingual status and extreme gestational age at 24-25 weeks were associated with a six-fold increased risk of SLI (OR 6.09, 95% CI 1.89-19.56; OR 6.09, 95% CI 1.28-29.0).

Conclusion: We defined a high incidence of SLI among our cohort, but only a limited diagnostic accuracy of early language testing. Multilingual status and extreme prematurity were independent risk factors for SLI. It remains imperative to perform continued developmental assessments beyond pre-school age to identify language impairment with greater accuracy.

Keywords: Developmental follow-up; Neonatal long term outcomes; Preterm infants.

MeSH terms

Child, Preschool
Cohort Studies
Humans
Infant, Extremely Premature / growth & development*
Language Development*
Language Disorders / diagnosis*
Logistic Models
New South Wales
Predictive Value of Tests
Retrospective Studies
Risk Factors