Risk Factors for cognitive, motor and language development of preterm children in the first year of life

Hass, Júlia Vicente; Panceri, Carolina; Procianoy, Renato Soibelmann; Silveira, Rita de Cássia; Valentini, Nadia Cristina

doi:10.1590/1984-0462/2023/41/2021165

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Revista Paulista de Pediatria

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Original Article • Rev. paul. pediatr. 41 • 2023 • https://doi.org/10.1590/1984-0462/2023/41/2021165 copy

Risk Factors for cognitive, motor and language development of preterm children in the first year of life

Fatores de risco para o desenvolvimento cognitivo, motor e de linguagem ao longo do primeiro ano de vida de crianças nascidas prematuras

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To perform a longitudinal investigation of risk factors in premature infants’ cognitive, motor, and language development.

Methods:

Thirty-three preterm infants were assessed at 4, 8, and 12 months of corrected age, using the Bayley-III Scales. Parents completed questionnaires regarding development opportunities at home, parenting practices and knowledge.

Results:

Significant associations were found (1) at 4-months between cognitive scores and family income, variety of stimuli, availability of toys, parenting practices and knowledge; language and parenting practices; and motor skills and parenting practices; (2) at 8-months between cognitive score and length of stay in the Neonatal Intensive Care Unit (NICU), gestational age, birth weight, toys, and parenting knowledge; language and toys; and motor skills and toys and parenting knowledge; (3) at 12-months between cognitive scores and length of stay in the NICU, family income, breastfeeding, toys, and parenting knowledge; language and income and toys; and motor scores and length of stay in the NICU, gestational age, income, stimuli, toys, and parenting knowledge. Regression analyses indicated that: for (1) cognitive development, stimulus variety explained 72% of the model variance at 4 months of age; time at the NICU explained 67 and 43% at 8 and 12 months of age, respectively, and breastfeeding time explained 41% of the model variance at 12 months; (2) for language development, family income explained 42% of the model variance at 12 months; and for motor development (3), time at the NICU explained 80% of the model variance at 12 months.

Conclusions:

The development over the first year of life is not explained by the severity of birth conditions and associated morbidities only, but also by parenting practices.

Keywords:
Preterm birth; Child development; Developmental disability

		n (%) or mean (SD)
Gender — n (%)	Male	23 (69.7)
Birth weight (g) — mean (SD)		1,053.4 (280.9)
Weight categorization — n (%)	Low	1 (3.0)
	Very low	18 (54.6)
	Extremely low	14 (42.4)
Gestational age in weeks — mean (SD)		28.6 (2.4)
Head circumference — mean (SD)		25.7 (2.5)
Apgar 5th minute — mean (SD)		7.5 (2.0)
NICU days — mean (SD)		70.9 (29.2)
Mechanical ventilation days — mean (SD)		5.0 (11.8)
Small for gestational age — n (%)		9 (27.3)
Early sepsis — n (%)		21 (63.6)
Late sepsis — n (%)		20 (60.6)
Antibiotic use in the NICU — n (%)		24 (72.7)
Seizures in the NICU — n (%)		5 (15.1)
Periventricular hemorrhage — n (%)	Absent	21 (63.6)
	Grade I	6 (18.2)
	Grade II	4 (12.1)
	Grade IV	2 (6.1)
Periventricular leukomalacia — in (%)		3 (9.1)
Changes in neurological examination — na (%)		6 (18.2)
Bronchopulmonary dysplasia — no (%)		6 (18.2)
Participation in intervention — n (%)	Monthly guidance for parents	15 (45.4)
	Weekly physical therapy	12 (36.4)
	No assistance	5 (15.2)
	No information	1 (3.0)
Family income (R$) — mean (SD)		2,672.1 (1,426.8)
Mother’s age — mean (SD)		28.9 (6.2)
Father’s age — mean (SD)		32.4 (8.6)
Mother’s education — n (%)	Incomplete elementary school	5 (15.2)
	Complete elementary school	6 (18.2)
	Incomplete high school	5 (15.2)
	Complete high school	11 (33.2)
	Incomplete higher education	2 (6.1)
	Complete higher education	4 (12.1)
Father’s education — n (%)	Incomplete elementary school	7 (21.2)
	Complete elementary school	3 (9.1)
	Incomplete high school	4 (12.1)
	Complete high school	17 (51.5)
	Incomplete higher education	1 (3.0)
	Complete higher education	1 (3.0)

Risk factors	Cognitive			Language			Motor
Risk factors	4 months	8 months	12 months	4 months	8 months	12 months	4 months	8 months	12 months
Head circumference^a	0.40	0.47	0.51	0.16	0.27	0.23	0.73	0.30	0.06
Apgar 5th minute^a	0.54	0.16	0.96	0.24	0.59	0.96	0.64	0.28	0.23
Mechanical ventilation days^b	0.65	0.07	0.99	0.99	0.42	0.96	0.88	0.63	0.21
Small for gestational age^c	0.28	0.49	0.37	0.37	0.96	0.58	0.83	0.70	0.40
Early sepsis^c	0.58	0.44	0.84	0.20	0.53	0.32	0.86	0.24	0.58
Late sepsis^c	0.36	0.28	0.59	0.06	0.52	0.64	0.75	0.25	0.48
Use of antibiotics^c	0.89	0.42	0.44	0.29	0.21	0.66	0.56	0.38	0.39
Seizure^c	0.16	0.29	0.06	0.40	0.20	0.20	0.27	0.34	0.49
Periventricular hemorrhage^c	0.53	0.13	0.17	0.83	0.16	0.20	0.27	0.08	0.61
Periventricular leukomalacia^c	0.33	0.38	0.12	0.19	0.08	0.21	0.09	0.29	0.44
Neurological exam^c	0.71	0.95	0.81	0.29	0.62	0.98	0.94	0.62	0.77
bronchopulmonary Dysplasia^c	0.06	0.27	0.61	0.43	0.70	0.79	0.48	0.23	0.40
Participation in intervention^c	0.28	0.79	0.39	0.18	0.45	0.47	0.21	0.37	0.82
Mother’s age^a	0.36	0.54	0.45	0.17	0.58	0.45	0.48	0.32	0.38
Father’s age^a	0.43	0.20	0.27	0.27	0.64	0.27	0.61	0.25	0.80
Mother’s education^c	0.67	0.25	0.53	0.11	0.31	0.25	0.70	0.42	0.75
Father’s education^c	0.34	0.77	0.43	0.07	0.38	0.51	0.41	0.24	0.06

AHEMD-IS	Affordances in the home environment for development
	Physical space	Variety of stimuli	Toys
	Physical space	Variety of stimuli	Fine motor skills	Gross motor skills
Less than adequate — n (%)	5 (15.2)	3 (9.1)	9 (27.3)	12 (36.4)
Moderately adequate — n (%)	31 (33.3)	6 (18.2)	1 (3.0)	6 (18.2)
Adequate — n (%)	13 (39.4)	8 (24.2)	12 (36.4)	8 (24.2)
Excellent — n (%)	4 (12.1)	16 (48.5)	11 (33.3)	7 (21.2)
Gross Score — M (SD)	4.25 (1.26)	10.75 (2.06)	5.25 (1.71)	6.25 (2.63)
	BSID-III Development Scores
BSID III	Cognitive	Language	Motor
4 months — M (SD)	97.69 (15.27)	92.24 (9.10)	97.07 (13.28)
8 months — M (SD)	94.58 (12.96)	93.53 (13.83)	90.25 (15.86)
12 months — M (SD)	93.79 (18.37)	92.52 (16.17)	83.68 (18.25)

BSID-III outcome	Age (months)	Regression model variables	Pearson (p) or chi-square (p)	Regression
Cognitive score	4	Family income (R$)	r=0.41 (0.034)	R²2. Spittle A, Orton J, Anderson PJ, Boyd R, Doyle LW. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database Syst Rev. 2015;24:CD005495. https://doi.org/10.1002/14651858.cd005495.pub4 https://doi.org/10.1002/14651858.cd00549... =0.70. f²=2.33^### F=8.26. p=0.001 Variety of stimuli: β=0.72. p≤0.001
		Variety of stimuli	r=0.37 (0.048)
		Toys: broad motor skills	r=0.40 (0.030)
		Parenting practices	r=0.44 (0.020)
		Parental knowledge	r=0.55 (0.003)
	8	Time in NICU (days)	r=-0.61 (0.001)	R²⁼0.58. f²⁼1.38^### F=5.51. p=0.002 Time in NICU: β=-0.67. p=0.015
		Gestational age (weeks)	r=0.44 (0.014)
		Birth weight (g)	r=0.44 (0.014)
		Toys: fine motor skills	r=0.44 (0.015)
		Parental knowledge	r=0.51 (0.008)
	12	Time in NICU (days)	r=-0.37 (0.041)	R²⁼0.55. f²⁼1.22^### F=4.53. p=0.008 Time in NICU: β=-0.43. p=0.035 Months of breastfeeding: β=0.41. p=0.020
		Family income (R$)	r=0.49 (0.007)
		Months of breastfeeding	r=0.44 (0.015)
		Toys: fine motor skills	r=0.40 (0.027)
		Parental knowledge	r=0.48 (0.013)
Language score	4	Parental knowledge	r=0.52 (0.007)	-----
	8	Toys: fine motor skills	r=0.42 (0.020)	R²=0.20. f²⁼0.25^## F=3.38. p=0.049 Non-significant predictors
	8	Toys: broad motor skills	r=0.41 (0.025)
	12	Family income (R$)	r=0.58 (0.002)	R²=0.38. f²⁼0.61^### F=5.16. p=0.006 Family income: β=0.42. p=0.028
		Toys: fine motor skills	r=0.50 (0.005)
		Toys: broad motor skills	r=0.46 (0.010)
Motor score	4	Parental knowledge	r=0.39 (0.049)	-----
	8	Toys: fine motor skills	r=0.44 (0.016)	R²⁼0.30. f²⁼0.43^### F=4.99. p=0.016 Non-significant predictors
	8	Parental knowledge	r=0.46 (0.017)
	12	Gestational age (weeks)	r=0.36 (0.045)	R²⁼0.62. f²=1.63^### F=3.71. p=0.014 Time in NICU: β=-0.80. p=0.012
		Time in NICU (days)	r=-0.57 (0.001)
		Family income (R$)	r=0.45 (0.015)
		Variety of stimuli	r=0.41 (0.022)
		Toys: fine motor skills	r=0.48 (0.007)
		Toys: broad motor skills	r=0.41 (0.021)
		Parental knowledge	r=0.54 (0.005)

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[1] *Corresponding author. E-mail: nadiacv@esef.ufrgs.br (N. C. Valentini).