Abstract
BackgroundInfants born very preterm (< 32 weeks gestational age (GA)) are at risk for developmental language delays. Poor language outcomes in children born preterm have been linked to neurobiological factors, including impaired development of the brain’s structural connectivity (white matter), and environmental factors, including decreased exposure to maternal speech in the neonatal intensive care unit (NICU). Interventions that enhance preterm infants’ exposure to maternal speech show promise as potential strategies for improving short-term health outcomes. Intervention studies have yet to establish whether increased exposure to maternal speech in the NICU offers benefits beyond the newborn period for brain and language outcomes.MethodsThis randomized controlled trial assesses the long-term effects of increased maternal speech exposure on structural connectivity at 12 months of age (age adjusted for prematurity (AA)) and language outcomes between 12 and 18 months of age AA. Study participants (N = 42) will include infants born very preterm (24–31 weeks 6/7 days GA). Newborns are randomly assigned to the treatment (n = 21) or standard medical care (n = 21) group. Treatment consists of increased maternal speech exposure, accomplished by playing audio recordings of each baby’s own mother reading a children’s book via an iPod placed in their crib/incubator. Infants in the control group have the identical iPod setup but are not played recordings. The primary outcome will be measures of expressive and receptive language skills, obtained from a parent questionnaire collected at 12–18 months AA. The secondary outcome will be measures of white matter development, including the mean diffusivity and fractional anisotropy derived from diffusion magnetic resonance imaging scans performed at around 36 weeks postmenstrual age during the infants’ routine brain imaging session before hospital discharge and 12 months AA.DiscussionThe proposed study is expected to establish the potential impact of increased maternal speech exposure on long-term language outcomes and white matter development in infants born very preterm. If successful, the findings of this study may help to guide NICU clinical practice for promoting language and brain development. This clinical trial has the potential to advance theoretical understanding of how early language exposure directly changes brain structure for later language learning.Trial registrationNIH Clinical Trials (ClinicalTrials.gov) NCT04193579. Retrospectively registered on 10 December 2019.
Highlights
Infants born very preterm (< 32 weeks gestational age (GA)) are at risk for developmental language delays
One observational study of preterm newborns found that variations in the amount of adult speech a newborn heard on a single day in the neonatal intensive care unit (NICU) at 32 and 36 weeks postmenstrual age (PMA) were positively associated with language skills at 7 and 18 months [17]
We focus on these language abilities because they have been linked to language processing abilities that are known to be strong predictors of later academic outcomes [34,35,36]
Summary
Infants born very preterm (< 32 weeks gestational age (GA)) are at risk for developmental language delays. Small interventional studies have found that experimentally increasing preterm infants’ exposure to maternal speech can significantly improve short-term health outcomes [14], including improvements in oxygen saturation [23, 24], decreases in apnea and bradycardia events [25, 26], improvements in weight gain [26], feeding tolerance [27, 28], and auditory cortex thickness as measured by cranial ultrasound [29] It is not known yet, whether there are sustained long-term benefits of early maternal speech exposure on language outcomes
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