Early Human Development 90 (2014) 891–892
Contents lists available at ScienceDirect
Early Human Development journal homepage: www.elsevier.com/locate/earlhumdev
Delayed language development at two years of age in very preterm infants in the Perinatal Network of Haute-Normandie
between one and two years and to precise their predictive value at school-age [5] is ongoing. Acknowledgements
Preterm birth often leads to compromised neurodevelopment. They were observed in more than 35% of the very preterm (VPT) children in the EPIPAGE 1 study [1]. Learning difficulties at school are related to disorders of language acquisition, which can be identified increasingly early, even in the absence of evidence of neonatal brain injury [2]. In order to study this aspect for this purpose, we have assessed language development in VPT children at two years of age through a follow-up programme of the Perinatal Network of Haute-Normandie approved by the National Data Protection Authority (CNIL). Children admitted to the NICU of the Rouen University Hospital were included at the time of hospital discharge, after signed parental consent of the parents. At 12 and 24 months, a specialist nurse using the short French version of the MacArthur–Bates (IFDC French Inventory Communicative Development) [3] evaluated them. All tests were two-sided; p values of less than 0.05 were considered significant. All statistical analyses were performed with SAS v9·3 software. From February 2012 to October 2013, we report the results of 80 questionnaires administered at 12 months and 117 at 24 months. At one year, 80 VPT (39 boys and 41 girls), born between 25 and 32 WG, were classified in three groups according to the gestational age at birth (Group 1 (b28 WG), N = 27; Group 2 (28–30 WG), N = 26; Group 3 (31–32 WG), N = 27). Three measures were studied: gesture, comprehension and vocabulary. In each group, normal comprehension score up to the 50th centile was noted and indicated normal ageappropriate receptive language. In contrast, associations between gestational age and production of words or gesture were observed (normal score for all the children in Group 3; between the 25th centile and 50th centile for all Group 2 and below the 25th centile for all Group 1). At 24 months, 117 VPT (57 boys and 60 girls) were classified as follows: Group 1 (b28 WG), N = 43; Group 2 (28–30 WG), N = 36; and Group 3 (31–32 WG), N = 38. Production of words and utterance lengths were significantly different from the reference population (p b 0.001) (Table 1). Girls performed slightly better than boys, as in the general population of the IFDC [3]. Sixty-three percent of the 117 VPT studied at two years of age obtained a score lower than the 25th centile for “production of words” and 50% had a score lower than the 25th centile for “average length of phrase”. The proportion of the children presenting with scores lower than 10th centile was inversely correlated to gestational age (r = 0,67, p b 0.001). These results confirm that VPT children are at increased risk of altered language skills at one and two years of age [4]. The norm reached in comprehension, whereas gesture and production of words are more altered with earlier gestational age at birth, could suggest the importance of motor activity in the language development and a delay in maturation of neural networks or the engagement of alternate circuits for language processing [5]. A study to analyse, in each child, the dynamic of language development
http://dx.doi.org/10.1016/j.earlhumdev.2014.10.001 0378-3782/© 2014 Elsevier Ltd. All rights reserved.
We are grateful to Nathalie Mestre, for providing assistance. We are indebted to the women and children who participated in the study. Nathalie Mestre and Frédéric Pasquet were supported by the FEDER (Regional European Funds). References [1] Larroque B, Ancel PY, Marret S, Marchand L, Andre M, Arnaud C, et al. EPIPAGE Study group. Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation (the EPIPAGE study): a longitudinal cohort study. Lancet 2008;371:813–20. [2] Marret S, Marchad-Martin L, Picaud JC, Hascoet JM, Arnaud C, Roze JC, et al. Brain injury in very preterm children and neurosensory and cognitive disabilities during childhood: the EPIPAGE cohort study. PLoS One 2013;8:e62683. [3] Bovet F. Les inventaires français du développement communicatif (IFDC): un nouvel outil pour évaluer le développement communicatif du nourrisson. Méd Enfance 2005;25:327–32. [4] 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;34:655–75. [5] Charollais A, Marret S, Stumpf MH, Lemarchand M, Delaporte B, Phillip E, et al. Understand the neurodevelopment of language: a necessity to prevent learning disabilities in children. Arch Pediatr 2013;20:994–9.
Aude Charollais Department of Neonatal Medicine and Intensive Care, Neuropediatrics and Reference Centre for Learning Disabilities, Rouen University Hospital, France Region-INSERM Team (ERI28) Neovasc, Perinatal Handicap, Institute for Biomedical Research and Innovation (IRIB), School of Medicine, University of Rouen, Rouen, France ICONES Lab. (EA 4699), University of Rouen, Mont Saint-Aignan, France Corresponding author at: Neuropediatrics and Reference Centre for Learning Disabilities, Rue de Germont, 1, Rouen University Hospital, France. Tel.: +33 2 32 88 80 97; fax: +33 2 32 88 86 33. E-mail address: [email protected]. Marie-Hélène Stumpf Ronan De Quelen Stephane Rondeau Department of Neonatal Medicine and Intensive Care, Neuropediatrics and Reference Centre for Learning Disabilities, Rouen University Hospital, France Region-INSERM Team (ERI28) Neovasc, Perinatal Handicap, Institute for Biomedical Research and Innovation (IRIB), School of Medicine, University of Rouen, Rouen, France Frédéric Pasquet Department of Neonatal Medicine and Intensive Care, Neuropediatrics and Reference Centre for Learning Disabilities, Rouen University Hospital, France ICONES Lab. (EA 4699), University of Rouen, Mont Saint-Aignan, France
892 Table 1 Language of very preterm children (25–32 weeks' gestation) at two years of age using the MacArthur–Bates scale. Production of words
Centile 1 to 10
Centile 10 to 25
Centiles 26 to 50
Centiles 51 to 75
Centiles 76 to 90
Centiles 91 to100
Norm (N = 385) VPT (N = 117) Adjusted Χ2 (p)
38.5 (10%) 48 (41%) 125.1 (b0.0001)
57.75 (15%) 26 (22%) 4.7 (b0.05)
96.25 (25%) 24 (20.5%) 1.2 (0.26/NS)
96.25 (25%) 14 (12%) 10.6 (b0.01)
57.75 (15%) 3 (2.6%) 14.2 (b0.001)
38.5 (10%) 2 (2%) 8.9 (b0.01)
Utterance length
Centiles 1 to 25
Centiles 26 to 50
Centiles 51 to 75
Centiles 76 to 90
Centiles 91 to 100
Norm (N = 385) VPT (N = 117) Adjusted Χ2 (p)
96.25 (25%) 78 (66.6%) 108.3 (b0.0001)
96.25 (25%) 24 (20.5%) 1.2 (0.26/NS)
96.25 (25%) 12 (10.2%) 13.5 (b0.001)
57.75 (15%) 2 (1.7%) 16.2 (b0.0001)
38.5 (10%) 1 (0.8%) 10.8 (b0.001)
N: number; %: percentage; VPT: very preterm (25–32 weeks' gestation).
Stéphane Marret Department of Neonatal Medicine and Intensive Care, Neuropediatrics and Reference Centre for Learning Disabilities, Rouen University Hospital, France Region-INSERM Team (ERI28) Neovasc, Perinatal Handicap, Institute for Biomedical Research and Innovation (IRIB), School of Medicine, University of Rouen, Rouen, France for the Perinatal Network of Haute-Normandie 24 July 2014 Available online xxxx
Contents lists available at ScienceDirect
Early Human Development journal homepage: www.elsevier.com/locate/earlhumdev
Delayed language development at two years of age in very preterm infants in the Perinatal Network of Haute-Normandie
between one and two years and to precise their predictive value at school-age [5] is ongoing. Acknowledgements
Preterm birth often leads to compromised neurodevelopment. They were observed in more than 35% of the very preterm (VPT) children in the EPIPAGE 1 study [1]. Learning difficulties at school are related to disorders of language acquisition, which can be identified increasingly early, even in the absence of evidence of neonatal brain injury [2]. In order to study this aspect for this purpose, we have assessed language development in VPT children at two years of age through a follow-up programme of the Perinatal Network of Haute-Normandie approved by the National Data Protection Authority (CNIL). Children admitted to the NICU of the Rouen University Hospital were included at the time of hospital discharge, after signed parental consent of the parents. At 12 and 24 months, a specialist nurse using the short French version of the MacArthur–Bates (IFDC French Inventory Communicative Development) [3] evaluated them. All tests were two-sided; p values of less than 0.05 were considered significant. All statistical analyses were performed with SAS v9·3 software. From February 2012 to October 2013, we report the results of 80 questionnaires administered at 12 months and 117 at 24 months. At one year, 80 VPT (39 boys and 41 girls), born between 25 and 32 WG, were classified in three groups according to the gestational age at birth (Group 1 (b28 WG), N = 27; Group 2 (28–30 WG), N = 26; Group 3 (31–32 WG), N = 27). Three measures were studied: gesture, comprehension and vocabulary. In each group, normal comprehension score up to the 50th centile was noted and indicated normal ageappropriate receptive language. In contrast, associations between gestational age and production of words or gesture were observed (normal score for all the children in Group 3; between the 25th centile and 50th centile for all Group 2 and below the 25th centile for all Group 1). At 24 months, 117 VPT (57 boys and 60 girls) were classified as follows: Group 1 (b28 WG), N = 43; Group 2 (28–30 WG), N = 36; and Group 3 (31–32 WG), N = 38. Production of words and utterance lengths were significantly different from the reference population (p b 0.001) (Table 1). Girls performed slightly better than boys, as in the general population of the IFDC [3]. Sixty-three percent of the 117 VPT studied at two years of age obtained a score lower than the 25th centile for “production of words” and 50% had a score lower than the 25th centile for “average length of phrase”. The proportion of the children presenting with scores lower than 10th centile was inversely correlated to gestational age (r = 0,67, p b 0.001). These results confirm that VPT children are at increased risk of altered language skills at one and two years of age [4]. The norm reached in comprehension, whereas gesture and production of words are more altered with earlier gestational age at birth, could suggest the importance of motor activity in the language development and a delay in maturation of neural networks or the engagement of alternate circuits for language processing [5]. A study to analyse, in each child, the dynamic of language development
http://dx.doi.org/10.1016/j.earlhumdev.2014.10.001 0378-3782/© 2014 Elsevier Ltd. All rights reserved.
We are grateful to Nathalie Mestre, for providing assistance. We are indebted to the women and children who participated in the study. Nathalie Mestre and Frédéric Pasquet were supported by the FEDER (Regional European Funds). References [1] Larroque B, Ancel PY, Marret S, Marchand L, Andre M, Arnaud C, et al. EPIPAGE Study group. Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation (the EPIPAGE study): a longitudinal cohort study. Lancet 2008;371:813–20. [2] Marret S, Marchad-Martin L, Picaud JC, Hascoet JM, Arnaud C, Roze JC, et al. Brain injury in very preterm children and neurosensory and cognitive disabilities during childhood: the EPIPAGE cohort study. PLoS One 2013;8:e62683. [3] Bovet F. Les inventaires français du développement communicatif (IFDC): un nouvel outil pour évaluer le développement communicatif du nourrisson. Méd Enfance 2005;25:327–32. [4] 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;34:655–75. [5] Charollais A, Marret S, Stumpf MH, Lemarchand M, Delaporte B, Phillip E, et al. Understand the neurodevelopment of language: a necessity to prevent learning disabilities in children. Arch Pediatr 2013;20:994–9.
Aude Charollais Department of Neonatal Medicine and Intensive Care, Neuropediatrics and Reference Centre for Learning Disabilities, Rouen University Hospital, France Region-INSERM Team (ERI28) Neovasc, Perinatal Handicap, Institute for Biomedical Research and Innovation (IRIB), School of Medicine, University of Rouen, Rouen, France ICONES Lab. (EA 4699), University of Rouen, Mont Saint-Aignan, France Corresponding author at: Neuropediatrics and Reference Centre for Learning Disabilities, Rue de Germont, 1, Rouen University Hospital, France. Tel.: +33 2 32 88 80 97; fax: +33 2 32 88 86 33. E-mail address: [email protected]. Marie-Hélène Stumpf Ronan De Quelen Stephane Rondeau Department of Neonatal Medicine and Intensive Care, Neuropediatrics and Reference Centre for Learning Disabilities, Rouen University Hospital, France Region-INSERM Team (ERI28) Neovasc, Perinatal Handicap, Institute for Biomedical Research and Innovation (IRIB), School of Medicine, University of Rouen, Rouen, France Frédéric Pasquet Department of Neonatal Medicine and Intensive Care, Neuropediatrics and Reference Centre for Learning Disabilities, Rouen University Hospital, France ICONES Lab. (EA 4699), University of Rouen, Mont Saint-Aignan, France
892 Table 1 Language of very preterm children (25–32 weeks' gestation) at two years of age using the MacArthur–Bates scale. Production of words
Centile 1 to 10
Centile 10 to 25
Centiles 26 to 50
Centiles 51 to 75
Centiles 76 to 90
Centiles 91 to100
Norm (N = 385) VPT (N = 117) Adjusted Χ2 (p)
38.5 (10%) 48 (41%) 125.1 (b0.0001)
57.75 (15%) 26 (22%) 4.7 (b0.05)
96.25 (25%) 24 (20.5%) 1.2 (0.26/NS)
96.25 (25%) 14 (12%) 10.6 (b0.01)
57.75 (15%) 3 (2.6%) 14.2 (b0.001)
38.5 (10%) 2 (2%) 8.9 (b0.01)
Utterance length
Centiles 1 to 25
Centiles 26 to 50
Centiles 51 to 75
Centiles 76 to 90
Centiles 91 to 100
Norm (N = 385) VPT (N = 117) Adjusted Χ2 (p)
96.25 (25%) 78 (66.6%) 108.3 (b0.0001)
96.25 (25%) 24 (20.5%) 1.2 (0.26/NS)
96.25 (25%) 12 (10.2%) 13.5 (b0.001)
57.75 (15%) 2 (1.7%) 16.2 (b0.0001)
38.5 (10%) 1 (0.8%) 10.8 (b0.001)
N: number; %: percentage; VPT: very preterm (25–32 weeks' gestation).
Stéphane Marret Department of Neonatal Medicine and Intensive Care, Neuropediatrics and Reference Centre for Learning Disabilities, Rouen University Hospital, France Region-INSERM Team (ERI28) Neovasc, Perinatal Handicap, Institute for Biomedical Research and Innovation (IRIB), School of Medicine, University of Rouen, Rouen, France for the Perinatal Network of Haute-Normandie 24 July 2014 Available online xxxx
