Early Detection of Cognitive, Language, and Motor Delays for Low-Income Preterm Infants: A Brazilian Cohort Longitudinal Study on Infant Neurodevelopment and Maternal Practice

Abstract

Aim: This study examined the neurodevelopment trajectories, the prevalence of delays, and the risks and protective factors (adverse outcomes, environment, and maternal factors) associated with cognitive, motor, and language development for preterm infants from 4– to 24-months.Method: We assessed 186 preterm infants (24.7% extremely preterm; 54.8% very preterm; 20.4% moderate/late preterm) from 4– to 24-months using the Bayley Scales of Infant Development – III. Maternal practices and knowledge were assessed using the Daily Activities of Infant Scale and the Knowledge of Infant Development Inventory. Birth risks and adverse outcomes were obtained from infant medical profiles.Results: A high prevalence of delays was found; red flags for delays at 24-months were detected at 4– and 8-months of age. The neurodevelopmental trajectories showed steady scores across time for cognitive composite scores for extremely- and very-preterm infants and for language composite scores for the extremely- and moderate/late-preterm; a similar trend was observed for the motor trajectories of moderate/late preterm. Changes over time were restricted to motor composite scores for extremely- and very-preterm infants and for cognitive composite scores for moderate/late preterm; declines, stabilization, and improvements were observed longitudinally. Positive, strong, and significant correlations were for the neurodevelopment scores at the first year of life and later neurodevelopment at 18 and 24 months. The cognitive, language, and motor composite scores of extremely and very preterm groups were associated with more risk factors (adverse outcomes, environment, and maternal factors). However, for moderate/late preterm infants, only APGAR and maternal practices significantly explained the variance in neurodevelopment.Discussion: Although adverse outcomes were strongly associated with infant neurodevelopment, the environment and the parents’ engagement in play and breastfeeding were protective factors for most preterm infants. Intervention strategies for preterm infants should start at 4– to 8-months of age to prevent unwanted outcomes later in life.

Early factors associated with risk of developmental coordination disorder in very preterm children: A prospective area‐based cohort study in Italy

“…Belfort et al 57 found that, in infants below 30 weeks of GA, breastmilk intake in the first 28 days of life was associated with greater brain deep nuclear grey matter at term equivalent age, and better motor and cognitive performance at 7 years of age. However, these findings were not replicated by subsequent studies, 55,58 which did not identify any feeding associated differences in the achievement of motor milestones in very preterm infants. Our study found that, adjusting for maternal age, smoking in pregnancy, and SES index, maternal milk feeding at discharge from the neonatal unit was associated with lower DCD risk, particularly overall and in the Fine Motor/Handwriting domains.…”

“…As with other developmental outcomes, 54 we found that socio‐economic variables such as maternal age, smoking in pregnancy, parental education, and occupational profession may be important in shaping the neuropsychological profile of a child, and in our study were associated with risk of motor problems even when controlling for biomedical factors. The root of these relations may be both socio‐economic and educational, linked to the level of home affordances, 30 opportunities for motor activities, training, and outdoor leisure time, as well as to more active parenting practices and stimulating environment 55 …”

“…Our study found that, adjusting for maternal age, smoking in pregnancy, and SES index, maternal milk feeding at discharge from the neonatal unit was associated with lower DCD risk, particularly overall and in the Fine Motor/Handwriting domains. Proposed mechanisms linking breast feeding with brain development are the nutritional properties of breastmilk, 57 and possibly the quality of mother–infant relation that may be enhanced by breast feeding 55,57 . Recently, the report by Kar et aly 59 of an association between breast‐feeding exclusivity and duration and brain global and regional white matter microstructure has provided additional support to the link between breast feeding and infant motor development.…”

“…Proposed mechanisms linking breast feeding with brain development are the nutritional properties of breastmilk, 57 and possibly the quality of mother-infant relation that may be enhanced by breast feeding. 55,57 Recently, the report by Kar et aly 59 of an association between breast-feeding exclusivity and duration and brain global and regional white matter microstructure has provided additional support to the link between breast feeding and infant motor development.…”

“…The root of these relations may be both socio-economic and educational, linked to the level of home affordances, 30 opportunities for motor activities, training, and outdoor leisure time, as well as to more active parenting practices and stimulating environment. 55 While the effect of maternal smoking on intrauterine growth is well known, its role in developmental disorders, and specifically DCD, has been less researched. We found that both SGA and smoking were independently associated with increased DCD risk, although in different domains, with only smoking affecting Control during Movement.…”