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Language Skills in Children Born Preterm (<30 Wks' Gestation) Throughout Childhood

Associations With Biological and Socioenvironmental Factors

Nguyen, Thi-Nhu-Ngoc PhD*,†; Spencer-Smith, Megan PhD; Pascoe, Leona PhD*,†; Treyvaud, Karli PhD*,‡,§,‖; Lee, Katherine J. PhD*,¶; Thompson, Deanne K. PhD*,§,**; Cheong, Jeanie L. Y. MD*,††,‡‡; Doyle, Lex W. MD*,§,‖,††; Anderson, Peter J. PhD*,†

Journal of Developmental & Behavioral Pediatrics: October 14, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/DBP.0000000000000742
Original Article: PDF Only

Objective: To examine the individual and collective contribution of biological and socioenvironmental factors associated with language function at 2, 5, 7, and 13 years in children born preterm (<30 weeks' gestation or <1250 g birth weight).

Methods: Language function was assessed as part of a prospective longitudinal study of 224 children born preterm at 2, 5, 7, and 13 years using age-appropriate tools. Language Z-scores were generated based on a contemporaneous term-born control group. A selection of biological factors (sex, small for gestational age, bronchopulmonary dysplasia, infection, and qualitatively defined brain injury) and early socioenvironmental factors at age 2 years (primary income earner employment status and type, primary caregiver education level, English as a second language, parental mental health history, parent sensitivity and facilitation, and parent-child synchrony) was chosen a priori. Associations were assessed using univariable and multivariable linear regression models applied to outcomes at each time point.

Results: Higher primary caregiver education level, greater parent-child synchrony, and parent sensitivity were independently associated with better language function across childhood. Socioenvironmental factors together explained an increasing percentage of the variance (9%–18%) in language function from 2 to 13 years of age. In comparison, there was little evidence for associations between biological factors and language function, even during early childhood years.

Conclusion: This study highlights the importance of socioenvironmental factors over biological factors for language development throughout childhood. Some of these socioenvironmental factors are potentially modifiable, and parent-based interventions addressing parenting practices and education may benefit preterm children's language development.

This article has supplementary material on the web site:

*Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia;

School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia;

School of Psychology and Public Health, La Trobe University, Melbourne, Australia;

§Department of Pediatrics, University of Melbourne, Melbourne, Australia;

Newborn Research, The Royal Women's Hospital, University of Melbourne, Melbourne, Australia;

Clinical Epidemiology and Biostatics Unit, Murdoch Children's Research Institute, Melbourne, Australia;

**Florey Institute of Neuroscience and Mental Health, Melbourne, Australia;

††Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia;

‡‡Neonatal Service, Royal Women's Hospital, Melbourne, Australia.

Address for reprints: Peter J. Anderson, PhD, School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne 3800, Australia; e-mail:

This study was supported by the Australian National Health and Medical Council (NHMRC) (Centres of Research Excellence 1060733; Project Grants 237117, 491209, and 1066555; Senior Research Fellowship (1081288 [P. J. Anderson]; Career Development Fellowship 1085754 [D. K. Thompson], 1141354 [J. L. Y. Cheong], and 1127984 [K. J. Lee]), the US National Institutes of Health (HD058056), Murdoch Children's Research Institute, the Royal Children's Hospital Foundation, and the Victorian Government's Operational Infrastructure Support Program.

Disclosure: The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received May , 2019

Accepted August , 2019

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