Bayley Scales of Infant Development – Third Edition Article Summary
Title: Association between feeding difficulties and language delay in preterm infants using Bayley Scales of infant development-third edition.
Purpose: The purpose of this study by Adams-Chapman et al. (2013) aimed to analyze any correlation between language development delays due to atypical feeding in preterm babies. This understanding is growing importance due to the increased survival rate of preterm infants.
Study population: The Adams-Chapman et al. (2013) study population included 1,477 infants born less than or at 26 weeks gestation, and infants enrolled in a clinical trial through the National Institute of Child Health and Human Development, Neonatal Research Network.
Methods: Data collection schedule included birth to hospital discharge, death, or 120 days postnatal age. This data included any variables that could impact development, such as demographics, and neonatal aspects. The parent/caregiver was questioned, about abnormal feeding behaviors, such as: physician orders for no oral feeding, choking, coughing, or extreme drooling with oral feeding, aspiration, and challenge swallowing. Each infant completed a neurodevelopment assessment at the adjusted age of 18 months. The Cognitive and Receptive and Expressive Language Subscales of the Bayley Scales of Infant Development (BSID-III) were used to assess cognition and language abilities. Participants were placed into 3 categories based on these scores, which were defined as no delay, mild delay, and moderate-severe delay. The Harcourt manual was utilized for children who were not able to go through assessment due to extreme developmental delay. Data was also collected for neonatal and maternal information, bronchopulmonary dysplasia, cranial sonograms, periventricular leukomalacia, hearing impairments, and ventilatory needs. Analysis was done by using a x2 test for categorical, and an ANOVA test for continuous data. Multilevel linear regression models were used to predict factors contributing to abnormal feeding, and to analyze the relationship between feeding behaviors and BSID-III scores.
Outcome measures: Bayley Scales of Infant Development – Third Edition (BSID-III); Gross Motor Functional Classification System (GMFCS).
Interventions: None. The study was evaluative.
Results: This study found that infants with abnormal feeding had remarkably lower gestational age and lower birth weight. Atypical feeding behaviors were correlated with lower cognitive and language scores on the BSID-III. 45% of infants with atypical feeding met criteria for neurodevelopment impairment. Adams-Chapman et al. (2013) also found that a GMFCS score of greater than or equal to 2 had the largest impact on the cognitive and language scores of the BSID-III.
Strengths/Limitations: One strength of this study included looking at various contributing factors including neonatal and maternal data, bronchopulmonary dysplasia, periventricular leukomalacia, hearing impairments, and ventilatory needs in addition to what was discussed above in the methods section. Another advantage is the 18-month assessment timeline. This evaluation timing allows to control for any dysfunctional feeding around the time of discharge. A limitation of this study was the dependence on the parent/caregiver subjective assessment of feeding behaviors.
Conclusion: The overall conclusion of this study is extreme language developmental delays are more likely in infants with atypical feeding behaviors. The follow-up assessment revealed over 50% of children reported abnormal feeding did not have any motor impairment. This finding suggests that there may be more accrediting factors to the developmental delay. Continued research is needed to better understand various attributing factors to the language and growth developmental delay.
Full Reference: Adams-Chapman I, Bann CM, Vaucher YE, Stoll BJ. Association between feeding difficulties and language delay in preterm infants using Bayley Scales of infant development-third edition. The Journal of Pediatrics. 2013;163(3):680-685. doi:10.1016/j.jpeds.2013.03.006
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I think this is a very interesting article. When my family members talk about their experiences with feeding their newborns, the discussion seemed to always be around what you are feeding them. This article shows another side of feeding and the impact of abnormal feeding with no mention of what is being fed to these individuals. Plus, this article seems to highlight the importance of feeding at this stage of life with quantitative impact of neurodevelopment.