Language and cognitive outcome for high-risk neonates at the age of 2-3 years - experience from an Arab Country

Table 1 Demographic data of the studied children/their mothers

Demographic data of children	Median	Range	Number	%
Age (mo)	31	24-37
Gestational age (wk)	37	24-38
Birth weight (kg)	2.5	0.75-5
Outcome of pregnancy
Single			79	76.7
Twin			15	14.6
Triplet			9	8.7
Order of birth
First			54	52.4
Second			32	31.1
Third			10	9.7
Fourth			7	6.8
Sex
Male			62	60.2
Female			41	39.8
Demographic data of the mothers
Maternal age (yr)	25	18-40
Maternal age groups
≤ 18			2	1.9
18-35			95	92.2
≥ 35			6	5.8
Maternal risk factors1
Yes			48	46.6
No			55	53.4

¹Maternal risk factors as diabetes mellitus, hypertension, pre-eclampsia, antepartum hemorrhage, chorioamnionitis, premature rupture of membranes, etc.

Table 2 The distribution of risk factors in the studied children and their mothers

	Number	%
The neonatal risk factors
Prematurity	25	24.3
RDS	25	24.3
Hypoxic-ischemic encephalopathy	15	14.6
Hyperbilirubinemia	10	9.7
Hypoglycemia	13	12.6
Mixed risk factors	15	14.6
The maternal risk factors
PROM	12	25
Anemia	8	16.70
Pre-eclampsia	10	20.80
DM	10	20.80
Assisted fertilization techniques	8	16.70

RDS: Respiratory distress syndrome; PROM: Premature rupture of membrane; DM: Diabetes mellitus.

Table 3 Underlying causes of delayed language development among studied children

Causes of DLD	Number of children	%
Mental retardation	26	38.2
Environmental deprivation	12	17.6
Below average mentality	10	14.7
Specific language impairment	6	8.8
Cerebral palsy	5	7.4
Hearing impairment	5	7.4
ADHD (inattentive)	2	2.9
ASD - autism	2	2.9

DLD: Delayed language development; ADHD: Attention deficit hyperactivity disorder; ASD: Autism spectrum disorder.

Table 4 Correlation between gestational age and birth weight of high risk children vs different language parameters and cognitive abilities

		Gestational age	Birth weight
Receptive language score	R	0.054	0.112
	P	0.591	0.26
Receptive language age (mo)	R	0.189	0.241
	P	0.055	0.014a
Expressive language score	R	0.231	0.309
	P	0.019a	0.001a
Expressive language age (mo)	R	0.168	0.289
	P	0.09	0.003a
Total language score	R	0.192	0.239
	P	0.051	0.015a
Total language age (mo)	R	0.197	0.286
	P	0.046a	0.003a
IQ score	R	0.125	0.178
	P	0.208	0.072
Social age (mo)	R	0.214	0.322
	P	0.030a	0.001a

^aP < 0.05. R: Spearman’s rho correlation coefficient.

Table 5 Association between high-risk factors regarding language parameters and cognitive abilities

	Hyperbilir-ubinemia	Hypogly-cemia	Hypoxic-ischemic encephalopathy	Prematurity	Respiratory distress syndrome	Mixed risk factors	P-value
Receptive language score
Median	76.5	76	53	63	82	72	0.5
Range	51.0-110.0	51.0-110.0	52.0-110.0	51.0-105.0	53.0-115.0	51.0-105.0
Receptive language age (mo)
Median	21.5	24	20.02	20.02	30.035	20	0.027a
Range	1.0-36.0	12.0-39.0	1.0-39.0	1.0-36.0	2.0-43.0	1.0-37.0
Expressive language score
Median	58.5	57	52.0	52.02	62.05	53.02	0.049a
Range	50.0-105.0	52.0-105.0	50.0-93.0	50.0-78.02	50.0-112.0	50.0-93.0
Expressive language age (mo)
Median	21.5	25	16.02	18.002	21.004	15.002	0.037a
Range	10.0-35.0	15.0-39.0	1.0-39.0	1.0-36.0	1.0-41.0	1.0-36.0
Total language score
Median	57.5	56	50	50	71	51	0.11
Range	50.0-110.0	50.0-124.0	50.0-96.0	50.0-92.0	50.0-117.0	50.0-96.0
Total language age (mo)
Median	22	26	18	17.02	24.05	17.02	0.03a
Range	4.0-35.0	13.0-39.0	1.0-39.0	1.0-32.0	1.0-39.0	1.0-36.0
IQ score
Median	79	85	67	78	74	75	0.38
Range	54.0-90.0	64.0-95.0	54.0-33.0	54.0-94.0	53.0-33.0	29.0-90.0
Social age (mo)
Median	30	36	29.02	27.02	31.05	27.02	0.004a
Range	24.0-39.0	24.0-41.0	24.0-37.0	19.0-38.0	24.0-44.0	12.0-41.0
Mental age (mo)
Median	25.5	24	24	21.01	28.045	24.0	0.005a
Range	15.0-36.0	18.0-36.0	18.0-36.0	12.0-36.0	17.0-36.0	12.0-34.0

Kruskal-Wallis test.

^aP < 0.05.

¹Significance relative to hyperbilirubinemia;

²Significance relative to hypoglycemia;

³Significance relative to hypoxic-ischemic encephalopathy;

⁴Significance relative to mixed risk factors;

⁵Significance relative to prematurity.

Table 6 Comparison between presence vs absence of maternal risk factors regarding language parameters and cognitive abilities

	Maternal risk factors				P-value
	Absence		Presence
	Median	Range	Median	Range
Receptive language score	66	51.0-115.0	77	51.0-115.0	0.3
Receptive language age (mo)	22	1.0-43.0	22.5	1.0-37.0	0.8
Expressive language score	53	50.0-105.0	53.5	50.0-112.0	0.6
Expressive language age (mo)	20	1.0-39.0	19	1.0-41.0	0.9
Total language score	51	8.0-124.0	52	50.0-117.0	0.7
Total language age (mo)	23	1.0-39.0	19.5	1.0-39.0	0.9
IQ score	78	53.0-133.0	78	29.0-110.0	0.78
Social age (mo)	31	19.0-44.0	28	12.0-41.0	0.008a
Mental age (mo)	24	12.0-6.0	24	12.0-6.0	0.3

Test used: Mann-Whitney;

^aP < 0.05.

Table 7 Comparison between delayed language development and non-delayed language development groups as regard demographic data

	DLD group n = 68		n (%)	Non-DLD n = 35		n (%)	P-value
	Median	Range		Median	Range
Age (mo)	29	24-36		31	24-37		0.17
Maternal age (yr)	25	18-39		25	19-40		0.38
Gestational age (wk)	37	24-38		36.5	27-38		0.2
Birth weight (kg)	2.75	0.75-5		2.5	0.75-4.5		0.027a
Sex
Male			14 (40.0%)			48 (70.6%)	0.003a
Female			21 (60.0%)			20 (29.4%)
Order of birth
1			20 (57.1%)			34 (50.0%)	0.6
2			10 (28.6%)			22 (32.4%)
3			4 (11.4%)			6 (8.8%)
4			1 (2.9%)			6 (8.8%)
Outcome of pregnancy
Single			28 (80.0%)			51 (75.0%)	0.8
Twin			4 (11.4%)			11 (16.2%)
Triple			3 (8.6%)			6 (8.8%)
Consanguinity
Negative			27 (77.1%)			53 (77.9%)	0.9
Positive			8 (22.9%)			15 (22.1%)
Maternal risk factors
No			19 (54.3%)			36 (52.9%)	0.9
Yes			16 (45.7%)			32 (47.1%)

Test used: Mann-Whitney;

^aP < 0.05. DLD: Delayed language development.

Table 8 Comparison between delayed language development and non-delayed language development groups as regard different language parameters and cognitive abilities

	DLD group n = 68		Non-DLD n = 35		P-value
	Median	Range	Median	Range
Receptive language score	54.0	51.0-105.0	94.0	76.0-115.0	< 0.001a
Receptive language age (mo)	18.5	1.0-37.0	32.0	22.0-43.0	< 0.001a
Expressive language score	52.0	50.0-71.0	84.0	50.0-112.0	< 0.001a
Expressive language age (mo)	15.0	1.0-36.0	28.0	15.0-41.0	< 0.001a
Total language score	50.0	50.0-75.0	89.0	8.0-124.0	< 0.001a
Total language age (mo)	17.0	1.0-35.0	30.0	23.0-39.0	< 0.001a
IQ score	67.0	29.0-90.0	87.0	74.0-133.0	< 0.001a
Social age (mo)	29.0	12.0-40.0	34.0	24.0-44.0	0.002a

Test used: Mann-Whitney;

^aP < 0.05. DLD: Delayed language development.

Table 9 Comparison between different parents-child interactions regarding language parameters and cognitive abilities

	Parent-child interactions				P-value
	Negative (n = 41)		Positive (n = 62)
	Median	Range	Median	Range
Receptive language score	58.0	51.0-105.0	82.0	51.0-115.0	0.003a
Receptive language age (mo)	20.0	1.0-37.0	24.0	1.0-43.0	0.6
Expressive language	53.0	50.0-78.0	67.5	50.0-112.0	0.02a
Expressive language age (mo)	19.0	1.0-35.0	21.0	1.0-41.0	0.3
Total language score	51.0	50.0-90.0	76.5	50.0-124.0	0.009a
Total language age (mo)	19.0	1.0-35.0	23.0	1.0-39.0	0.4
IQ score	70.0	53.0-90.0	85.0	29.0-133.0	< 0.001a
Social age (mo)	30.0	20.0-40.0	30.0	12.0-44.0	0.6

^aP < 0.05.

Table 10 Univariate logistic regression for different neonatal risk factors

	95%CI for OR
	P-value	OR	Lower	Upper
Hyperbilrubinemia	0.714	1.307	0.313	5.457
Hypoglycemia	0.799	0.922	0.492	1.725
Hypoxic-ischemic encephalopathy	0.671	0.781	0.25	2.444
Respiratory distress syndrome	0.256	0.599	0.247	1.451
Prematurity	0.023a	3.937	1.21	12.813

^aP < 0.05.

Table 11 Forward logistic regression

		B	P-value	OR	95%CI for EXP(B)
					Lower	Upper
Step 1	Total language	-0.178	0.000a	0.837	0.783	0.895
Step 2	Total language	-0.168	0.000a	0.845	0.793	0.902
	Parents interaction	-2.246	0.019a	0.106	0.016	0.695

^aP < 0.05.