Download PDF
Am J Perinatol
DOI: 10.1055/a-2023-8813
Original Article

Investigating Relations between the NICU Speech Environment and Weight Gain in Infants Born Very Preterm

Komal Kumar
1   Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, California
,
Virginia A. Marchman
2   Department of Psychology, Stanford University, Stanford, California
3   Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University, Stanford, California
,
Maya C. Morales
3   Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University, Stanford, California
,
Melissa Scala   *
1   Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, California
,
Katherine E. Travis    *
3   Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University, Stanford, California
› Author Affiliations Funding This research work was supported by grants from the U.S. Department of Health and Human Services, National Institutes of Health—Eunice Kennedy Shriver National Institute of Child Health and Human Development (K.E.T., PI; 5R00HD8474904), Stanford Maternal Child Health Research Institute grant.
› Further Information
    Permissions and Reprints

Abstract

Objective Children born preterm, especially those born very preterm (<32 weeks of gestational age [GA]) are at risk for poor growth and adverse neurodevelopmental outcomes. Adverse growth and neurodevelopmental outcomes in preterm children have been attributed, in part, to the aversive sounds and relative speech paucity of the neonatal intensive care unit (NICU). Experimental studies that directly expose preterm infants to speech sounds in the NICU find significant improvements in health factors relevant to neurodevelopment. Few studies have examined whether natural variations in the speech environment of the NICU are related to short-term health outcomes in preterm infants. Such data are important for optimizing the sound environment of the NICU. Our objective was to examine relations between the NICU speech environment and the rate of weight gain during hospitalization.

Study Design Participants were infants born very preterm (n = 20). The speech environment of each infant was assessed at 32 to 36 weeks of postmenstrual age using an automatic speech-counting device. Average rates of weight gain (g/kg/d) were ascertained over the same period. Calories were derived from charted intake (kcals/kg/d). Linear regressions examined caloric intake and speech counts as predictors of infant weight gain.

Results Infant weight gain was significantly predicted by caloric intake and speech exposure, each uniquely accounting for approximately 27% variance (total R 2 = 60.2%; p < 0.001). Speech counts were uncorrelated with rates of family visitation, time in incubator, or health acuity.

Conclusion While future research should establish causality and direction of effects, enhancing speech exposure in the NICU may be beneficial for physical growth. NICU care plans should consider opportunities to increase speech exposure.

Key Points

  • Preterm infants who experienced greater amounts of speech in the NICU gained significantly more weight than preterm infants who were exposed to lower amounts of speech during the same developmental period (32–36 weeks of postmenstrual age).

  • Caloric intake and speech counts accounted for almost 60% of variance in infant weight gain between 32 and 36 weeks of postmenstrual age.

  • Speech counts were not significantly correlated with family visitation, how long infants resided in incubators, or health acuity.

  • Findings suggest that the NICU speech environment may play an important role in the physical health of preterm infants; however, more studies are needed to determine the directionality of the observed associations.

Keywords

preterm birth - NICU - language exposure - weight gain - growth

Note

A version of this study was previously submitted as a preprint to medRxiv.[27]


* equally contributing senior authors.




Publication History

Received: 02 September 2022

Accepted: 30 January 2023

Accepted Manuscript online:
31 January 2023

Article published online:
14 March 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Twilhaar ES, de Kieviet JF, Aarnoudse-Moens CS, van Elburg RM, Oosterlaan J. Academic performance of children born preterm: a meta-analysis and meta-regression. Arch Dis Child Fetal Neonatal Ed 2018; 103 (04) F322-F330
    CrossrefPubMedGoogle Scholar
  • 2 Aarnoudse-Moens CSH, Weisglas-Kuperus N, van Goudoever JB, Oosterlaan J. Meta-analysis of neurobehavioral outcomes in very preterm and/or very low birth weight children. Pediatrics 2009; 124 (02) 717-728
    CrossrefPubMedGoogle Scholar
  • 3 Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJS. Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis. JAMA 2002; 288 (06) 728-737
    CrossrefPubMedGoogle Scholar
  • 4 Foster-Cohen SH, Friesen MD, Champion PR, Woodward LJ. High prevalence/low severity language delay in preschool children born very preterm. J Dev Behav Pediatr 2010; 31 (08) 658-667
    CrossrefPubMedGoogle Scholar
  • 5 Catts HW, Fey ME, Tomblin JB, Zhang X. A longitudinal investigation of reading outcomes in children with language impairments. J Speech Lang Hear Res 2002; 45 (06) 1142-1157
    CrossrefPubMedGoogle Scholar
  • 6 Johnson S, Hennessy E, Smith R, Trikic R, Wolke D, Marlow N. Academic attainment and special educational needs in extremely preterm children at 11 years of age: the EPICure study. Arch Dis Child Fetal Neonatal Ed 2009; 94 (04) F283-F289
    CrossrefPubMedGoogle Scholar
  • 7 Rand K, Lahav A. Impact of the NICU environment on language deprivation in preterm infants. Acta Paediatr 2014; 103 (03) 243-248
    CrossrefPubMedGoogle Scholar
  • 8 Wachman EM, Lahav A. The effects of noise on preterm infants in the NICU. Arch Dis Child Fetal Neonatal Ed 2011; 96 (04) F305-F309
    CrossrefPubMedGoogle Scholar
  • 9 Caskey M, Stephens B, Tucker R, Vohr B. Adult talk in the NICU with preterm infants and developmental outcomes. Pediatrics 2014; 133 (03) e578-e584
    CrossrefPubMedGoogle Scholar
  • 10 Filippa M, Devouche E, Arioni C, Imberty M, Gratier M. Live maternal speech and singing have beneficial effects on hospitalized preterm infants. Acta Paediatr 2013; 102 (10) 1017-1020
    CrossrefPubMedGoogle Scholar
  • 11 Scala M, Seo S, Lee-Park J. et al. Effect of reading to preterm infants on measures of cardiorespiratory stability in the neonatal intensive care unit. J Perinatol 2018; 38 (11) 1536-1541
    CrossrefPubMedGoogle Scholar
  • 12 Chorna OD, Slaughter JC, Wang L, Stark AR, Maitre NL. A pacifier-activated music player with mother's voice improves oral feeding in preterm infants. Pediatrics 2014; 133 (03) 462-468
    CrossrefPubMedGoogle Scholar
  • 13 Krueger C, Parker L, Chiu SH, Theriaque D. Maternal voice and short-term outcomes in preterm infants. Dev Psychobiol 2010; 52 (02) 205-212
    CrossrefPubMedGoogle Scholar
  • 14 Doheny L, Hurwitz S, Insoft R, Ringer S, Lahav A. Exposure to biological maternal sounds improves cardiorespiratory regulation in extremely preterm infants. J Matern Fetal Neonatal Med 2012; 25 (09) 1591-1594
    CrossrefPubMedGoogle Scholar
  • 15 Best K, Bogossian F, New K. Language exposure of preterm infants in the neonatal unit: a systematic review. Neonatology 2018; 114 (03) 261-276
    CrossrefPubMedGoogle Scholar
  • 16 Ehrenkranz RA, Dusick AM, Vohr BR, Wright LL, Wrage LA, Poole WK. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics 2006; 117 (04) 1253-1261
    Google Scholar
  • 17 Stephens BE, Walden RV, Gargus RA. et al. First-week protein and energy intakes are associated with 18-month developmental outcomes in extremely low birth weight infants. Pediatrics 2009; 123 (05) 1337-1343
    CrossrefPubMedGoogle Scholar
  • 18 Sammallahti S, Pyhälä R, Lahti M. et al. Infant growth after preterm birth and neurocognitive abilities in young adulthood. J Pediatr 2014; 165 (06) 1109-1115 .e3
    CrossrefPubMedGoogle Scholar
  • 19 Ong KK, Kennedy K, Castañeda-Gutiérrez E. et al. Postnatal growth in preterm infants and later health outcomes: a systematic review. Acta Paediatr 2015; 104 (10) 974-986
    Google Scholar
  • 20 Zimmerman E, Keunen K, Norton M, Lahav A. Weight gain velocity in very low-birth-weight infants: effects of exposure to biological maternal sounds. Am J Perinatol 2013; 30 (10) 863-870
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Scala ML, Marchman VA, Godenzi C, Gao C, Travis KE. Assessing speech exposure in the NICU: Implications for speech enrichment for preterm infants. J Perinatol 2020; 40 (10) 1537-1545
    CrossrefPubMedGoogle Scholar
  • 22 Hollingshead A. Four factor index of social status. New Haven, CT: Yale University; 1975
    Google Scholar
  • 23 Caskey M, Stephens B, Tucker R, Vohr B. Importance of parent talk on the development of preterm infant vocalizations. Pediatrics 2011; 128 (05) 910-916
    CrossrefPubMedGoogle Scholar
  • 24 Brignoni-Pérez E, Morales MC, Marchman VA. et al. Listening to mom in the NICU: effects of increased maternal speech exposure on language outcomes and white matter development in infants born very preterm. Trials 2021; 22 (01) 444
    CrossrefPubMedGoogle Scholar
  • 25 Grieser DAL, Kuhl PK. Maternal speech to infants in a tonal language: support for universal prosodic features in motherese. Dev Psychol 1988; 24 (01) 14-20
    CrossrefPubMedGoogle Scholar
  • 26 Scala M, Marchman VA, Brignoni-Pérez E, Morales MC, Dubner SE, Travis KE. Impact of the COVID-19 pandemic on developmental care practices for infants born preterm. Early Hum Dev 2021; 163: 105483
    CrossrefPubMedGoogle Scholar
  • 27 Kumar K, Marchman VA, Morales MC, Scala M, Travis KE. Investigating relations between the NICU speech environment and weight gain in infants born very preterm. medRxiv 2022; (e-pub ahead of print). DOI: 10.1101/2022.05.18.22275280.
    CrossrefPubMedGoogle Scholar