Predicting the outcome of specific language impairment at five years of age through early developmental assessment in preterm infants

Background: Very preterm infants (<. 30. weeks of gestation) are at increased risk of specific language impairment and systematic developmental follow-up is essential for the provision of targeted early intervention. Aims: To define the predictive value of early language testing and stability of language development, and perinatal and demographic risk factors for the diagnosis of SLI at 5. years, in a cohort of preterm infants. Study design: We used a retrospective hospital based cohort study. Subjects: Preterm infants <. 30. weeks of gestation, were cared for in NICU at RPAH, between 2004 and 2007, and prospectively enrolled in developmental follow-up. Standardised developmental assessment was done at 3. years utilising the Bayley Scales of Infant and Toddler Development-III and the Wechsler Preschool and Primary Scale of Intelligence-III was done at 5. years. Outcome measures: Predictive value and stability of early language testing were assessed with respect to SLI at 5. years, using measures of diagnostic accuracy and kappa values. Multivariate logistic regression was performed during the distribution of perinatal and demographic risk factors for SLI. Results: One-in-five met diagnostic criteria for SLI (19%, n. =. 24). Limited diagnostic accuracy was found with early expressive language and the stability of language scores demonstrated only fair agreement (Cohen's κ.383). Multilingual status and extreme gestational age at 24-25. weeks were associated with a six-fold increased risk of SLI (OR 6.09, 95% CI 1.89-19.56; OR 6.09, 95% CI 1.28-29.0). Conclusion: We defined a high incidence of SLI among our cohort, but only a limited diagnostic accuracy of early language testing. Multilingual status and extreme prematurity were independent risk factors for SLI. It remains imperative to perform continued developmental assessments beyond pre-school age to identify language impairment with greater accuracy.