Healthcare professionals, neonatal units, hospitals, health services, and follow-up services
Statement of standard
Standardised assessment of communication, speech, and language development is conducted by two years of age and repeated at transition to school.
Rationale
The goal is to assess and evaluate communication, speech and language development and guide pathways for parents and educational management in case of impairment.
Clinically significant long-term adverse effects of preterm birth have been shown for speech and language. (1–4) Biomedical risk factors, such as brain injury, extremely low gestational age, intrauterine growth restriction, and bronchopulmonary dysplasia (5–7), as well as social risk factors, such as low maternal education, lack of parenting responsiveness, and ethnical minority status (4,6,8), increase risk. Association with delays in other domains is common (30%) and very frequent in case of neurological damage (9), motor or neurosensory impairments. (10)
Weaknesses in early basic cognitive, communication and motor skills affect later language abilities. (5,6,11,12) In particular, gestural, and vocal production are less advanced in very preterm infants and predictive of language skills at two years. (6,13–15) Joint attention is weaker in very preterm infants but modulated by maternal behaviour. (16,17) Early feeding problems may contribute to oral, sensory, motor, and speech dysfunctions. (18) Delays in lexicon, grammar, and phonological skills are detectable at two-three years (2,5,19–23) and become more evident during preschool and school age when also pragmatic difficulties appear. (1,2,24–26)
Delays in phonological awareness, a precursor of literacy and school achievement, have been identified in very preterm infants at six and eight years. (24,27) Language difficulties impact learning and academic achievement as well as social interactions (28) and are associated with high individual and societal costs.
Benefits
Short-term benefits
N/A
Long-term benefits
Improved information on communication, speech, and language functioning that is required for diagnosis of communication, speech, and language impairment and for differential diagnosis (autism, etc.) (4,16)
Provides feedback to parents and/or main caretakers (4,16)
Improved planning of appropriate intervention or management (4,16)
Improved decision making for schooling and learning support (4,16)
Provides feedback to perinatal and neonatal services and healthcare officials (4,16)
Provides an endpoint for obstetric and neonatal high-quality trials (4,16)
Reduced undue performance pressure on the child (consensus)
Reduced risk of secondary mental health problems (consensus)
Improved parent-child interaction and adaptation to the child language skills (4,16)
Improved reading and writing skills and academic outcomes (consensus)
Increased social integration and quality of life (consensus)
Reduced social burden and social costs (consensus)
Components of the standard
Component
Grading of evidence
Indicator of meeting the standard
For parents and family
Parents are informed about and invited by healthcare professionals to attend follow-up programme including speech and language assessments.
B (High quality)
Patient information sheet1
Parents receive standardised feedback in language that is accessible to them.
A guideline on standardised follow-up programme including speech and language assessments is adhered to by all healthcare professionals.
B (High quality)
Guideline
Country specific test norms are applied when interpreting the results of screening tests. (30)
A (High quality)
Training documentation
Training on standardised speech and language assessments, in which gestational age and first language are taken into account is attended by all responsible healthcare professionals. (1–4,7)
A (High quality) B (High quality)
Training documentation
The predominant language at home (main caretaker), is noted in the assessment. (31,32)
A (High quality)
Parent feedback, training documentation
For neonatal unit, hospital, and follow-up team
A unit guideline on standardised follow-up programme including speech and language assessments is available and regularly updated.
B (High quality)
Guideline
Speech and language follow-up programme after discharge is funded and supported.
B (Moderate quality)
Audit report2
Appropriate assessment rooms and facilities are available (hospital or provider).
B (Moderate quality)
Audit report2
Follow-up rates are continuously monitored. (33,34)
A (High quality) B (Moderate quality)
Audit report2
Speech and language outcomes are used for healthcare professional feedback.
B (Moderate quality)
Training documentation
Training on standardised speech and language assessments is ensured.
B (High quality)
Training documentation
For health service
A national guideline on standardised follow-up programme including speech and language assessments is available and regularly updated.
B (High quality)
Guideline
A follow-up service including speech and language assessments is funded and monitored.
B (High quality)
Audit report2
1The indicator “patient information sheet” is an example for written, detailed information, in which digital solutions are included, such as web-based systems, apps, brochures, information leaflets, and booklets.
2The indicator “audit report” can also be defined as a benchmarking report.
Parents are provided with incentives to attend follow-up for those who are socially disadvantaged.
B (Moderate quality)
Families receive support in communication and language strategies.
B (Moderate quality)
For healthcare professionals
N/A
For neonatal unit, hospital, and follow-up team
Establish an integrated electronic system with communication, speech, and language follow-up provider to schedule follow-up visits.
B (Moderate quality)
Provide a dedicated assessment facility.
B (Moderate quality)
Support feeding, functioning or communication by physiotherapists and speech therapists.
B (Moderate quality)
For health service
Develop a national network for benchmarking of follow-up quality.
B (Moderate quality)
Provide common observation and clinical tools for identifying early indexes of risk of language delay in preterm children.
B (Moderate quality)
Getting started
Initial steps
For parents and family
Parents are informed by healthcare professionals about follow-up programme including speech and language assessments.
A service is initiated that uses parent reports using screening questionnaires. (35–42)
For healthcare professionals
Attend training on standardised speech and language assessments.
Institute a standard schedule of assessment.
Establish communication with other healthcare institutions providing follow-up care.
For neonatal unit, hospital, and follow-up team
Develop and implement a unit guideline on standardised speech and language assessments.
Develop information material on follow-up programme including speech and language assessments for parents.
Support healthcare professionals to participate in training on standardised speech and language assessments.
Provide space and resources for follow-up assessments in clinics or postal/online.
For health service
Develop and implement a national guideline on standardised follow-up programme including speech and language.
Barre N, Morgan A, Doyle LW, Anderson PJ. Language abilities in children who were very preterm and/or very low birth weight: a meta-analysis. J Pediatr. 2011 May;158(5):766–774.e1.
van Noort-van der Spek IL, Franken M-CJP, Weisglas-Kuperus N. Language functions in preterm-born children: a systematic review and meta-analysis. Pediatrics. 2012 Apr;129(4):745–54.
Sansavini A, Guarini A, Caselli MC. Preterm birth: neuropsychological profiles and atypical developmental pathways. Dev Disabil Res Rev. 2011;17(2):102–13.
Vohr B. Speech and language outcomes of very preterm infants. Semin Fetal Neonatal Med. 2014 Apr;19(2):78–83.
Sansavini A, Pentimonti J, Justice L, Guarini A, Savini S, Alessandroni R, et al. Language, motor and cognitive development of extremely preterm children: modeling individual growth trajectories over the first three years of life. J Commun Disord. 2014 Jun;49:55–68.
Sansavini A, Guarini A, Savini S, Broccoli S, Justice L, Alessandroni R, et al. Longitudinal trajectories of gestural and linguistic abilities in very preterm infants in the second year of life. Neuropsychologia. 2011 Nov 1;49(13):3677–88.
Wolke D, Samara M, Bracewell M, Marlow N, EPICure Study Group. Specific language difficulties and school achievement in children born at 25 weeks of gestation or less. J Pediatr. 2008 Feb;152(2):256–62.
Bozzette M. A Review of Research on Premature Infant-Mother Interaction. Newborn Infant Nurs Rev. 2007 Mar 1;7(1):49–55.
Woodward LJ, Moor S, Hood KM, Champion PR, Foster-Cohen S, Inder TE, et al. Very preterm children show impairments across multiple neurodevelopmental domains by age 4 years. Arch Dis Child Fetal Neonatal Ed. 2009 Sep;94(5):F339-344.
Mwaniki MK, Atieno M, Lawn JE, Newton CRJC. Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review. Lancet Lond Engl. 2012 Feb 4;379(9814):445–52.
Rose SA, Feldman JF, Jankowski JJ. A cognitive approach to the development of early language. Child Dev. 2009 Feb;80(1):134–50.
Rose SA, Feldman JF, Jankowski JJ. Modeling a cascade of effects: the role of speed and executive functioning in preterm/full-term differences in academic achievement. Dev Sci. 2011 Sep;14(5):1161–75.
Benassi E, Savini S, Iverson JM, Guarini A, Caselli MC, Alessandroni R, et al. Early communicative behaviors and their relationship to motor skills in extremely preterm infants. Res Dev Disabil. 2016 Jan;48:132–44.
Stolt S, Mäkilä A-M, Matomäki J, Lehtonen L, Lapinleimu H, Haataja L. The development and predictive value of gestures in very-low-birth-weight children: a longitudinal study. Int J Speech Lang Pathol. 2014 Apr;16(2):121–31.
Rvachew S, Creighton D, Feldman N, Sauve R. Vocal development of infants with very low birth weight. Clin Linguist Phon. 2005 Jun 1;19(4):275–94.
Landry SH, Garner PW, Swank PR, Baldwin CD. Effects of Maternal Scaffolding During Joint Toy Play With Preterm and Full-Term Infants. Merrill-Palmer Q. 1996;42(2):177–99.
Sansavini A, Zavagli V, Guarini A, Savini S, Alessandroni R, Faldella G. Dyadic co-regulation, affective intensity and infant’s development at 12 months: A comparison among extremely preterm and full-term dyads. Infant Behav Dev. 2015 Aug 1;40:29–40.
Sanchez K, Spittle AJ, Slattery JM, Morgan AT. Oromotor Feeding in Children Born Before 30 Weeks’ Gestation and Term-Born Peers at 12 Months’ Corrected Age. J Pediatr. 2016 Nov;178:113–118.e1.
Sansavini A, Guarini A, Justice LM, Savini S, Broccoli S, Alessandroni R, et al. Does preterm birth increase a child’s risk for language impairment? Early Hum Dev. 2010 Dec;86(12):765–72.
Stolt S, Haataja L, Lapinleimu H, Lehtonen L. The early lexical development and its predictive value to language skills at 2 years in very-low-birth-weight children. J Commun Disord. 2009 Apr;42(2):107–23.
Foster-Cohen S, Edgin JO, Champion PR, Woodward LJ. Early delayed language development in very preterm infants: evidence from the MacArthur-Bates CDI. J Child Lang. 2007 Aug;34(3):655–75.
D’Odorico L, Majorano M, Fasolo M, Salerni N, Suttora C. Characteristics of phonological development as a risk factor for language development in Italian-speaking pre-term children: A longitudinal study. Clin Linguist Phon. 2011 Jan;25(1):53–65.
Ortiz-Mantilla S, Choudhury N, Leevers H, Benasich AA. Understanding language and cognitive deficits in very low birth weight children. Dev Psychobiol. 2008 Mar;50(2):107–26.
Guarini A, Sansavini A, Fabbri C, Savini S, Alessandroni R, Faldella G, et al. Long-term effects of preterm birth on language and literacy at eight years. J Child Lang. 2010 Sep;37(4):865–85.
Guarini A, Marini A, Savini S, Alessandroni R, Faldella G, Sansavini A. Linguistic features in children born very preterm at preschool age. Dev Med Child Neurol. 2016;58(9):949–56.
Wolke D, Dipl‐Psych; RM. Cognitive status, language attainment, and prereading skills of 6-year-old very preterm children and their peers: the Bavarian Longitudinal Study. Dev Med Child Neurol. 1999 Feb 1;41(2):94–109.
Guarini A, Sansavini A, Fabbri C, Alessandroni R, Faldella G, Karmiloff-Smith A. Reconsidering the impact of preterm birth on language outcome. Early Hum Dev. 2009 Oct;85(10):639–45.
St Clair MC, Pickles A, Durkin K, Conti-Ramsden G. A longitudinal study of behavioral, emotional and social difficulties in individuals with a history of specific language impairment (SLI). J Commun Disord. 2011 Apr;44(2):186–99.
Pineda R, Durant P, Mathur A, Inder T, Wallendorf M, Schlaggar BL. Auditory Exposure in the Neonatal Intensive Care Unit: Room Type and Other Predictors. J Pediatr. 2017 Apr;183:56–66.e3.
Westera JJ, Houtzager BA, Overdiek B, van Wassenaer AG. Applying Dutch and US versions of the BSID-II in Dutch children born preterm leads to different outcomes. Dev Med Child Neurol. 2008 Jun;50(6):445–9.
DeAnda S, Bosch L, Poulin-Dubois D, Zesiger P, Friend M. The Language Exposure Assessment Tool: Quantifying Language Exposure in Infants and Children. J Speech Lang Hear Res JSLHR. 2016 Dec 1;59(6):1346–56.
Hoff E, Core C, Place S, Rumiche R, Señor M, Parra M. Dual language exposure and early bilingual development. J Child Lang. 2012 Jan;39(1):1–27.
Hille ETM, Elbertse L, Gravenhorst JB, Brand R, Verloove-Vanhorick SP, Dutch POPS-19 Collaborative Study Group. Nonresponse bias in a follow-up study of 19-year-old adolescents born as preterm infants. Pediatrics. 2005 Nov;116(5):e662-666.
Wolke D, Söhne B, Ohrt B, Riegel K. Follow-up of preterm children: important to document dropouts. The Lancet. 1995 Feb 18;345(8947):447.
Fenson L, Marchman V, Thal D, Dale P, Reznick J, Bates E. MacArthur-Bates Communicative Development Inventories: User’s guide and technical manual. 2nd ed. Baltimore, MD: Brookes; 2007.
Johnson S, Wolke D, Marlow N, Preterm Infant Parenting Study Group. Developmental assessment of preterm infants at 2 years: validity of parent reports. Dev Med Child Neurol. 2008 Jan;50(1):58–62.
Cuttini M, Ferrante P, Mirante N, Chiandotto V, Fertz M, Dall’Oglio AM, et al. Cognitive assessment of very preterm infants at 2-year corrected age: performance of the Italian version of the PARCA-R parent questionnaire. Early Hum Dev. 2012 Mar;88(3):159–63.
Hix-Small H, Marks K, Squires J, Nickel R. Impact of implementing developmental screening at 12 and 24 months in a pediatric practice. Pediatrics. 2007 Aug;120(2):381–9.
Marks K, Hix-Small H, Clark K, Newman J. Lowering developmental screening thresholds and raising quality improvement for preterm children. Pediatrics. 2009 Jun;123(6):1516–23.
Schonhaut L, Armijo I, Schönstedt M, Alvarez J, Cordero M. Validity of the Ages and Stages Questionnaires in Term and Preterm Infants. Pediatrics. 2013 May 1;131(5):e1468–74.
Flamant C, Branger B, Tich SNT, Rochebrochard E de L, Savagner C, Berlie I, et al. Parent-Completed Developmental Screening in Premature Children: A Valid Tool for Follow-Up Programs. PLOS ONE. 2011 May 26;6(5):e20004.
Squires J, Bricker D, Potter L. Revision of a parent-completed development screening tool: Ages and Stages Questionnaires. J Pediatr Psychol. 1997 Jun;22(3):313–28.
November 2018 / 1st edition / next revision: 2023
Recommended citation
EFCNI, Sansavini A, Bosch L et al., European Standards of Care for Newborn Health: Communication, speech, and language. 2018.
