|
Article Excerpt
Survivors of the neonatal intensive care unit (NICU) have a higher prevalence of speech and language problems as compared to term babies; and those with prolonged respiratory support are most severely affected. The purpose of this study was (a) to investigate the relationship between the numbers of days of oral intubation and expressive language outcomes for premature infants and (b) to determine the best combination of predictors of expressive language outcomes for this population. An ambispective cohort study with 50 participants investigated the relationship between five variables of interest and expressive language at 24-30 months: birthweight, history of intraventricular hemorrhage, diagnosis of chronic lung disease, days on ventilator, and home on oxygen. Only days ventilated was found to be a significant predictor of expressive language outcomes. Results support a relationship between prolonged orotracheal intubation and speech outcomes.
**********
Survivors of the NICU have been reported to have a higher prevalence of speech and language problems as compared to term babies (Cusson, 2002; Luoma, Martikainen, & Ahonen, 1998; McAllister et al., 1993). Numerous studies have investigated the impact of various biological and environmental variables on the speech and language development of children born prematurely (McAllister et al., 1993; Wolke & Meyer, 1999). Of particular interest here is a study that suggests preterm infants with prolonged respiratory support are most often and most severely affected relative to speech and language outcomes (Hawdon, Beauregard, Slattery, & Kennedy, 2000). Studies investigating the long-term effects of intubation have focused on physical changes to the oral mechanism, but few have evaluated the specific impact of intubation on expressive language outcomes.
Infants with a history of low birthweight and intubation have been shown to exhibit a variety of oral defects that include notching or concavity of the alveolar ridge (Boice, Krous, & Foley, 1976; Duke, Coulson, Santos, & Johnson, 1976; Wetzel, 1980), palatal grooving (Fadavi, Punwani, Vidyasagar, & Adeni, 1990; Molteni & Bumstead, 1986), dental defects (Boice et al., 1976; Mason, Odell, & Longhurst, 1994; Wetzel, 1980), high arched palatal vaults (Kopra & Davis, 1991; Macey-Dare, Moles, Evans, & Nixon, 1999), and cleft palate (Duke et al., 1976).
Since the development of speech is thought to depend in large part on the structural integrity and function of the oral peripheral mechanism (Alexander, Boehme, & Cupps, 1993; Lacerda, 2001), the impact of intubation on language development in general, and speech development in particular, has been of interest to researchers (Bowman, Shanks, & Manion, 1972; Field, Dempsey, & Schuman, 1979; McAllister et al., 1993; Rothberg et al., 1983).
Bowman et al. (1972) reported a single case study in which prolonged nasotracheal intubation resulted in what they described as "minimal consequences" on the development of speech. Their subject reportedly failed to babble and did not begin approximating words until 25 months; however, this is not typical of a child who by 2 years of age is well on his or her way to being an effective communicator with an average expressive vocabulary of 200-300 words (Paul, 2001). Moreover, most 2-year-olds are also putting words together to create two-word utterances, beginning to use two-syllable words and producing 10 consonants with 70% accuracy (Paul, 2001). Consequently, the report that word approximations did not begin until 25 months of age is arguably more than a minimal consequence.
McAllister et al. (1993) reported that the use of mechanical ventilation for longer than 18 hours was not associated with poor speech and language outcomes at 3 years of age. Rather, they found that maternal education and pediatric complications had a greater impact on speech and language outcomes at 2 years of age than did mechanical ventilation. However, they did report that a diagnosis of respiratory distress syndrome was associated with poorer outcomes in articulation and language expression possibly related to intubation during the neonatal period. Similarly, Field et al. (1979) reported language production delays in 24% of children diagnosed with respiratory distress syndrome.
From the above discussion, it would seem that the few studies investigating the impact of intubation on speech and language development have yielded conflicting results. Given that intubation can lead to specific changes in oral growth and development, the integrity of the oral mechanism may be compromised for preterm infants with a history of prolonged respiratory support. Since the integrity of the oral mechanism impacts speech production specifically, it seems prudent to investigate the relationship between length of intubation and expressive language outcomes.
The purpose of this study was twofold: (a) to investigate the relationship between the numbers of days of...
|
