Maternal singing sustains preterm hospitalized newborns' autonomic nervous system maturation: an RCT.

BACKGROUND: Premature birth is known to affect the newborn's autonomic nervous system (ANS) maturation, with potential short and long-term impact on their neurobehavioral development. The purpose of the study was to investigate the effects of maternal directed singing and speaking on the preterm infants' autonomic nervous system (ANS) maturation as measured by the heart rate variability (HRV) parameters. METHODS: In this multi-center randomized clinical trial, 30 stable preterm infants (m = 29,6 weeks of gestational age), without any abnormalities were randomized into an intervention (16) or a control group (14). HRV was measured weekly, for a total of 80 recordings during hospitalization, as well as before and after each session of singing or speaking. RESULTS: The intervention group showed a significant increase of the percentage value of HRV power in the high frequency range when compared to the control group (p = 0.044). More specifically, the maternal singing significantly increased the high frequency power and decreased the low/high frequency power ratio (p = 0.037). CONCLUSIONS: The preterm infant's vagal activity significantly increased in the intervention group, potentially enhancing their ANS maturation. The effect is specifically evidenced in the singing condition. IMPACT: Maternal singing affects the autonomic nervous system maturation of preterm hospitalized newborns in the NICU. No previous studies investigated how early vocal parental intervention can affect preterm infants developement, throught their autonomic nervous system maturation. Early Vocal Contact as an early intervention involving parents has a positive impact on preterm infant's development and it can be easily implemented in the care of preterm infants. TRIAL REGISTRATION: NCT04759573, retrospectively registered, 17 February 2021.

Neurodevelopmental Correlates of Brain Magnetic Resonance Imaging Abnormalities in Extremely Low-birth-weight Infants.

OBJECTIVE: To evaluate the relationship between impaired brain growth and structural brain abnormalities at term-equivalent age (TEA) and neurodevelopment in extremely low-birth-weight (ELBW) infants over the first 2 years. METHODS: ELBW infants born from 2009 through 2018 and undergoing brain magnetic resonance imaging (MRI) at TEA were enrolled in this retrospective cohort study. MRI scans were reviewed using a validated quali-quantitative score, including several white and gray matter items. Neurodevelopment was assessed at 6, 12, 18, and 24 months using the Griffiths scales. The independent associations between MRI subscores and the trajectories of general and specific neurodevelopmental functions were analyzed by generalized estimating equations. RESULTS: One hundred-nine ELBW infants were included. White matter volume reduction and delayed myelination were associated with worse general development (b = -2.33, P = .040; b = -6.88, P = .049 respectively), social skills (b = -3.13, P = .019; b = -4.79, P = .049), and eye-hand coordination (b = -3.48, P = .009; b = -7.21, P = .045). Cystic white matter lesions were associated with poorer motor outcomes (b = -4.99, P = .027), while white matter signal abnormalities and corpus callosum thinning were associated with worse nonverbal cognitive performances (b = -6.42, P = .010; b = -6.72, P = .021, respectively). Deep gray matter volume reduction correlated with worse developmental trajectories. CONCLUSIONS: Distinctive MRI abnormalities correlate with specific later developmental skills. This finding may suggest that TEA brain MRI may assist with neurodevelopmental prediction, counseling of families, and development of targeted supportive interventions to improve neurodevelopment in ELBW neonates.

Neurodevelopmental outcomes of very preterm infants born following early foetal growth restriction with absent end-diastolic umbilical flow.

This study aims to assess the impact of time of onset and features of early foetal growth restriction (FGR) with absent end-diastolic flow (AEDF) on pregnancy outcomes and on preterm infants' clinical and neurodevelopmental outcomes up to 2 years corrected age. This is a retrospective, cohort study led at a level IV Obstetric and Neonatal Unit in Bologna, Italy. Pregnant women were eligible if having singleton pregnancies, with no major foetal anomaly detected, and diagnosed with early FGR + AEDF (defined as FGR + AEDF detected before 32 weeks gestation). Early FGR + AEDF was further classified according to time of onset and specific features into very early and persistent (VEP, FGR + AEDF first detected at 20-24 weeks gestation and persistent at the following scans), very early but transient (VET, FGR + AEDF detected at 20-24 weeks gestation and progressively improving at the following scans) and later (LA, FGR + AEDF detected between 25 and 32 weeks gestation). Pregnancy and neonatal outcomes and infant follow-up data were collected and compared among groups. Neurodevelopment was assessed using the revised Griffiths Mental Developmental Scales (GMDS-R) 0-2 years. A regression analysis was performed to identify early predictors of preterm infants' neurodevelopmental impairment. Fifty-two pregnant women with an antenatal diagnosis of early FGR + AEDF were included in the study (16 VEP, 14 VET, 22 LA). Four intrauterine foetal deaths occurred, all in the VEP group (p = 0.010). Compared to LA infants, VEP infants were born with lower gestational age and lower birth weight, had lower arterial cord blood pH and were at higher risk for intraventricular haemorrhage and periventricular leukomalacia (p < 0.05 for all comparisons). At 12 months, VEP infants had worse GMDS-R scores, both in the general quotient (mean [SD] 91.8 [12.4] vs 104.6 [8.7] in LA) and in the performance domain (mean [SD] 93.3 [15.4] vs 108.8 [8.8] in LA). This latter difference persisted at 24 months (mean [SD] 68.3 [17.0] vs 92.9 [17.7] in LA). In multivariate analysis, at 12 months corrected age, PVL was found to be an independent predictor of impaired general quotient, while the features and timing of antenatal Doppler alterations predicted worse scores in the performance domain.   Conclusion: Timing of onset and features of early FGR + AEDF might impact differently on neonatal clinical and neurodevelopmental outcomes. Shared awareness of the importance of FGR + AEDF features between obstetricians and neonatologists may offer valuable tools for antenatal counselling and for tailoring pregnancy management and neonatal follow-up in light of specific antenatal and neonatal risk factors. What is Known: • Foetal growth restriction (FGR), together with antenatal umbilical Doppler abnormalities, is known to affect maternal and neonatal outcomes. • Infants born preterm and growth-restricted face the highest risk for neurodevelopmental impairment, especially when FGR occurs early during pregnancy (early FGR, before 32 weeks gestation). What is New: • The timing of onset and features of FGR and antenatal umbilical Doppler abnormalities impact differently on maternal and neonatal outcomes; when FGR and Doppler abnormalities occur very early, at the limit of neonatal viability, and persist until delivery, infants face the highest risk for neurodevelopmental impairment. • Shared knowledge between obstetricians and neonatologists about timing of onset and features of FGR would provide a valuable tool for informed antenatal counselling in high-risk pregnancies.

The effects of an active breaks intervention on physical and cognitive performance: results from the I-MOVE study.

BACKGROUND: The present quasi-experimental study aimed to evaluate the effects of active breaks intervention (ABs) to promote physical and cognitive improvement in primary school. METHODS: The active breaks group (ABsG) performed 10 min of ABs three times per school day and the control group (CG) did normal lessons. The baseline and follow-up evaluation was conducted respectively in October 2019 and in May 2021. Cognitive performance was assessed using working memory test, physical performance was analyzed with ActiGraph accelerometers and physical fitness tests, quality of life was monitored using the Paediatric Quality of Life questionnaire (PedsQL) and classroom behavior was collected with an ad hoc questionnaire. RESULTS: We enrolled 153 children (age: 7.61 ± 1.41, 54.2% males). Working memory significantly increased in the ABsG (ΔWM: 1.30 ± 1.17) than in CG (ΔWM: 0.96 ± 1.20). The 6 min Cooper test increased in the ABsG (Δ: 1.77 ± 136.03) but not in CG (Δ: -156.42 ± 187.53), P < 0.05. The weekly physical activity levels increased in both groups; however, the sedentary behavior significantly increased both in ABsG and CG. Children reported improvements in their quality of school life including feeling better in class and in school when using ABs; moreover, children improved their time on task behaviors in ABsG. CONCLUSION: The present study has proven to be effective on children's physical and cognitive performance.

Predischarge cerebral oxygenation and psychomotor outcome in very preterm infants: is there an association?

This observational study aimed to investigate whether predischarge cerebral oxygenation (CrSO2), monitored by near-infrared spectroscopy, correlates with later psychomotor outcome in very preterm infants. Infants <32 weeks' gestation or <1500 g without evidence of major brain lesions underwent a 3-h continuous CrSO2 monitoring before hospital discharge. Psychomotor development was assessed at 6, 12, 18, and 24 months using the Griffiths Mental Developmental Scales. The developmental quotients (DQ) at each follow-up appointment were correlated with predischarge CrSO2. Significant correlations were adjusted for possible confounders. Sixty-three infants were enrolled. A significant correlation between CrSO2 and DQ was observed at 6 months ca (p=0.010), but not at later psychomotor assessments. This correlation was confirmed significant (b=0.274, p=0.038) even after the adjustment for relevant covariates.   Conclusion: According to these preliminary findings, the association between predischarge CrSO2 and psychomotor development over the first 24 months in preterm infants without major brain lesions is time-limited. Hence, this parameter may not represent an effective predictor for medium-term neurodevelopment. What is Known: • Prematurity is a major risk factor for adverse neurodevelopment. • The validation of clinical tools for psychomotor outcome prediction may aid to identify high-risk preterm infants who might benefit from early interventions. What is New: • In infants without major brain lesions, predischarge CrSO2 correlates with psychomotor outcome at 6 months ca but not later, indicating a short time predictability.

Early-life gut microbiota and neurodevelopment in preterm infants: any role for Bifidobacterium?

Despite the well-recognized importance of proper gut microbiota assembly for the child's future health, the connections between the early-life gut microbiota and neurocognitive development in humans have not been thoroughly explored so far. In this pilot observational study, we aimed to unveil the relation between dynamic succession of the gut microbiota in very low birth weight infants during the first month of life and their neurodevelopment, assessed at 24-month corrected age. According to our data, the early-life gut microbiota of preterm infants with normal vs. impaired neurodevelopment followed distinct temporal trajectories with peculiar compositional rearrangements. In this context, early Bifidobacterium deficiency appears to be a negative biomarker of adverse neurological outcomes. CONCLUSION: Our data might pave the way for future in-depth studies focusing on the potential impact of bifidobacteria or specific microbiota patterns on neonatal neurodevelopment and lay the foundation for microbiome-based clinical practices to modulate altered profiles and improve long-term health. WHAT IS KNOWN: • Preterm infants are at increased risk for adverse neurological outcomes and gut microbiota dysbiosis. • The gut microbiota and the nervous system share critical developmental windows in early life. WHAT IS NEW: • The absence of Bifidobacterium at 30 days of life in preterm infants is associated with neurodevelopmental impairment in early childhood. • The administration of Bifidobacterium strains could promote optimal neurocognitive development in fragile infants.

The impact of COVID-19 on physical activity behaviour in Italian primary school children: a comparison before and during pandemic considering gender differences.

BACKGROUND: The World Health Organization stated an average of 60 min of Moderate to Vigorous Physical Activity (MVPA) that children should accumulate every day. Nevertheless physical inactivity is growing and, due to restrictions imposed during pandemic, PA levels of children might be more negatively affected. The study aimed to analyse the impact of COVID-19 on the PA of an Italian sample of primary school children by comparing it before and during COVID-19 considering gender differences. METHODS: A pre-post analysis (October 2019-January 2021) was conducted using a randomized sample (N = 77) from the I-MOVE study settled in an Italian primary school. Both objective (Actigraph accelerometers) and self-reported (PAQ-c questionnaires) assessments of PA were performed. Changes were compared using T-Student and Chi-Square test. Gender differences were calculated using Anova. RESULTS: Weekly and daily minutes time spent in MVPA significantly decreased respectively by - 30.59 ± 120.87 and - 15.32 ± 16.21 from before to during pandemic while the weekly time spent in sedentary behaviour increased (+ 1196.01 ± 381.49). PAQ-c scores followed the same negative trend (- 0.87 ± 0.72). Boys seem to have suffered more than girls from the imposed restrictions. CONCLUSION: These findings outline the need for strategies to promote PA and reduce sedentary behaviours in children to prevent COVID-19 restriction long-term effects.

Distance Education among Italian Teachers: Differences and Experiences.

The successful integration of technology in teaching is a key component of education. Although prior research highlighted factors fostering the use of technology by teachers, few studies focused on whether these factors vary among teachers of different grade levels and subjects. Moreover, no studies have investigated personal experiences related to distance education among a large sample of teachers. To address these gaps, the present mixed-method study sought to examine whether factors promoting distance education varied among Italian teachers of different grade levels and subjects. A further aim was to explore experiences of teachers using distance education. The sample involved 357 Italian teachers and preservice teachers who completed an online questionnaire during the COVID-19 pandemic that also contained open-ended questions. Findings indicated that teaching self-efficacy was greater in pre-service and primary teachers, while facilitating conditions were greater in humanities and science secondary teachers. The perceived ease of use of technology and technology for pedagogy skills were more pronounced among science secondary teachers. Advanced technology skills were lower in humanities secondary teachers while the behavioural intention to use technology was greatest among pre-service teachers. Four themes emerged from the qualitative study of teachers' insights. These included positive and negative aspects of using technology, the relationship with students, the versatility of distance education, and the quality of lessons. This study underscores the need to address training based on different teachers' grade levels and subjects, and to focus on the emerging themes to better integrate the use of technology in schools.

Linguistic features in children born very preterm at preschool age.

AIM: This cross-sectional study focused on the effect of very preterm (VPT) birth on language development by analysing phonological, lexical, grammatical, and pragmatic skills and assessing the role of cognitive and memory skills. METHOD: Sixty children (29 males, 31 females) born VPT (<32wks) aged 5 years were compared with 60 children with typical development. The linguistic assessment was performed by administering a battery of Italian tests for the evaluation of language; cognitive and memory skills were assessed by Raven's coloured progressive matrices and digit span subtest (Wechsler Intelligence Scale for Children [WISC-III]). RESULTS: Children born VPT showed delays in lexical (comprehension: z-score difference -1.18; 95% confidence interval [CI] -1.60 to -0.77; naming: -0.88; 95% CI -1.19 to -0.58) and pragmatic skills (comprehension: -0.76; 95% CI -1.02 to -0.49; narrative production: -0.47; 95% CI -0.72 to -0.23). Delays in phonology and grammar were less diffuse, involving productive skills (-1.09; 95% CI -1.64 to -0.54; -0.48; 95% CI -0.85 to -0.12, respectively), and were dependent by cognitive and memory skills. Lexical delays were more specific. INTERPRETATION: The linguistic profile of children born preterm is characterized by some abilities more impaired than others. This highlights the need of a linguistic assessment at the end of preschool age in order to plan a focused intervention aimed at improving lexical and pragmatic skills.

Investigating Facilitators and Barriers for Active Breaks among Secondary School Students: Formative Evaluation of Teachers and Students.

Physical activity in the form of "active breaks" can be combined with academic instruction in primary school. However, few studies have examined the feasibility of conducting active breaks in secondary school. To address this gap, we conducted focus groups (FGs) regarding the implementation of an active breaks (ABs) protocol with 20 teachers and 10 secondary school students. Barriers/facilitators toward the implementation of ABs were classified using grounded theory inductive methods framed by the socio-ecological model. Individual-level factors were instrumental for both teachers and students. Teachers highlighted personal fears and concerns regarding using ABs, while students reported fears related to peer behaviour during the activity. Both teachers and students agreed that ABs can improve cognitive skills and time-on-task behaviour. Teachers articulated concerns related to student behaviour during ABs including possible social exclusion and injury. Students felt that ABs might affect classroom management and interfere with maintaining students' academic focus. Teachers underscored that ABs required social support from the administration and colleagues. Students felt that ABs could support teachers' instructional focus and provide them with an energy respite. Collectively, the FGs suggested that environmental limitations could hinder the implementation of ABs. Involving teacher and student feedback during the codesign phase can rationally inform the design of school-based ABs.

Lexical skills and gesture use: A comparison between expressive and receptive/expressive late talkers.

BACKGROUND: Studies on late talkers (LTs) highlighted their heterogeneity and the relevance of describing different communicative profiles. AIMS: To examine lexical skills and gesture use in expressive (E-LTs) vs. receptive-expressive (R/E-LTs) LTs through a structured task. METHODS AND PROCEDURES: Forty-six 30-month-old screened LTs were distinguished into E-LTs (n= 35) and R/E-LTs (n= 11) according to their receptive skills. Lexical skills and gesture use were assessed with a Picture Naming Game by coding answer accuracy (correct, incorrect, no response), modality of expression (spoken, spoken-gestural, gestural), type of gestures (deictic, representational), and spoken-gestural answers' semantic relationship (complementary, equivalent, supplementary). OUTCOMES AND RESULTS: R/E-LTs showed lower scores than E-LTs for noun and predicate comprehension with fewer correct answers, and production with fewer correct and incorrect answers, and more no responses. R/E-LTs also exhibited lower scores in spoken answers, representational gestures, and equivalent spoken-gestural answers for noun production and in all spoken and gestural answers for predicate production. CONCLUSIONS AND IMPLICATIONS: Findings highlighted more impaired receptive and expressive lexical skills and lower gesture use in R/E-LTs compared to E-LTs, underlying the relevance of assessing both lexical and gestural skills through a structured task, besides parental questionnaires and developmental scales, to describe LTs' communicative profiles.

Eye-Movements in a Text Reading Task: A Comparison of Preterm Children, Children with Dyslexia and Typical Readers.

Preterm birth is associated with weaknesses in reading skills that are usually less severe than those of children with dyslexia. To understand the characteristics of reading processes in preterm children, we adopted a cross-population and multi-modal approach comparing eye movements in reading tasks among three groups: children with preterm birth, children with a diagnosis of dyslexia, and children with typical development. The study involved 78 participants (10.5 years). Eye movements (number and duration of fixations, amplitude and number of saccades, number of regressions) were recorded during the silent reading of two texts; cognitive and reading standardized tasks were also administered. Children with dyslexia had more fixations and more frequent and smaller saccades compared to the preterm group and children with typical development. They also showed more regressions compared to the control group. Preterm children showed shorter fixations compared to the other groups. Cognitive and reading standardized tasks confirmed severe delays in reading in children with dyslexia and some weaknesses in text reading speed and comprehension in preterm children. These results are discussed with reference to candidate mechanisms that underlie reading processes in preterm children and considering possible implications for research.

Early-life gut microbiota and neurodevelopment in preterm infants: a narrative review.

Infants born preterm are at a high risk of both gut microbiota (GM) dysbiosis and neurodevelopmental impairment. While the link between early dysbiosis and short-term clinical outcomes is well established, the relationship with long-term infant health has only recently gained interest. Notably, there is a significant overlap in the developmental windows of GM and the nervous system in early life. The connection between GM and neurodevelopment was first described in animal models, but over the last decade a growing body of research has also identified GM features as one of the potential mediators for human neurodevelopmental and neuropsychiatric disorders. In this narrative review, we provide an overview of the developing GM in early life and its prospective relationship with neurodevelopment, with a focus on preterm infants. Animal models have provided evidence for emerging pathways linking early-life GM with brain development. Furthermore, a relationship between both dynamic patterns and static features of the GM during preterm infants' early life and brain maturation, as well as neurodevelopmental outcomes in early childhood, was documented. Future human studies in larger cohorts, integrated with studies on animal models, may provide additional evidence and help to identify predictive biomarkers and potential therapeutic targets for healthy neurodevelopment in preterm infants.

Describing communication profiles of low-risk preterm and full-term late talkers.

INTRODUCTION: Late talkers represent a heterogeneous population. We aimed to describe communication profiles of low-risk preterm and full-term late talkers according to their receptive and expressive vocabulary size, considering communicative, linguistic, cognitive, and motor skills, as well as biological and environmental risk factors. METHODS: Sixty-eight late talkers (33 born low-risk preterm and 35 full-term) were identified through a language screening at 30 months. Parents filled out the Italian Short Forms of the MacArthur Bates Communicative Development Inventories and the Socio Conversational Skills Rating Scales. Children were assessed with the Picture Naming Game test and the Bayley Scales of Infant and Toddler Development. RESULTS: A two-step cluster analysis identified three distinct profiles among late talkers according to their receptive and expressive vocabulary size. Severe late talkers (25%) showed less frequent use of pointing, limited verbal imitation, receptive vocabulary size, lexical and sentence production, responsiveness and assertiveness, and lower cognitive scores than mild late talkers (40%). Moderate late talkers (35%) showed less frequent verbal imitation, limited lexical and sentence production and lower cognitive scores than mild late talkers. Male gender was significantly more represented in the severe late profile, whereas other biological and environmental factors did not differ among the three profiles. CONCLUSIONS: Findings highlighted the relevance of assessing communicative, lexical, grammar, pragmatic, and cognitive skills to describe late talkers' profiles. A deeper investigation of phonological skills might also contribute to a further understanding of interindividual variability in this population.

Mindful Parenting Intervention MinUTo App for Parents of Preschool Children: Study Protocol of a Randomised Controlled Trial.

BACKGROUND: Mindful parenting and the use of technology for parenting intervention have expanded separately from one another with promising results, but their relationship is underexplored. The current study protocol proposes a new universal intervention via app, MINd Us TOghether (MinUTo), based on mindful parenting for parents of typically developing children of 4-5 years of age. METHODS: The effect of the intervention is evaluated using a randomised controlled trial. Around 2000 parents are enrolled and randomised to the intervention and control groups. Data are collected in three different waves from parents at baseline and endline; APP usage data allow for the analysis of intervention adherence. The MinUTo app proposes contents and activities for five dimensions of mindful parenting. Each dimension is presented within a two-week distance, explaining its importance, providing information, and offering activities for parents and children. EXPECTED RESULTS: We hypothesise a positive effect of the intervention on primary outcomes (mindful parenting, parenting stress, parent behaviours and parental time investment), increasing parents' skills and promoting a positive parent-child relationship. We also test possible effects on secondary outcomes (parenting attitudes and beliefs) at an explorative level. CONCLUSIONS: The study will add new considerations about the psychological and economic impact of technologies in implementing parenting interventions in non-clinical populations.

Night Sleep and Parental Bedtime Practices in Low-Risk Preterm and Full-Term Late Talkers.

Night sleep and parental bedtime practices have rarely been investigated in late talkers. This study aimed to explore: night sleep, parental bedtime practices, and their associations in late talkers as well as individual, socio-demographic, and socio-relational factors affecting them. Parents of 47 30-month-old late talkers, born low-risk preterm (n = 24) or full-term (n = 23), with an expressive vocabulary size ≤10th percentile measured by the MacArthur-Bates Communicative Development Inventory Words and Sentences, and normal cognitive abilities measured by the Bayley Scales, completed the Infant Sleep Questionnaire, the Parental Interactive Bedtime Behaviour Scale, and the Parenting Stress Index Short Form. Results showed slight settling difficulties, night wakings, and frequent co-sleeping in late talkers. Encouraging autonomy practices were frequently used by parents, rather than active physical comforting ones. Recurrent settling difficulties were reported by parents who often applied encouraging autonomy practices, whereas greater night waking problems and frequent co-sleeping were reported by parents who often left their child crying. Low-risk preterm birth and mother's parenting stress predicted total sleep difficulties and night wakings; first-born, high maternal education level and mother's parenting stress predicted settling difficulties; mother's parenting stress was the only predictor for co-sleeping and leaving to cry. These findings have relevant implications for improving late talkers' night sleep and their parents' bedtime practices.

Integrating Gestures and Words to Communicate in Full-Term and Low-Risk Preterm Late Talkers.

Young children use gestures to practice communicative functions that foster their receptive and expressive linguistic skills. Studies investigating the use of gestures by late talkers are limited. This study aimed to investigate the use of gestures and gesture-word combinations and their associations with word comprehension and word and sentence production in late talkers. A further purpose was to examine whether a set of individual and environmental factors accounted for interindividual differences in late talkers' gesture and gesture-word production. Sixty-one late talkers, including 35 full-term and 26 low-risk preterm children, participated in the study. Parents filled out the Italian short forms of the MacArthur-Bates Communicative Development Inventories (MB-CDI), "Gesture and Words" and "Words and Sentences" when their children were 30-months-old, and they were then invited to participate in a book-sharing session with their child. Children's gestures and words produced during the book-sharing session were transcribed and coded into CHAT of CHILDES and analyzed with CLAN. Types of spontaneous gestures (pointing and representational gestures) and gesture-word combinations (complementary, equivalent, and supplementary) were coded. Measures of word tokens and MLU were also computed. Correlational analyses documented that children's use of gesture-word combinations, particularly complementary and supplementary forms, in the book-sharing session was positively associated with linguistic skills both observed during the session (word tokens and MLU) and reported by parents (word comprehension, word production, and sentence production at the MB-CDI). Concerning individual factors, male gender was negatively associated with gesture and gesture-word use, as well as with MB-CDI action/gesture production. In contrast, having a low-risk preterm condition and being later-born were positively associated with the use of gestures and pointing gestures, and having a family history of language and/or learning disorders was positively associated with the use of representational gestures. Furthermore, a low-risk preterm status and a higher cognitive score were positively associated with gesture-word combinations, particularly complementary and supplementary types. With regard to environmental factors, older parental age was negatively associated with late talkers' use of gestures and pointing gestures. Interindividual differences in late talkers' gesture and gesture-word production were thus related to several intertwined individual and environmental factors. Among late talkers, use of gestures and gesture-word combinations represents a point of strength promoting receptive and expressive language acquisition.

Maternal Singing but Not Speech Enhances Vagal Activity in Preterm Infants during Hospitalization: Preliminary Results.

BACKGROUND: Early parental interventions in the Neonatal Intensive Care Units (NICUs) have beneficial effects on preterm infants' short and long-term outcomes. The aim of this study was to investigate the effects of Early Vocal Contact (EVC)-singing and speaking-on preterm infants' vagal activity and autonomic nervous system (ANS) maturation. METHODS: In this multi-center randomized clinical trial, twenty-four stable preterm infants, born at 25-32 weeks gestational age, were randomized to either the EVC group or control group, where mothers did not interact with the babies but observed their behavior. Heart Rate Variability (HRV) was acquired before intervention (pre-condition), during vocal contact, and after it (post condition). RESULTS: No significant effect of the vocal contact, singing and speaking, was found in HRV when the intervention group was compared to the control group. However, a significant difference between the singing and the pre and post conditions, respectively, preceding and following the singing intervention, was found in the Low and High Frequency power nu, and in the low/high frequency features (p = 0.037). By contrast, no significant effect of the speaking was found. CONCLUSIONS: Maternal singing, but not speaking, enhances preterm infants' vagal activity in the short-term, thus improving the ANS stability. Future analyses will investigate the effect of enhanced vagal activity on short and long-term developmental outcomes of preterm infants in the NICU.

Special Issue: Preterm Birth: Research, Intervention and Developmental Outcomes.

As indicated by the World Health Organization, preterm birth is a relevant public health issue, being one of the leading causes of death in children under five years of age [...].