Cleft Lip and/or Palate in Infants Prenatally Exposed to Opioids.

OBJECTIVE: To determine the prevalence and odds ratios for cleft lip and/or palate (CL/P) among infants prenatally exposed to opioids with or without neonatal opioid withdrawal syndrome (NOWS). DESIGN: This study represents an exploratory, retrospective cohort study design of newborn medical health records from 2011 to 2016. SETTING: Records were drawn from a regional health system located in South Central Appalachia. POPULATION AND STUDY SAMPLE: The original population yielded 3 cohorts of infants: (1) infants with opioid exposure (OE) but not requiring pharmacological intervention (OE; N = 168); (2) infants with NOWS requiring pharmacological intervention (N = 294); and (3) infants with no opioid exposure (NOE; N = 16 090), the primary comparison group. MAIN OUTCOME: Infants in the NOWS and OE groups showed significantly increased prevalence and odds ratios for CL/P when compared to those in the NOE group. RESULTS: Prevalence rates per 1000 live births for infants with OE (35.71) and infants with NOWS (6.80) were significantly higher than those for infants with NOE (1.37). Comparison of infants with OE to the NOE group revealed significantly increased odds for CL/P, isolated cleft palate (CP), cleft lip (CL), and cleft lip and palate (CLP) (27.05, 41.81, 19.26, 19.37, respectively; all Ps < .008). The odds ratios for infants with NOWS compared to the NOE group were significantly higher for CL/P and CP (5.00 and 10.98, respectively; Ps < .03) but not for CL and CLP. CONCLUSION: The results provide additional evidence that prenatal OE should be considered among the critical environmental risk factors that can contribute to CL/P.

Newborn Hearing Screening Results for Infants With Prenatal Opioid Exposure in Southern Appalachia.

PURPOSE: Infants prenatally exposed to opioids exhibit withdrawal symptomology that introduce physiological noise and can impact newborn hearing screening results. This study compared the referral rate and physiological noise interpreted by number of trials rejected due to artifact on initial newborn hearing screenings of infants with prenatal opioid exposure (POE) and infants with no opioid exposure (NOE). Furthermore, within the POE group, it examined the relationship of referral rates with severity of withdrawal symptomology, and with maternal and infant risk factors. METHOD: This study used a retrospective cohort design of electronic medical records from six delivery hospitals in South-Central Appalachia. Newborn hearing screenings were conducted using automated auditory brainstem response (ABR) for 334 infants with POE and 226 infants with NOE. Severity of withdrawal symptomology was measured using the Modified Finnegan Neonatal Abstinence Scoring Tool, which includes observation of behaviors that introduce physiological noise. RESULTS: There was no significant difference in newborn hearing screening referral rate between infants with POE and infants with NOE. Referral rate was not affected by maternal or infant risk factors. Infants with POE had statistically significant higher artifact (defined as rejected ABR sweeps) than infants with NOE. There was a strong positive correlation between Finnegan scores and artifact but not referral rates. Sensitivity and specificity analysis indicated artifact decreased substantially after Day 4 of life. CONCLUSIONS: Referral rates of infants with POE were similar to those of infants with NOE. Nevertheless, the withdrawal symptomology of infants with POE introduces physiological noise reflected as artifact on ABR, which can affect efficiency of newborn hearing screenings.

Early and later vocalization skills in children with and without cleft palate.

OBJECTIVE: The purpose of this study was to describe the early vocalization skills in children with cleft lip and palate (CLP) at 6 and 12 months of age and compare these early vocalization measures to later speech and vocabulary development at 30 months of age. METHODS: The participants in the study included 13 children without cleft lip or palate (NCLP) who were typically developing and 13 children with CLP matched for age, gender and socioeconomic status. Standardized measures of cognition, language, hearing, and prelinguistic vocalization measures were administered at 6 and 12 months and speech production, and vocabulary measures were collected at 30 months of age. RESULTS: Group differences were observed in both receptive and expressive language development at 12 and 30 months of age. Group differences were observed in the frequency of babbling and Mean Babbling Level at 12 months and speech sound accuracy and vocabulary production at 30 months of age. Significant correlation coefficients were observed between babbling frequency at 6 months and consonant inventory size, vocabulary at 30 months for the children with clefts and PCC-R for noncleft children. CONCLUSIONS: This study documented that young children with clefts have persistent vocalization and vocabulary deficits well beyond palate closure. Measures of babbling frequency, Mean Babbling Level and consonant inventories provide clinically effective means of identifying these early deficits. Additionally, these measures may provide a tool for monitoring the effects of early intervention programs that promote facilitation of sound and vocabulary development.

Recast density and acquisition of novel irregular past tense verbs.

PURPOSE: Children with specific language impairment (SLI) lag behind children with typical language (TL) in their grammatical development, despite equivalent early exposure to recasts in conversation (M. E. Fey, T. E. Krulik, D. F. Loeb, & K. Proctor-Williams, 1999) and the ability to learn from recasts in intervention as quickly as do children with TL (K. E. Nelson, S. Camarata, J. Welsh, L. Butovsky, & M. Camarata, 1996). This experiment tested whether this apparent paradox could be attributed to variations in the density of recasts in conversation versus intervention. METHOD: Thirteen children (7-8 years of age) with SLI and 13 language-similar children (5-6 years of age) with TL were exposed to 3 recast densities of novel irregular past tense verbs (none, conversation-like, intervention-like) over 5 sessions. Outcomes were based on spontaneous conversational productions and a post-test probe. RESULTS: As predicted, at conversation-like densities, children with TL more accurately produced the target verbs they heard in recasts than in nonrecast models (d = 0.58), children with SLI showed no differences, and children with TL produced the verbs more accurately than did children with SLI (d = 0.54). Contrary to expectations, at higher intervention-like recast densities, the SLI group did not improve their accuracy, and the TL group performances were significantly poorer (d = 0.47). CONCLUSION: At conversational levels, recasts facilitated greater verb learning than models alone but only in the TL group. Increasing recast density to the modest levels in this brief intervention experiment did not benefit children with SLI and led to poorer learning for children with TL. To optimize learning, efficiency of recast distribution as well as rate must be considered.

Oral and written story composition skills of children with language impairment.

In this study 538 children composed 1 oral and 1 written fictional story in both 2nd and 4th grades. Each child represented 1 of 4 diagnostic groups: typical language (TL), specific language impairment (SLI), nonspecific language impairment (NLI), or low nonverbal IQ (LNIQ). The stories of the TL group had more different words, more grammatical complexity, fewer errors, and more overall quality than either language-impaired group at either grade. Stories of the SLI and LNIQ groups were consistently stronger than were those of the NLI group. Kindergarten children with language impairment (LI) whose standardized test performance suggested normalization by 2nd grade also appeared to have recovered in storytelling abilities at that point. By 4th grade, however, these children's stories were less like the children with TL and more like those of children with persistent LI than they had been in 2nd grade. Oral stories were better than written stories in both grades, although the greatest gains from 2nd to 4th grade were generally made on written stories. Girls told stronger stories than did boys at both grades, regardless of group placement. It is concluded that story composition tasks are educationally relevant and should play a significant role in the evaluation of children with developmental LI.