Language function following preterm birth: prediction using machine learning.

BACKGROUND: Preterm birth can lead to impaired language development. This study aimed to predict language outcomes at 2 years corrected gestational age (CGA) for children born preterm. METHODS: We analysed data from 89 preterm neonates (median GA 29 weeks) who underwent diffusion MRI (dMRI) at term-equivalent age and language assessment at 2 years CGA using the Bayley-III. Feature selection and a random forests classifier were used to differentiate typical versus delayed (Bayley-III language composite score <85) language development. RESULTS: The model achieved balanced accuracy: 91%, sensitivity: 86%, and specificity: 96%. The probability of language delay at 2 years CGA is increased with: increasing values of peak width of skeletonized fractional anisotropy (PSFA), radial diffusivity (PSRD), and axial diffusivity (PSAD) derived from dMRI; among twins; and after an incomplete course of, or no exposure to, antenatal corticosteroids. Female sex and breastfeeding during the neonatal period reduced the risk of language delay. CONCLUSIONS: The combination of perinatal clinical information and MRI features leads to accurate prediction of preterm infants who are likely to develop language deficits in early childhood. This model could potentially enable stratification of preterm children at risk of language dysfunction who may benefit from targeted early interventions. IMPACT: A combination of clinical perinatal factors and neonatal DTI measures of white matter microstructure leads to accurate prediction of language outcome at 2 years corrected gestational age following preterm birth. A model that comprises clinical and MRI features that has potential to be scalable across centres. It offers a basis for enhancing the power and generalizability of diagnostic and prognostic studies of neurodevelopmental disorders associated with language impairment. Early identification of infants who are at risk of language delay, facilitating targeted early interventions and support services, which could improve the quality of life for children born preterm.

[Neonatal intensive care unit--therapeutical success and what next?]. / Pacjenci oddzialu intensywnej terapii noworodka--sukces terapeutyczny i co dalej?

The increasing number of successfully treated newborns with disturbances of the adaptive period can measure effectiveness of neonatal intensive care units (NICU). The authors summarized some health problems of the former NICU patients. Central nervous system (CNS) of the premature, especially low (LBW) and very low birth weight (VLBW) infant, is in serious danger of improper development. The lack of neurological disturbances in early infancy does not exclude further pathological events and such patients require long-term observation and follow-up. High-risk newborns are of great need of precise imaging and diagnosis of CNS, which should be performed before discharge. Early stimulation and developmental care program are the crucial points in the management of newborns with neurological abnormalities. Sensorial problems, especially the rate of vision and hearing impairments, can be significantly reduced when prophylactic schedule is applied. Both, etiological factors leading to respiratory insufficiency and some iatrogenic effects of the therapy, can influence respiratory system. Symptoms of different intensity--from sneezing caused by nasal mucous membrane edema to the severe forms of bronchopulmonary dysplasia (BPD)--may last for a long time and influence the child's general condition. The surgical closure of Botall's duct (persistent ductus arteriosus--PDA) usually normalizes the circulatory system. In serious heart defects or isolated shunt-type defects, the compensation of the circulatory system can easily be disturbed. Digestive tract problems belong to the two main groups: first--connected with the prematurity and immature interstitial functioning (necrotizing enterocolitis, digestive and absorption abnormalities, hepatic cholestasis), and second--caused by congenital defects requiring immediate surgical intervention. Despite different types of the diseases, the treatment and care have to be focused on necessary for the growing organism, optimal nutrients and calories uptake. Disturbances of social development, improper behavior, adaptation and emotional problems are mainly presented in VLBW patients and those with organic defects of the central nervous system.

[The post-hospital care of the newborn and infant with disturbances of the adaptation period]. / Opieka poszpitalna nad noworodkiem i niemowleciem po przebytych zaburzeniach okresu adaptacyjnego.

Medical care of the newborn or infant discharged from the neonatal intensive care unit is difficult and requires close co-operation between the primary care pediatrician and the team of specialists. The authors are trying to collect the rules of pediatric guidance of the high-risk patients to help in practical approach to such children and highlight the issues requiring special attention. The newborn should be discharged with precisely described plan of following treatment and controls. Despite careful discussion with parents on child's clinical status, many questions and daubts appear as sooll as the infant arrives home. All these problems have to be explained by the primary care pediatrician. Defining the subgroup of special care patients on the basis of perinatal and adaptive period risk factors can protect them from being "overseen" (the steadily progressing deterioration or problems occurring in the course of development). On the other hand, some non-typical symptoms are normal for these special patients and should be taken into consideration in the following evaluation of the development and recognition of changes in clinical condition. The attention is drawn to the meaning of corrected age and its use in growth monitoring and psychomotor development, and also the carefulness in recognizing mental psychomotor disability. Other problems, like early neurodevelopmental stimulation program, feeding difficulties, immunization questions and the care of children with chronic diseases are also discussed.