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OBJECTIVE: To examine the relationship between inpatient skin-to-skin care rates and neurodevelopmental scores measured at 12 months in very preterm (VPT) infants. STUDY DESIGN: From a retrospective review of medical records of 181 VPT infants (<32 weeks gestational age [GA] at birth), we derived skin-to-skin care rate, ie, total minutes of skin-to-skin care each infant received over the number of days of hospital stay. We used scores on the Capute Scales from routine follow-up assessments at 12 months to measure neurodevelopmental outcomes. RESULTS: Families averaged approximately 17 minutes/day of skin-to-skin care (2 days/week, 70 minutes/session), although there was substantial variability. Variation in skin-to-skin rate was positively associated with outcomes at 12 months corrected age (r = 0.25, P < .001). Skin-to-skin rate significantly predicted 6.2% unique variance in 12-month neurodevelopmental outcomes, after adjusting for GA, socioeconomic status (SES), health acuity, and visitation frequency. A 20-minute increase in skin-to-skin care per day was associated with a 10-point increase (0.67 SDs) in neurodevelopmental outcomes at 12 months. GA and infant health acuity did not moderate these relations. CONCLUSION: VPT infants who experienced more skin-to-skin care during hospitalization demonstrated higher scores on 12-month neurodevelopmental assessments. Results provide evidence that skin-to-skin care confers extended benefits to VPT infants through the first year of life. Skin-to-skin care offers promise as a family-centered intervention designed to promote positive developmental outcomes in at-risk infants.
ABSTRACT
Language processing efficiency-that is, the skill at processing language in real time-assessed in toddlerhood is associated with later language outcomes in children born full term (FT) and preterm (PT) during school age. No studies to date have assessed patterns of relations between early language processing efficiency and pre-literacy skills, such as print knowledge and phonological awareness, and whether relations are similar in FT and PT children. In this study, participants (N = 94, 49 FT and 45PT) were assessed in the looking-while-listening (LWL) task at 18 months of age (corrected for degree of prematurity), deriving measures of processing speed and accuracy. At 4½ years of age, children were assessed on standardized tests of print knowledge, phonological awareness, and expressive language. Processing speed and accuracy predicted both pre-literacy outcomes (r2 change = 7.8%-19.5%, p < .01); birth group did not moderate these effects. Relations were significantly reduced when controlling for expressive language. Thus, early language processing efficiency supports later expressive language abilities, which in turn supports developing pre-literacy skills. Processing speed and phonological awareness were also directly related, indicating an independent role for processing speed in literacy development. Mediation effects were not moderated by birth group, suggesting a similar developmental pathway in FT and PT children.
Subject(s)
Infant, Premature , Language Development , Humans , Female , Male , Child, Preschool , Infant , LiteracyABSTRACT
A large number of children are exposed to more than one language. One well-established method of assessing early vocabulary development in monolingual children is parent report; however, its use in bilingual/multilingual contexts is less established and brings unique challenges. In this methodological scoping review, we reviewed studies of early vocabulary development using parent report with bilingual/multilingual children (January 1980-March 2022). A total of 576 articles were screened, yielding 101 studies for analysis. The number of studies on bilingual/multilingual vocabulary has grown in the last two decades; yet representation of the world's languages remains sparse. The majority of studies assessed bilingual/multilingual children's vocabulary in each language and used instruments adapted for linguistic and cultural characteristics. However, the field could benefit from standardized reporting practices regarding definitions of bi/multilingualism, selection of reporters, and tool development and is in critical need of studies that develop, validate, and norm parent report instruments specifically for the bilingual/multilingual case.
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The valid assessment of vocabulary development in dual-language-learning infants is critical to developmental science. We developed the Dual Language Learners English-Spanish (DLL-ES) Inventories to measure vocabularies of U.S. English-Spanish DLLs. The inventories provide translation equivalents for all Spanish and English items on Communicative Development Inventory (CDI) short forms; extended inventories based on CDI long forms; and Spanish language-variety options. Item-Response Theory analyses applied to Wordbank and Web-CDI data (n = 2603, 12-18 months; n = 6722, 16-36 months; half female; 1% Asian, 3% Black, 2% Hispanic, 30% White, 64% unknown) showed near-perfect associations between DLL-ES and CDI long-form scores. Interviews with 10 Hispanic mothers of 18- to 24-month-olds (2 White, 1 Black, 7 multi-racial; 6 female) provide a proof of concept for the value of the DLL-ES for assessing the vocabularies of DLLs.
Subject(s)
Citrus sinensis , Malus , Multilingualism , Child , Infant , Humans , Female , Vocabulary , Child Language , Language Tests , LanguageABSTRACT
Bilingual environments present an important context for word learning. One feature of bilingual environments is the existence of translation equivalents (TEs)-words in different languages that share similar meanings. Documenting TE learning over development may give us insight into the mechanisms underlying word learning in young bilingual children. Prior studies of TE learning have often been confounded by the fact that increases in overall vocabulary size with age lead to greater opportunities for learning TEs. To address this confound, we employed an item-level analysis, which controls for the age trajectory of each item independently. We used Communicative Development Inventory data from four bilingual datasets (two English-Spanish and two English-French; total N = 419) for modeling. Results indicated that knowing a word's TE increased the likelihood of knowing that word for younger children and for TEs that are more similar phonologically. These effects were consistent across datasets, but varied across lexical categories. Thus, TEs may allow bilingual children to bootstrap their early word learning in one language using their knowledge of the other language. RESEARCH HIGHLIGHTS: Bilingual children must learn words that share a common meaning across both languages, that is, translation equivalents, like dog in English and perro in Spanish. Item-level models explored how translation equivalents affect word learning, in addition to child-level (e.g., exposure) and item-level (e.g., phonological similarity) factors. Knowing a word increased the probability of knowing its corresponding translation equivalent, particularly for younger children and for more phonologically-similar translation equivalents. These findings suggest that young bilingual children use their word knowledge in one language to bootstrap their learning of words in the other language.
Subject(s)
Language Development , Multilingualism , Verbal Learning , Vocabulary , Humans , Child, Preschool , Verbal Learning/physiology , Male , Female , Child , Learning/physiology , Child Language , LanguageABSTRACT
Objective: Limited research links hospital-based experiences of skin-to-skin (STS) care to longer-term neurodevelopmental outcomes in preterm children. The present study examined relations between inpatient STS and neurodevelopmental scores measured at 12 months in a sample of very preterm (VPT) infants. Study Design and Methods: From a retrospective study review of medical records of 181 VPT infants (<32 weeks gestational age (GA)) we derived the STS rate, i.e., the total minutes of STS each infant received/day of hospital stay. We used scores on the Capute Scales from routine follow-up care at 12 months as the measure of neurodevelopmental outcome (n=181). Results: Families averaged approximately 17 minutes/day of STS care (2 days/week, 70 minutes/session), although there was substantial variability. Variation in STS rate was positively associated with outcomes at 12 months corrected age ( r = 0.25, p < .001). STS rate significantly predicted 6.2% unique variance in 12-month neurodevelopmental outcomes, after controlling for GA, socioeconomic status (SES), health acuity, and visitation frequency. A 20-minute increase in STS per day was associated with a 10-point increase (.67 SDs) in neurodevelopmental outcomes at 12 months. SES, GA, and infant health acuity did not moderate these relations. Conclusion: VPT infants who experienced more STS during hospitalization demonstrated higher scores on 12-month assessments of neurodevelopment. Results provide evidence that STS care may confer extended neuroprotection on VPT infants through the first year of life.
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Head-mounted cameras have been used in developmental psychology research for more than a decade to provide a rich and comprehensive view of what infants see during their everyday experiences. However, variation between these devices has limited the field's ability to compare results across studies and across labs. Further, the video data captured by these cameras to date has been relatively low-resolution, limiting how well machine learning algorithms can operate over these rich video data. Here, we provide a well-tested and easily constructed design for a head-mounted camera assembly-the BabyView-developed in collaboration with Daylight Design, LLC., a professional product design firm. The BabyView collects high-resolution video, accelerometer, and gyroscope data from children approximately 6-30 months of age via a GoPro camera custom mounted on a soft child-safety helmet. The BabyView also captures a large, portrait-oriented vertical field-of-view that encompasses both children's interactions with objects and with their social partners. We detail our protocols for video data management and for handling sensitive data from home environments. We also provide customizable materials for onboarding families with the BabyView. We hope that these materials will encourage the wide adoption of the BabyView, allowing the field to collect high-resolution data that can link children's everyday environments with their learning outcomes.
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OBJECTIVE: To examine associations between maternal mental health and involvement in developmental care in the NICU. STUDY DESIGN: Mothers of infants born <32 weeks gestation (n = 135) were approached to complete mental health screening questionnaires at two weeks after admission. Mothers who completed screening (n = 55) were further classified as with (n = 19) and without (n = 36) elevated scores. Mothers' frequency, rate, and duration of developmental care activities were documented in the electronic health record. RESULTS: 35% of screened mothers scored above the cutoff for clinical concern on ≥1 measure. No significant differences between the 3 groups were identified for rates, frequency, or amount of all developmental care, kangaroo care, and swaddled holding. CONCLUSION: Elevated scores on maternal mental health questionnaires did not relate to developmental care. Maternal developmental care engagement may not indicate mental health status. Universal screening for psychological distress is required to accurately detect symptoms in mothers of hospitalized preterm infants.
Subject(s)
Infant, Premature , Intensive Care Units, Neonatal , Infant, Newborn , Female , Humans , Mental Health , Mothers/psychology , Gestational AgeABSTRACT
OBJECTIVE: Children born preterm, especially those born very preterm (<32 weeks of gestational age [GA]) are at risk for poor growth and adverse neurodevelopmental outcomes. Adverse growth and neurodevelopmental outcomes in preterm children have been attributed, in part, to the aversive sounds and relative speech paucity of the neonatal intensive care unit (NICU). Experimental studies that directly expose preterm infants to speech sounds in the NICU find significant improvements in health factors relevant to neurodevelopment. Few studies have examined whether natural variations in the speech environment of the NICU are related to short-term health outcomes in preterm infants. Such data are important for optimizing the sound environment of the NICU. Our objective was to examine relations between the NICU speech environment and the rate of weight gain during hospitalization. STUDY DESIGN: Participants were infants born very preterm (n = 20). The speech environment of each infant was assessed at 32 to 36 weeks of postmenstrual age using an automatic speech-counting device. Average rates of weight gain (g/kg/d) were ascertained over the same period. Calories were derived from charted intake (kcals/kg/d). Linear regressions examined caloric intake and speech counts as predictors of infant weight gain. RESULTS: Infant weight gain was significantly predicted by caloric intake and speech exposure, each uniquely accounting for approximately 27% variance (total R 2 = 60.2%; p < 0.001). Speech counts were uncorrelated with rates of family visitation, time in incubator, or health acuity. CONCLUSION: While future research should establish causality and direction of effects, enhancing speech exposure in the NICU may be beneficial for physical growth. NICU care plans should consider opportunities to increase speech exposure. KEY POINTS: · Preterm infants who experienced greater amounts of speech in the NICU gained significantly more weight than preterm infants who were exposed to lower amounts of speech during the same developmental period (32-36 weeks of postmenstrual age).. · Caloric intake and speech counts accounted for almost 60% of variance in infant weight gain between 32 and 36 weeks of postmenstrual age.. · Speech counts were not significantly correlated with family visitation, how long infants resided in incubators, or health acuity.. · Findings suggest that the NICU speech environment may play an important role in the physical health of preterm infants; however, more studies are needed to determine the directionality of the observed associations..
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Accumulating evidence suggests that the role of cerebellum includes regulation of behaviors; cerebellar impairment may lead to behavioral problems. Behavioral problems differ by sex: internalizing problems are more common in girls, externalizing problems in boys. Behavioral problems are also elevated in children born preterm (PT) compared to children born full term (FT). The current study examined internalizing and externalizing problems in 8-year-old children in relation to sex, birth-group, fractional anisotropy (FA) of the three cerebellar peduncles (superior, middle, and inferior), and interactions among these predictor variables. Participants (N = 78) were 44 boys (28 PT) and 34 girls (15 PT). We assessed behavioral problems via standardized parent reports and FA of the cerebellar peduncles using deterministic tractography. Internalizing problems were higher in children born PT compared to children born FT (p = .032); the interaction of sex and birth-group was significant (p = .044). When considering the contribution of the mean-tract FA of cerebellar peduncles to behavioral problems, there was a significant interaction of sex and mean-tract FA of the inferior cerebellar peduncle (ICP) with internalizing problems; the slope was negative in girls (p = .020) but not in boys. In boys, internalizing problems were only associated with mean-tract FA ICP in those born preterm (p = .010). We found no other significant associations contributing to internalizing or externalizing problems. Thus, we found sexual dimorphism and birth-group differences in the association of white matter metrics of the ICP and internalizing problems in school-aged children. The findings inform theories of the origins of internalizing behavioral problems in middle childhood and may suggest approaches to treatment at school age.
Subject(s)
Problem Behavior , White Matter , Male , Infant, Newborn , Female , Humans , Child , Diffusion Tensor Imaging , CerebellumABSTRACT
The ability to rapidly recognize words and link them to referents is central to children's early language development. This ability, often called word recognition in the developmental literature, is typically studied in the looking-while-listening paradigm, which measures infants' fixation on a target object (vs. a distractor) after hearing a target label. We present a large-scale, open database of infant and toddler eye-tracking data from looking-while-listening tasks. The goal of this effort is to address theoretical and methodological challenges in measuring vocabulary development. We first present how we created the database, its features and structure, and associated tools for processing and accessing infant eye-tracking datasets. Using these tools, we then work through two illustrative examples to show how researchers can use Peekbank to interrogate theoretical and methodological questions about children's developing word recognition ability.
Subject(s)
Eye-Tracking Technology , Language Development , Infant , Humans , Auditory Perception , VocabularyABSTRACT
Associations between children's early language processing efficiency and later verbal and non-verbal outcomes shed light on the extent to which early information processing skills support later learning across different domains of function. Examining whether the strengths of associations are similar in typically developing and at-risk populations provides an additional lens into the varying routes to learning that children may take across development. In this follow-up study, children born full-term (FT, n = 49) and preterm (PT, n = 45, ≤32 weeks gestational age, birth weight <1800 g) were assessed in the Looking While Listening (LWL) task at 18 months (corrected for degree of prematurity in PT group). This eye-tracking task assesses efficiency of real-time spoken language comprehension as accuracy and speed (RT) of processing. At 4 ½ years, children were assessed on standardized tests of receptive vocabulary, expressive language, and non-verbal IQ. Language processing efficiency was associated with both language outcomes (r2-change: 7.0-19.7%, p < 0.01), after covariates. Birth group did not moderate these effects, suggesting similar mechanisms of learning in these domains for PT and FT children. However, birth group moderated the association between speed and non-verbal IQ (r2-change: 4.5%, p < 0.05), such that an association was found in the PT but not the FT group. This finding suggests that information processing skills reflected in efficiency of real-time language processing may be recruited to support learning in a broader range of verbal and non-verbal domains in the PT compared to the FT group.
Subject(s)
Infant, Premature , Language , Infant, Newborn , Humans , Child , Follow-Up Studies , Infant, Premature/psychology , Vocabulary , Language Development , Cognition , Language TestsABSTRACT
Variation in how frequently caregivers engage with their children is associated with variation in children's later language outcomes. One explanation for this link is that caregivers use both verbal behaviors, such as labels, and non-verbal behaviors, such as gestures, to help children establish reference to objects or events in the world. However, few studies have directly explored whether language outcomes are more strongly associated with referential behaviors that are expressed verbally, such as labels, or non-verbally, such as gestures, or whether both are equally predictive. Here, we observed caregivers from 42 Spanish-speaking families in the US engage with their 18-month-old children during 5-min lab-based, play sessions. Children's language processing speed and vocabulary size were assessed when children were 25 months. Bayesian model comparisons assessed the extent to which the frequencies of caregivers' referential labels, referential gestures, or labels and gestures together, were more strongly associated with children's language outcomes than a model with caregiver total words, or overall talkativeness. The best-fitting models showed that children who heard more referential labels at 18 months were faster in language processing and had larger vocabularies at 25 months. Models including gestures, or labels and gestures together, showed weaker fits to the data. Caregivers' total words predicted children's language processing speed, but predicted vocabulary size less well. These results suggest that the frequency with which caregivers of 18-month-old children use referential labels, more so than referential gestures, is a critical feature of caregiver verbal engagement that contributes to language processing development and vocabulary growth. RESEARCH HIGHLIGHTS: We examined the frequency of referential communicative behaviors, via labels and/or gestures, produced by caregivers during a 5-min play interaction with their 18-month-old children. We assessed predictive relations between labels, gestures, their combination, as well as total words spoken, and children's processing speed and vocabulary growth at 25 months. Bayesian model comparisons showed that caregivers' referential labels at 18 months best predicted both 25-month vocabulary measures, although total words also predicted later processing speed. Frequent use of referential labels by caregivers, more so than referential gestures, is a critical feature of communicative behavior that supports children's later vocabulary learning.
Subject(s)
Caregivers , Vocabulary , Humans , Child, Preschool , Infant , Gestures , Bayes Theorem , Language , Language DevelopmentABSTRACT
PURPOSE: Measuring the growth of young children's vocabulary is important for researchers seeking to understand language learning as well as for clinicians aiming to identify early deficits. The MacArthur-Bates Communicative Development Inventories (CDIs) are parent report instruments that offer a reliable and valid method for measuring early productive and receptive vocabulary across a number of languages. CDI forms typically include hundreds of words, however, and so the burden of completion is significant. We address this limitation by building on previous work using item response theory (IRT) models to create computer adaptive test (CAT) versions of the CDIs. We created CDI-CATs for both comprehension and production vocabulary, for both American English and Mexican Spanish. METHOD: Using a data set of 7,633 English-speaking children ages 12-36 months and 1,692 Spanish-speaking children ages 12-30 months, across three CDI forms (Words & Gestures, Words & Sentences, and CDI-III), we found that a 2-parameter logistic IRT model fits well for a majority of the 680 pooled vocabulary items. We conducted CAT simulations on this data set, assessing simulated tests of varying length (25-400 items). RESULTS: Even very short CATs recovered participant abilities very well with little bias across ages. An empirical validation study with N = 204 children ages 15-36 months showed a correlation of r = .92 between language ability estimated from full CDI versus CDI-CAT forms. CONCLUSION: We provide our item bank along with fitted parameters and other details, offer recommendations for how to construct CDI-CATs in new languages, and suggest when this type of assessment may or may not be appropriate.
Subject(s)
Child Language , Language Development , Language Tests , Child, Preschool , Humans , Infant , Internet , Language , VocabularyABSTRACT
Objectives: Families in the Neonatal Intensive Care Unit (NICU) experience significant psychological distress. Fellowship training requires education on mental health issues. No standardized program exists. We evaluated the impact of an online course, combining research with family perspectives, on neonatology fellow knowledge and self-efficacy when emotionally supporting NICU families. Methods: Fellows from 20 programs completed a course covering: (1) Parent Mental Health, (2) Infant Mental Health, (3) Communication, and (4) Comprehensive Mental Health (e.g., discharge, bereavement) with pre- and post-course knowledge and self-efficacy assessments. Results: Fellows (n=91) completed the course and assessments. Pre-course knowledge was similar by year of training (1st: 66.9%; 2nd: 67.2%; 3rd: 67.4%). Mean knowledge and self-efficacy improved between pre- and post-course assessments regardless of training year or prior education for knowledge (d=1.2) (67.1% vs. 79.4%) and for self-efficacy (d=1.2) (4.7 vs 5.2 on 6-point Likert scale). Fellows who gained more knowledge had higher self-efficacy scores at post-test (r = .37). Conclusions: Current neonatal fellowship training under-educates on mental health. An online course improved fellow knowledge and self-efficacy. Our course may be an exemplar for others creating similar curricula. Innovation: An online course enriched by patient perspectives is an effective method of disseminating education around mental health.
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OBJECTIVE: The aim of this study was to investigate whether preterm infants whose families have lower socioeconomic status (SES) or communicate with clinical staff in a language other than English experience differences in the rate, frequency, and duration of kangaroo care (KC) in the neonatal intensive care unit (NICU) compared with preterm infants of higher SES or primarily English-speaking families. METHODS: Participants were infants born <32 weeks' gestational age (GA), N = 116. We defined SES by the infants' health insurance (private/higher vs public/lower) and language by the language mothers used to communicate with clinical staff (English vs Other language). SES or language groups were compared on (1) rate of KC infants experienced during hospitalization per visitation days, (2) frequency of KC per visitation days, and (3) duration of KC events per day. RESULTS: Infants in the lower SES and Other language groups experienced KC in reduced amounts, lower frequencies, and shorter durations than infants in either the higher SES or English language groups. SES and language group differences remained significant after controlling for family visitation and GA at birth. After controlling for SES, language group differences in KC duration remained significant. CONCLUSION: Our findings revealed disparities in the rate, frequency, and duration of KC experienced in the NICU as a function of both SES and language. Such disparities reduced infants' access to this developmental care practice shown to stabilize clinical status and promote neurodevelopment. We recommend that hospital nurseries implement policies that minimize these disparities.
Subject(s)
Intensive Care Units, Neonatal , Kangaroo-Mother Care Method , Child , Female , Humans , Infant, Low Birth Weight , Infant, Newborn , Infant, Premature , MothersABSTRACT
OBJECTIVES: To assess the impact of the COVID-19 pandemic on rates of hospital visitation and rates and durations of developmental care practices for infants born preterm. METHODS: We analyzed electronic medical record data from 129 infants born at less than 32 weeks gestational age (GA) cared for in the Lucile Packard Children's Hospital neonatal intensive care unit (NICU) in a COVID-19-affected period (March 8, 2020 to Nov 30, 2020, n = 67) and the analogous period in 2019 (n = 62). Rates of family visitation and of family- and clinical staff-delivered developmental care were compared across cohorts, adjusting for covariates. RESULTS: Families of infants visited the hospital at nearly half of the rate during 2020 as during 2019 (p = 0.001). Infants experienced developmental care less frequently in 2020 vs. 2019 (3.0 vs. 4.3 activities per day; p = 0.001), resulting in fewer minutes per day (77.5 vs. 130.0; p = 0.001). In 2020, developmental care activities were 5 min shorter, on average, than in 2019, p = 0.001. Similar reductions occurred in both family- and staff-delivered developmental care. Follow-up analyses indicated that effects persisted and even worsened as the pandemic continued through fall 2020, despite relaxation of hospital visitation policies. CONCLUSIONS: The COVID-19 pandemic has negatively impacted family visitation and preterm infant developmental care practices in the NICU, both experiences associated with positive health benefits. Hospitals should create programs to improve family visitation and engagement, while also increasing staff-delivered developmental care. Careful attention should be paid to long-term follow up of preterm infants and families.
Subject(s)
COVID-19 , Infant, Premature , Infant, Very Low Birth Weight , Intensive Care Units, Neonatal , Intensive Care, Neonatal/methods , Gestational Age , Humans , Infant, Newborn , PandemicsABSTRACT
Young children typically begin learning words during their first 2 years of life. On the other hand, they also vary substantially in their language learning. Similarities and differences in language learning call for a quantitative theory that can predict and explain which aspects of early language are consistent and which are variable. However, current developmental research practices limit our ability to build such quantitative theories because of small sample sizes and challenges related to reproducibility and replicability. In this chapter, we suggest that three approaches-meta-analysis, multi-site collaborations, and secondary data aggregation-can together address some of the limitations of current research in the developmental area. We review the strengths and limitations of each approach and end by discussing the potential impacts of combining these three approaches.
Subject(s)
Language , Learning , Child , Child, Preschool , Humans , Language Development , Reproducibility of ResultsABSTRACT
BACKGROUND: Infants born very preterm (< 32 weeks gestational age (GA)) are at risk for developmental language delays. Poor language outcomes in children born preterm have been linked to neurobiological factors, including impaired development of the brain's structural connectivity (white matter), and environmental factors, including decreased exposure to maternal speech in the neonatal intensive care unit (NICU). Interventions that enhance preterm infants' exposure to maternal speech show promise as potential strategies for improving short-term health outcomes. Intervention studies have yet to establish whether increased exposure to maternal speech in the NICU offers benefits beyond the newborn period for brain and language outcomes. METHODS: This randomized controlled trial assesses the long-term effects of increased maternal speech exposure on structural connectivity at 12 months of age (age adjusted for prematurity (AA)) and language outcomes between 12 and 18 months of age AA. Study participants (N = 42) will include infants born very preterm (24-31 weeks 6/7 days GA). Newborns are randomly assigned to the treatment (n = 21) or standard medical care (n = 21) group. Treatment consists of increased maternal speech exposure, accomplished by playing audio recordings of each baby's own mother reading a children's book via an iPod placed in their crib/incubator. Infants in the control group have the identical iPod setup but are not played recordings. The primary outcome will be measures of expressive and receptive language skills, obtained from a parent questionnaire collected at 12-18 months AA. The secondary outcome will be measures of white matter development, including the mean diffusivity and fractional anisotropy derived from diffusion magnetic resonance imaging scans performed at around 36 weeks postmenstrual age during the infants' routine brain imaging session before hospital discharge and 12 months AA. DISCUSSION: The proposed study is expected to establish the potential impact of increased maternal speech exposure on long-term language outcomes and white matter development in infants born very preterm. If successful, the findings of this study may help to guide NICU clinical practice for promoting language and brain development. This clinical trial has the potential to advance theoretical understanding of how early language exposure directly changes brain structure for later language learning. TRIAL REGISTRATION: NIH Clinical Trials (ClinicalTrials.gov) NCT04193579 . Retrospectively registered on 10 December 2019.