Language outcomes at 18-24 months of preterm infants from US Spanish- and English-speaking homes

Aim To evaluate the association of Spanish compared to English primary household language on preterm (PT) infants' language outcomes in the United States and to examine associations with socio-economic factors.Methods This was a retrospective cohort of PT infants born <32 weeks gestation from Spanish-speaking (n = 95) and English-speaking homes (n = 1030) born 2005-2019. Language (primary outcome) and cognitive and motor skills (secondary outcomes) were measured using the BSID-III at 18-24 months corrected age. Group differences were evaluated using bivariate comparisons and logistic regression analyses.Results Mothers reporting Spanish-speaking homes had higher rates of public insurance and lower educational achievement. Group newborn characteristics were similar. Preterm infants from Spanish-speaking homes had significantly lower BSID-III language composite, cognitive composite, receptive and expressive scores compared to infants from English-speaking homes. Logistic regression modelling identified independent negative effects of Spanish-speaking household OR 3.26 (CI 1.89-5.62) and public insurance OR 2.31 (CI 1.71-3.12) with a protective benefit derived from breast milk OR 0.68 (CI 0.50-0.92) when adjusting for medical morbidities, socio-economic factors and gestational age.Conclusion Public health policies and interventions in the United States should target language and cognitive outcomes of PT infants from Spanish-speaking homes.