Objective of this study was to assess effectiveness of Reach Out and Read literacy program in infants of NICU using GMA and BSID III. In this study, there were more number of subjects that were born early preterm showing poor repertoire in their GMs when compared to subjects born late preterm. This is supported by the previous evidences present. A study conducted to determine the GMs and Motor Optimality Score of 40 early preterm infants concluded that in preterm at writhing age, poor repertoire is common. At fidgety age however, majority, normal fidgety movements are seen.[12] The reason could be, physiologically, the complete development of the structures of the inner ear occurs between 24–26 weeks of gestational age, and gaining auditory stimuli begins during this time period. As a result, when the infant is taken out of that environment and placed in the NICU, neural differentiation is altered, which may affect forthcoming development. The sensory environment influences brain growth, structures, connectivity and function throughout the first three years of life, making this a critical period of brain plasticity.[13]
As studies suggest, the commonest cause of NICU stay in India is low birth weight (< 1500gms).[14] It therefore also increases the number of days in NICU causing increased exposure of NICU environment. NICU architecture promotes social seclusion, language deprivation, and the likelihood of atypical language development. Ambient noise blocks most human discussions in a multi-bed NICU, robbing the infant of relevant linguistic input. Human speech exposure during the neonatal period, particularly the voice of the mother, imparts linguistic richness that can be critical for the brain's early wiring for language development.[3] The demographics of our study has shown similar results. There were more number of participants in the low birth weight category (< 1500grams) that showed poor repertoire than the subjects with birth weight 2.5kg and above.
Current studies on the influence of SES on language outcomes continue to comprehend the significance of educational qualifications.[5] Evidence suggests that low SES infants encounter considerable discrepancy in linguistic exposure during beginning of childhood and perhaps therefore have lower levels of vocabulary growth, school keenness, and reading skills.[6] The variation in the words used or auditory stimuli given is more in higher SES. In our current study, PR seen at early stage was more in subjects with lower middle SES. This is supported by evidences [6] hence predicting its ill effects at preschool age.
As Infant’s Nervous System is immature at the beginning and as the infant nears the term age, plasticity of the brain is enhanced which demands the need to incorporates an enriched intervention to positively influence the development of child. Early intervention is essential in modifying the underlying neural mechanism in the context of myelination, creation and sprouting of neural projections for development of the child.[13]
Previous research revealed ELBW infants vocalise as early as 8 weeks before their expected date of delivery; parent talk is a significant predictor of both infant vocalisations and Conversation Turns at 32 and 36 weeks' gestation. Furthermore, every 100 AWC/h increase in the NICU at 32 weeks' gestation was linked to a 2-point rise in the Bayley III, language composite score at 18 months (p 5.04). At 36 weeks' gestation, every 100 AWC/h improvement was linked with a 1.2-point rise in the BSID, cognitive composite score (p 5.004) and a 0.3-point increase in expressive communication at 18 months. This strongly suggests that parents converse in the NICU during the weeks leading up to an infant's expected date have a significant effect on their later cognitive and linguistic abilities.[15] On this background, in our study, BSID III was assessed at 5month-6month time period and was correlated with GMA at recruitment and CA 3 months. However statistical significant changes were not obtained.
The GMA outcome utilised to evaluate early motor repertoire in this study is a valid instrument for determining the infant's neurological functioning. Absent FMs exhibited a high specificity, NPV, and accuracy for motor, language, and cognitive scores of < 70 at two years, according to a study. [8] Contrary to this, the relationship between inadequate repertoire and fidgety movements and the BSID III scaled score for its receptive and expressive communication language components was not found to be statistically significant our study. This difference may be noted because the quoted article has used BSID at 2 years of age whereas in the current study assessment was done at CA 5months − 6months.
In present study as GMs has improved at the third assessment, these findings back up the idea of executing care giving programs with involvement of the family in the neonatal ICUs, implying that early born babies avail to the benefit from increased parental involvement and contact, such as caretaking, kangaroo care, snuggling, conversing, singing a song, and reading. ROR was instrumental in incorporating parts of early intervention in the current study by adhering to that. It was valuable in obtaining active engagement of the mother and family in the intervention.
Early reading activities that strengthen parent-child relationships can play an important role in developing emergent literacy abilities and preparing children for school.[6] With caring bonds between parents and newborns, early literacy starts in a child's initial days. ROR is a programme that focuses on giving resources, information, and assistance to low-income families so that they can concentrate on books and reciting loudly as one of the most crucial parenting skills in parent-child interaction. The assessment of the intended infant and the parent for reading experience is the first step in promoting literacy development. [4]
This study however has a few limitations; the infants those had minimal complications, hence fewer days in NICU, revisited hospital for follow-up less frequently than others. Due to travel and budgetary constraints, a poor retention rate was seen during follow-up visits. Due to smaller sample size association of GMA with other primary complications of the infant could not be analysed. Nonetheless, strength of the study was active participation of mother and family was encouraged for this intervention. ROR intervention was implemented from the early days of NICU encouraging stimulating environment and improving GMs.