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Gestational Age Effect on Developmental Changes in the First Year of Life

Amber Ortiz, Gina Ungaro, Isabella Ricottilli, Cadeesia Douglas, Kaitlyn Fitch

NURS 3749: Nursing Research

Dr. Valerie O’Dell

April 7, 2021
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Abstract

The purpose of this research was to look at the relationship between the weeks of gestation

and the babies motor, cognitive, emotional, physical, and behavioral development. The

correlation between the babies gestational age at birth and their developmental milestones

met across the first year of life were explored. This research was drawn from seven sources,

some qualitative studies and some literature reviews. It was found that there was significant

evidence supporting that the older the gestational age was at birth, the more on track the

babies were developmentally throughout the first year of life. This was significantly proven

comparing babies born less than 37 weeks old (preterm), to babies greater than 37 weeks old

(full term). It has been proven that even babies born full term, the babies that stayed in the

womb the longest number of weeks were the most developmentally on track. There was no

significant evidence related to a specific time frame of when the adverse health effects on

nurses occurs after working long hours. There was no definite evidence regarding proof of

automobile accidents after working long hours either. Overall, the research done showed that

the older the gestational age was the more developmentally on track the babies were

throughout the first year of life.

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Gestational Age Effect on Developmental Changes in the First Year of Life

Mothers everywhere have been able to receive prenatal care throughout their

pregnancies more now than ever before. This is attributed to the continuous advancements

being made in technology, and the ongoing education about pregnancy. These factors have

allowed the number of preterm babies to be reduced throughout the years. Although these

things help, there are still many factors that lead to babies being born before 37 weeks. Many

multifactorial studies have been conducted to support the fact that the older the gestational

age was at birth, the more developmentally on track the babies were throughout the first year

of life. This presents an issue in the nursing profession due to the fact that it increases the

workload on neonatal intensive care unit(NICU) nurses, and then in turn increases the

number of babies in and out of the hospital in the first year of life due to developmental

issues. These registered nurses(RN) are more likely to be overworked and experience burn

out. This in turn affects the quality of care these premature babies and their families are

receiving while in the hospital. Therefore, the following research question was addressed: In

babies born before 37 weeks gestation (pre-term) compared to babies born after 37 weeks

gestation (full term), how do developmental changes differ in the first year of life?

Literature Review

Introduction

In order to address this issue in the nursing profession, information was acquired via

OhioLINK databases. Seven sources were reviewed for comprehensive data collection

regarding gestational age and developmental milestones. In turn, the effect gestational age

has on motor, physical, cognitive, emotional, and behavioral development throughout the first

year of life will be discussed below.

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Motor Development

There are many motor skills that occur in the baby’s first year of life that contribute to

their continuing health and developmental progression. According to Bracewell and Marlow

(2002), motor patterns over the first year of life may depend on behaviors learned during long

periods spent in the NICU. These normal patterns of development may be altered by

disturbances of brain function. These disturbances can be caused by both the interruption of

normal brain maturation ex-utero and the envelopment of focal brain injuries that can follow

preterm birth. “Preterm infants have a high risk of neurological injuries, which can result in

severe motor problems” (Valentini et al., 2019, p.967). There is an abundance of research

studies that support the importance that gestational age has on a baby’s developmental

progression. The results of a study done on motor trajectories of preterm and full-term

infants in the first year of life reflected this.

During the first trimester of life, preterm infants have higher scores in the supine and

standing postures. Regarding motor trajectories, from newborn to 12 months, the period of

higher motor acquisition was similar between full-term and preterm infants for prone (3-10

months), supine (1-6 months), and standing (6-12 months). For the sitting posture, however,

full-term infants had a period of intensive motor learning of acquisition from the first to 7

months of life, whereas for preterm infants a shorter period was observed (3-7 months)

(Valentini et al., 2019, p. 974). “Poor postural control, which preterm infants often

demonstrate, limit the functional competencies that are acquired during development”

(Valentini et al., 2019, p.967). It is especially important that we find ways to help strengthen

these preterm babies in the first year of life.

From a clinical perspective, the present results reinforce the understanding that

intervention programs for preterm infants must go beyond the first 3 months of life
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and should necessarily include guidelines for parents and caregivers on motor

development specific to the age of the groups (Valentini et al., 2019, p.975).

The above quote helps to enforce the idea that early intervention programs are

especially important when dealing with preterm infants. The importance of parental and

caregivers understanding of this will only help in carrying out these actions. It is with these

early interventions, and continuing interventions, that we are giving these children a chance

to catch up to other children their age in developmental milestones.

Physical Development

In the first year of life for a preterm baby, one of the biggest comparisons to a full

term baby is the physical development. In a baby’s first year of life, one of the major reasons

for annual check ups are to monitor physical growth. If a baby is not completing those

milestones for their age it becomes a failure to thrive situation. Three common factors found

in the article relating to preterm births, are low birth weight, maternal inflammation and the

relation to cardiovascular diseases. According to Rogers (2011) there was a physical

difference in birth weights and one year of age found by looking at birth records from

Hertfordshire (England). This link was seen to create an increased risk for cardiac and stroke

related death into adulthood. “With increasing rates of obesity and diabetes and survival of

preterm infants born at early gestational ages, the need to elucidate mechanisms responsible

for programming of adult cardiovascular disease is essential for the treatment of upcoming

generations” (Rogers & Velten, 2011, p.417). This study showed that current health

conditions of the mother carrying the infant has a high impact on the size and timing of the

child's birth. The chronicity and overall health can affect how a baby develops and can cause

problems throughout that first year of life. This article found that later in the preterm infants

life, more complications may be high risk to them. “The interventional care provided to these
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infants in addition to their prematurity is likely to have a profound influence on their overall

health later in life” (Rogers & Velten, 2011, p.417). Early intervention can prevent physical

delays in regards to the infants milestones. Without these interventions and teaching mothers

about prenatal care, the infants delays will continue through its first year of life.

The overall result in their research shows that many factors went into the process of

an infant being preterm. But what they found as the most relevant and reoccurring factor was

the maternal health aspect. “Overall maternal health is tightly linked to the causes and

occurrence of preterm birth, thus discerning the distinct associations between maternal health

alone and the development of adult cardiovascular disease will be difficult” (Rogers &

Velten, 2011, p.418). The result of the mothers health leading up to the due date has a big

factor in the physical health of the baby in the first year of life and beyond.

Cognitive Development

Cognitive development of infants are crucial. Infants can be born preterm or full term

and with this comes developmental changes between the two. There are a plethora of studies

that show the consequences of sensory processing disorders and cognitive progression and

how they play a role in infant growth and development. There is not much proven about the

influence of these disorders in cognitive development, however, it is known that they do

negatively interfere with day-to-day activities and will continue to remain effective in that

infant's course of life (Buffone et al., 2016, p. 695-703). According to Buffone (2009-2010),

studies were done at Childcare Outpatient hospitals or Federal Universities to determine the

relations between sensory and cognitive development in infants and the relationship between

prematurity and sensory integration. The study interpreted the risk for deficits from an infant

less than 37 weeks gestation (preterm) compared to an infant more than 37 weeks gestation

(full term).
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The study consisted of 182 infants from 8-15 months of age, of which 54 (29.7%)

were born preterm with the maturity age connection made to 40 weeks of gestational age. The

Test of Sensory Functions in infants was used to evaluate the sensory evolution, while the

Bayley Scales of Infant and Toddler Development III are assessing cognitive development

(Buffone et al., 2016, p. 695-703). Based on results, risks for sensory and cognitive

development deficit was tremendously higher in the preterm infants as opposed to full term

infants past 37 weeks gestation (Buffone et al., 2016, p.695-703). Preterm infants expressed

signs of cognition delay and delayed sensory responses throughout the tests. A major issue

with this is that brain development is a part of cognitive development, therefore, development

of knowledge, skills, and even problem solving can be affected in preterm infants.

The studies help encompass the importance of cognition and sensory processing as

they grow and mature. Cognition and sensory development includes infants memory,

attention, thinking, and ability to respond to experiences in daily life. Understanding how

much difference a preterm infant is at risk for deficits such as these is important information

for parents to know. Helping to educate parents early about infants as they grow over the

months will help decrease the risk of cognitive and sensory deficit.

Emotional Development

The emotional development of a child is another important aspect to look at,

especially when considering their growth. Babies use emotion for the first year or two of life

until they learn to speak and tell you exactly what they want or need with words. Some of

these communication symbols can include crying, facial expressions, movements, sounds or

noises, and reflexes, all of which give you an idea of what the infeant or child needs in that

moment, and how he or she may be feeling. In the journal titled Social-emotional

development in very preterm infants during early infancy, it states that “This study included
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items that assess the child's mastery of functional emotional skills such as self-regulation,

communication abilities including the use of emotional signals or gestures, the child's ability

to engage with others and to use emotions in an interactive and purposeful manner.” (Gray et

al., 2018, p. 2). When comparing preterm infants with full term infants there was a decreased

use of emotional communication at 2 years old when the child was born preterm. According

to the journal “The results of the present study demonstrated that there was reduced

social-emotional development in very preterm infants at two years compared to infants born

at term as assessed by maternal completion of the Bayley-SE Scale.” (Gray et al., 2018, p. 8).

Babies born before term may have more trouble communicating emotionally than those who

are born at full term. Each week is critical in the development of the fetus which is why

keeping the baby growing to full term is so important. The brain is such an intricate organ

that even the slightest change can throw your emotions off, and cause further developmental

issues. Communication is the key to all things in life. Teaching preterm children how to

handle their emotions and use them to communicate is something all mothers with babies

should be aware of. Since the emotional development in preterm babies is much slower,

mothers should work with those children a little extra to get them back on track. According to

another journal titled “Emotional reactivity at 12 months in very preterm infants born at <29

weeks of gestation”, “The behavioral assessment showed that very preterm infants exhibited

as much joy as full term infants during a joy-eliciting episode. However, they expressed a

significantly higher reactivity in anger-eliciting situations and a reduced reactivity toward

fear-eliciting situations. For all three emotion-eliciting situations, the preterm infants reacted

with a higher level of motor activity.” (Langerock et al., 2013, p 1.). This study concluded

that infants who were born very preterm react to situations much differently than those who

are born full term. Their brain has an increased level of activity while experiencing emotional
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situations and can lead to an increased amount of crying related to situations they are

unhappy in.

Overall the emotional status of preterm babies is much more of an issue than in those

that are fully developed before birth and have a higher gestational age. Spending extra time

and giving some extra attention to preterm infants is critical in order for them to learn how to

react to emotional situations and how to use their emotions to communicate as well.

Educating mothers on the signs and symptoms of preterm labor and birth can help prevent

this issue all together and lead to full term babies who are fully developed emotionally.

Behavioral Development

When parents say, “she’s an easy baby” or “she can be difficult”, most of the time

they are referring to their infant’s behavior. Studies have shown that full term babies behave a

lot better than preterm babies. This behavior ranges from responding to stimulation to

socializing with other people and infants. A study conducted on groups of preterm babies and

full term babies was completed. “Although preterm infants averted less at 8 months, they

continued to show less enjoyment with interactions” (Crnic et al., 1983, p. 10). These

interactions included playing with other infants and interacting with the mother. The results

showed that preterm infants showed less enjoyment by averting gaze and smiling less

compared to full term infants. The interactions in the study were performed at four, eight and

12 months of age and although the preterm babies performed better at each observation

period, they still ranked lower than full term babies. It was also found that infants born

preterm had slower or nonexistent responses to stimulation by the mother. This stimulation

would be tickling, talking and general touch to try and elicit some type of reaction from the

baby.
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These infants vocalized much less than full-terms in the structured vocal elicitation

episode and also performed significantly less well than the full-term infants on

measures of early language expression. Thus, the language deficiencies noted in later

childhood follow-up studies are also apparent in the preterm infants first year, and

may indeed be a function of the neurophysiological lag associated with prematurity

(Crnic et al., 1983, p. 11).

The behavior of preterm infants was considered dull as these babies were slow to or

did not elicit a laugh, cry or even a response that signaled they were paying attention. Once

again, the behavior of the preterm babies improved at each observation period but still did not

compare to the behavior of the full term group. The attention span of preterm babies was

proven to be a lot shorter than in full term babies. This contributed to worse behavior in the

form of not sitting still, not wanting to listen and being stubborn because they wanted to

move to a different activity. These behavior issues have contributed to problems later on in

life as well. Though uncommon, preterm babies have a higher risk of developing attention

deficit hyperactivity disorders, autism spectrum disorders, depression and face more learning

challenges. Many signs of these disorders can be seen within the first year of life.

“Specifically, our results demonstrate that premature infants are less active and less

responsive than full-term infants; they vocalize and smile less frequently, avert their gaze and

bodies more frequently, and show less positive general affective tone” (Crnic et al., 1983, p.

9). It is very possible for preterms infants to go through life, especially the first year, without

having any difficulties but the risks are still there as well as the multiple studies to prove it.

Preterm infants overall have more negative body language, are less active and have slower

response times during their first year of life compared to full term infants.
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Conclusion

When addressing how gestational age affected the development of babies throughout

the first year of life, the studies consistently showed that the older the gestational age was at

the time of birth, the more developmentally on track the babies were throughout their first

year of life. Studies also showed that the earlier the intervention is started with these

premature children the quicker they get back on track, and are faced with less complications

throughout their lives. It is apparent that babies born premature are set back in many ways at

the time of birth. All of the developmental delays discussed above are crucial obstacles these

children and their parents have to face throughout the baby's life. There is hope that with

continuing advancements in technology, and education on the topic, the number of premature

babies will continue to decrease.

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References

Bracewell, M., & Marlow, N. (2002). Patterns of motor disability in very preterm children.

Mental Retardation & Developmental Disabilities Research Reviews, 8(4), 241–248.

https://doi-org.eps.cc.ysu.edu/10.1002/mrdd.10049

Crnic, K., Ragozin, A., Greenberg, M., Robinson, N., & Basham, R. (1983). Social

Interaction and Developmental Competence of Preterm and Full-Term Infants during

the First Year of Life. Child Development, 54(5), 1199–1210.

https://doi-org.eps.cc.ysu.edu/10.2307/1129675

Gray, P. H., Edwards, D. M., Hughes, I. P., & Pritchard, M. (2018, May 15). Social-emotional

development in very preterm infants during early infancyP. Retrieved April 02, 2021,

from

https://www-sciencedirect-com.eps.cc.ysu.edu/science/article/pii/S037837821830004

Langerock, N., Jonge, L., Graz, M., Hüppi, P., Tolsa, C., & Barisnikov, K. (2013, March 30).

Emotional reactivity at 12 months in very PRETERM infants born at. Retrieved April

02, 2021, from

https://www.sciencedirect.com/science/article/pii/S0163638313000258

Ribeiro Cavalcanti Buffone, F. R., Eickman, S. H., & de Carvalho Lima, M. (2016). Sensory

processing and cognitive development of preterm and full term infants. Cadernos de

Terapia Ocupacional Da UFSCar, 24(4), 695–703.

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Rogers, K., & Velten, M., (2011). Maternal inflammation, growth retardation, and preterm

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417-421, ISSN 0024-3205 https://doi.org/10.1016/j.lfs.2011.07.017.

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M. B. M. (2019). Motor trajectories of preterm and full-term infants in the first year

of life. Pediatrics International : Official Journal of the Japan Pediatric Society,

61(10), 967–977. https://doi-org.eps.cc.ysu.edu/10.1111/ped.13963