Nonverbal communication of prematurely born individuals during face-to-face interactions: A systematic review

Background Nonverbal social cues are essential for social communication and play a fundamental role in social interactions. Given the socio-communicative challenges often observed in prematurely born individuals, it is important to explore whether they have specific difficulties in using and interpreting these cues during face-to-face interactions. This systematic review examines how preterm (PT) born individuals use and process nonverbal cues compared to full-term (FT) peers. Methods A systematic search across multiple medical and psychological databases was conducted. Only studies investigating the use of or the response to nonverbal cues in face-to-face interactions among PT individuals, compared to FT controls were included. Risk of bias was assessed using the JBI Critical Appraisal Checklist. Results Across the 26 included observational studies, consistent findings indicate that PT infants gaze less at faces in early infancy, exhibit more gaze aversion and show less gaze following behavior. Their ability to respond to joint attention appears delayed but improves over time, with possible catch-up by early childhood. Moderately PT infants exhibit more negative facial expressions during the still-face procedure, and PT infants generally smile less and cry more during social interactions. Gesture production, both deictic and representational, is initially delayed but appears to normalize by early childhood. While basic imitation skills are present at birth, the imitation of more complex gestures tends to be delayed. Conclusion Compared to FT peers, PT individuals exhibit notable difficulties in both using and responding to nonverbal social cues during face-to-face interactions. This review highlights the need for further research, particularly longitudinal studies employing standardized coding methods and stricter inclusion criteria, to better understand the long-term impact of prematurity on socio-communicative development. Registration This systematic review is registered in PROSPERO with following identification ID CRD42024592467.