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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neonatal head ultrasound abnormalities in preterm infants and adolescent psychiatric disorders
Agnes H Whitaker1, Judith F Feldman, John M Lorenz
1Division of Adolescent and Child Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, New York, NY 10032, USA. whitakea@childpsych.columbia.edu
Insights
Premature infants with specific brain injuries detected by ultrasound face higher risks of adolescent psychiatric disorders, including depression and ADHD. These findings highlight the long-term impact of perinatal brain injury on mental health.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Psychiatry
Background:
- Premature infants are susceptible to perinatal encephalopathy, involving white and gray matter injuries.
- These injuries can impact cortical development, neural connectivity, and increase the risk of psychiatric disorders later in life.
Purpose of the Study:
- To investigate the association between perinatal brain injury, identified via neonatal head ultrasound, and psychiatric disorders in adolescents born prematurely.
Main Methods:
- A prospective cohort study of low-birth-weight infants (96% preterm) born between 1984-1987.
- Neonatal head ultrasounds categorized brain injuries into germinal matrix/intraventricular hemorrhage or parenchymal lesions/ventricular enlargement.
- Adolescent psychiatric disorders were assessed at age 16 using parent reports on the Diagnostic Interview Schedule for Children-IV.
Main Results:
- Germinal matrix/intraventricular hemorrhage was linked to increased risk of major depressive disorder and obsessive-compulsive disorder.
- Parenchymal lesions/ventricular enlargement were associated with higher risks of attention-deficit/hyperactivity disorder-inattentive type, tic disorders, and obsessive-compulsive disorder.
- These associations remained significant after controlling for other early risk factors and, for most, concurrent cognitive or motor problems.
Conclusions:
- Two distinct types of perinatal brain injury, detectable by neonatal head ultrasound, selectively elevate the risk for specific adolescent psychiatric disorders.
- These findings suggest a link between early brain injury and the dysfunction of subcortical-cortical circuits implicated in these disorders.
Context:
Infants born prematurely are at risk for a perinatal encephalopathy characterized by white and gray matter injuries that affect subsequent cortical development and neural connectivity and potentially increase risk for later psychiatric disorder.
Objective:
To determine the relation of perinatal brain injury, as detected by neonatal head ultrasound, to psychiatric disorders in adolescents who were born prematurely.
Design:
Prospective cohort.
Setting:
Community.
Participants:
Adolescent survivors of a population-based low-birth-weight (<2000 g; 96% preterm; born 1984-1987) cohort (n = 1105) screened as neonates with serial head ultrasounds. Neonatal head ultrasound abnormalities were categorized as either (1) germinal matrix and/or intraventricular hemorrhage or (2) parenchymal lesions and/or ventricular enlargement. Of 862 eligible survivors, 628 (72.9%) were assessed at age 16 years. The sample consisted of 458 nondisabled survivors assessed in person. Main Outcome Measure Adolescent current and lifetime psychiatric disorders assessed with parent report on the Diagnostic Interview Schedule for Children-IV.
Results:
Compared with no abnormality, germinal matrix/intraventricular hemorrhage increased risk for current major depressive disorder (odds ratio, 2.7; 95% confidence interval, 1.0-6.8) and obsessive-compulsive disorder (9.5; 3.0-30.1). Parenchymal lesions/ventricular enlargement increased risk for current attention-deficit/hyperactivity disorder-inattentive type (odds ratio, 7.6; 95% confidence interval, 2.0-26.5), tic disorders (8.4; 2.4-29.6), and obsessive-compulsive disorder (7.6; 1.39-42.0). Parenchymal lesions/ventricular enlargement were not related to lifetime attention-deficit/hyperactivity disorder-inattentive type, but all other relations were similar for lifetime disorders. Control for other early risk factors did not alter these relations. Most of these relations persisted with control for concurrent cognitive or motor problems.
Conclusion:
In preterm infants, 2 distinct types of perinatal brain injury detectable with neonatal head ultrasound selectively increase risk in adolescence for psychiatric disorders in which dysfunction of subcortical-cortical circuits has been implicated.
