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Prevalence and neonatal factors associated with autism spectrum disorders in preterm infants

Michael W Kuzniewicz1, Soora Wi2, Yinge Qian2

  • 1Division of Research, Kaiser Permanente Northern California, Oakland, CA; Division of Neonatology, Department of Pediatrics, University of California-San Francisco, San Francisco, CA.

The Journal of Pediatrics
|October 29, 2013
PubMed

Insights

Infants born prematurely, especially before 27 weeks, have a significantly higher risk of autism spectrum disorder (ASD). Shorter gestational age and factors like high-frequency ventilation increase this risk.

Area of Science:

  • Neonatal Medicine
  • Developmental Pediatrics
  • Epidemiology

Background:

  • Autism spectrum disorder (ASD) is a neurodevelopmental condition with increasing prevalence.
  • Gestational age at birth is a known factor influencing infant neurodevelopmental outcomes.
  • Understanding the specific risks associated with preterm birth is crucial for early intervention.

Purpose of the Study:

  • To determine the prevalence of autism spectrum disorders (ASD) across different gestational ages.
  • To examine the risk of ASD associated with gestational age, controlling for other risk factors.
  • To identify potential risk factors for ASD within the neonatal intensive care unit (NICU) setting.

Main Methods:

  • Retrospective cohort study of 195,021 infants born at ≥ 24 weeks gestation.
  • Data collected from January 1, 2000, to December 31, 2007, across 11 Northern California hospitals.
  • Cox proportional hazards regression models used to analyze associations between gestational age, NICU factors, and ASD diagnosis.

Main Results:

  • Prevalence of ASD was 1.78% in preterm infants (<37 weeks) versus 1.22% in term infants (≥37 weeks).
  • Infants born at 24-26 weeks had a 2.7-fold increased hazard ratio for ASD compared to term infants.
  • Increased ASD risk was observed for infants born at 27-33 weeks (HR 1.4) and 34-36 weeks (HR 1.3).
  • High-frequency ventilation and intracranial hemorrhage were associated with ASD in infants <34 weeks.

Conclusions:

  • ASD is approximately 3 times more prevalent in infants born before 27 weeks gestation compared to term infants.
  • Each week of reduced gestation is associated with a higher risk of developing ASD.
  • NICU interventions like high-frequency ventilation and conditions such as intracranial hemorrhage are linked to increased ASD risk in preterm infants.
Abstract

Keywords:
ASDAutism spectrum disordersCDERClient Development and Evaluation ReportDDSDevelopmental ServicesEDCEstimated date of confinementHRHazard ratioICD-9ICD-9-CMICD-9-clinical modificationICHInternational Classification of Diseases, 9th revisionIntracranial hemorrhageKPKPNCKaiser PermanenteKaiser Permanente Northern CaliforniaNICUNeonatal intensive care unitSGASmall for gestational age

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