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Neonatal jaundice and increased risk of attention-deficit hyperactivity disorder: a population-based cohort study
Chang-Ching Wei1, Chun-Hung Chang, Cheng-Li Lin
1Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan.
Insights
Neonatal jaundice significantly increases the risk of attention-deficit hyperactivity disorder (ADHD) in infants. Early diagnosis and monitoring for ADHD are crucial for affected newborns.
Area of Science:
- Neonatal care
- Pediatric neurology
- Public health
Background:
- Conflicting evidence exists on the link between neonatal jaundice and attention-deficit hyperactivity disorder (ADHD).
- A large population study in Taiwan was conducted to clarify this relationship.
Purpose of the Study:
- To investigate the incidence and risk of physician-diagnosed ADHD in infants with neonatal jaundice.
- To identify risk factors associated with ADHD development in this cohort.
Main Methods:
- A cohort of 24,950 neonatal jaundice cases and 69,964 controls was identified (2000-2004).
- Incidence rates and hazard ratios (HRs) for ADHD were calculated by the end of 2008.
Main Results:
- ADHD incidence was 2.48 times higher in the jaundice cohort (3.84 per 100,000 person-years) vs. controls (1.51 per 100,000 person-years).
- Higher ADHD risk was observed in male, preterm, and low-birth-weight infants with jaundice.
- Risk increased with longer follow-up (>6 years), higher bilirubin levels, phototherapy, and longer hospital stays.
Conclusions:
- Neonates with jaundice face a significantly elevated risk of developing ADHD.
- A need for risk alerts regarding potential neurologic consequences following neonatal jaundice diagnosis.
- Further research is required to elucidate the underlying pathogenesis.
Background:
Previous studies have posited conflicting results regarding the relationship between neonatal jaundice and the subsequent risk of attention-deficit hyperactivity disorder (ADHD). We therefore performed a large population study with a defined neonatal jaundice cohort to investigate the incidence and risk of physician-diagnosed ADHD in Taiwan.
Methods:
From 2000 to 2004, 24,950 neonatal jaundice cases and 69,964 matched nonjaundice controls were identified. At the end of 2008, the incidence rate and hazard ratios (HRs) of physician-diagnosed ADHD were calculated.
Results:
The incidence of ADHD was 2.48-fold greater in the jaundice cohort than in the nonjaundice cohort (3.84 vs. 1.51 per 100,000 person-years) in the study period. The HR of ADHD was substantially greater for male, preterm, and low-birth-weight infants with neonatal jaundice. The risk of developing ADHD in the jaundice cohort was greater after a diagnosis of neonatal jaundice for more than 6 years (HR: 2.64; 95% confidence interval: 2.13-3.28). The risk of ADHD increased for neonates with higher serum bilirubin levels requiring phototherapy and with longer admission days.
Conclusion:
Neonates with jaundice are at high risk for developing physician-diagnosed ADHD during their growth period. A risk alert regarding neurologic consequences is urgently required after a neonatal jaundice diagnosis. Additional studies should be conducted to clarify the pathogenesis of these relationships.
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