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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Mental health of extremely low birth weight survivors in their 30s
Ryan J Van Lieshout1, Michael H Boyle2, Saroj Saigal3
1Departments of Psychiatry and Behavioural Neurosciences, vanlierj@mcmaster.ca.
Insights
Extremely low birth weight survivors face higher risks for adult psychiatric disorders, particularly anxiety and ADHD, especially if exposed to antenatal corticosteroids. However, they show lower odds of alcohol or substance use disorders.
Area of Science:
- Neuroscience
- Psychiatry
- Developmental Pediatrics
Background:
- Extremely low birth weight (ELBW) survivors are a vulnerable population.
- Long-term psychiatric outcomes for ELBW individuals require further investigation.
- The impact of antenatal corticosteroids (ACS) on ELBW psychiatric risk is not fully understood.
Purpose of the Study:
- To assess psychiatric disorder risk in ELBW survivors in their early to mid-30s.
- To identify if being small for gestational age (SGA) or ACS exposure increases psychiatric risk.
- To compare psychiatric outcomes of ELBW survivors with normal birth weight (NBW) controls.
Main Methods:
- A prospective, population-based cohort study followed 84 ELBW survivors and 90 NBW controls.
- Participants were assessed in their early to mid-30s using the Mini-International Neuropsychiatric Interview.
- Interviewer blindness to birth weight status ensured objective assessment.
Main Results:
- ELBW survivors had lower odds of alcohol/substance use disorders but higher odds of non-substance-related psychiatric problems (OR=2.47).
- ELBW survivors exposed to ACS showed significantly higher odds of psychiatric disorders (OR=4.41), including anxiety, social phobia, and ADHD (inattentive subtype).
- ELBW survivors born SGA exhibited similar patterns with amplified effects.
Conclusions:
- ELBW survivors face increased risk for adult psychiatric disorders, excluding alcohol/substance use disorders.
- Antenatal corticosteroid exposure in ELBW survivors is linked to particularly high psychiatric risks.
- ELBW survivors exposed to ACS represent a high-risk group for adult psychopathology.
Objective:
To determine the risk for psychiatric disorders among extremely low birth weight (ELBW) survivors in their early to mid-30s and to determine whether those born small for gestational age or those exposed to a full course of antenatal corticosteroids (ACS) were at particularly high risk.
Methods:
A prospective, longitudinal, population-based cohort of 84 ELBW survivors and 90 normal birth weight (NBW) control participants born in Ontario, Canada from 1977 to 1982 were assessed by interviewers naive to birth weight status using the Mini-International Neuropsychiatric Interview.
Results:
ELBW survivors had lower odds of an alcohol or substance use disorder but higher odds of current non-substance-related psychiatric problems (odds ratio [OR] = 2.47; 95% confidence interval [CI], 1.19-5.14). Those born ELBW and SGA exhibited the same patterns with larger effects. ACS-exposed ELBW survivors had even higher odds of any current non-substance-related psychiatric disorder (OR = 4.41; 95% CI, 1.65-11.82), particularly generalized anxiety disorder (OR = 3.42; 95% CI, 1.06-11.06), the generalized type of social phobia (OR = 5.80; 95% CI, 1.20-27.99), and the inattentive subtype of attention-deficit/hyperactivity disorder (OR = 11.45; 95% CI, 2.06-63.50).
Conclusions:
In their early to mid-30s, ELBW survivors were less likely to have alcohol or substance use disorders but may be at greater risk for other psychiatric problems. Those exposed to ACS were at especially high risk and manifested no reduction in alcohol or substance use disorders. ELBW survivors exposed to ACS may be a special group at risk for psychopathology in adulthood.
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