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Attention-Deficit/Hyperactivity Disorder and Very Preterm/Very Low Birth Weight: A Meta-analysis
Adelar Pedro Franz1, Gul Unsel Bolat2, Hilmi Bolat3
1Postgraduate Program in Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
Insights
Very preterm (VP) and extremely preterm (EP) newborns face a significantly higher risk of attention-deficit/hyperactivity disorder (ADHD). This risk is amplified in extremely low birth weight (ELBW) infants, underscoring the need for further research into contributing factors.
Area of Science:
- Neonatal Health
- Neurodevelopmental Disorders
- Pediatric Psychiatry
Background:
- Very preterm (VP), extremely preterm (EP), very low birth weight (VLBW), and extremely low birth weight (ELBW) newborns are suspected to have an elevated risk of attention-deficit/hyperactivity disorder (ADHD).
- The precise magnitude of this risk has not been well-established, necessitating a comprehensive review.
Purpose of the Study:
- To systematically review and meta-analyze the risk of ADHD diagnosis and symptomatology in VP/VLBW and EP/ELBW individuals compared to controls.
- To quantify the association between preterm birth/low birth weight and ADHD outcomes.
Main Methods:
- Searched major databases (PsycINFO, Medline, Embase, Cochrane) for relevant studies.
- Included cross-sectional, prospective, and retrospective studies without time or language restrictions.
- Utilized independent reviewers for data screening and extraction.
Main Results:
- Meta-analysis of 12 studies (N=1787) revealed a significantly higher risk of ADHD diagnosis in VP/VLBW (OR=2.25) and EP/ELBW (OR=4.05) individuals compared to controls.
- Analysis of 29 studies (N=3504) showed significant associations between prematurity/low birth weight and ADHD symptomatology, including inattention (SMD=1.31), hyperactivity/impulsivity (SMD=0.74), and combined symptoms (SMD=0.55).
- Risk estimates increased with the severity of prematurity and low birth weight.
Conclusions:
- VP/VLBW and EP/ELBW individuals exhibit an increased risk for ADHD diagnosis and symptoms.
- The risk is more pronounced in the EP/ELBW group.
- Future research should investigate specific risk factors associated with prematurity and low birth weight that contribute to ADHD development.
Context:
Although very preterm (VP), extremely preterm (EP), very low birth weight (VLBW), and extremely low birth weight (ELBW) newborns seem to have a higher risk of later attention-deficit/hyperactivity disorder (ADHD), the magnitude of the risk is not well-defined.
Objective:
To systematically review and meta-analyze the risk of VP/VLBW and EP/ELBW individuals to develop a ADHD categorical diagnosis or dimensional symptomatology compared with controls with normal weight and/or birth age.
Data Sources:
We used PsycINFO, Medline, Embase, and Cochrane databases.
Study Selection:
We selected cross-sectional, prospective, or retrospective studies with no time or language restriction.
Data Extraction:
Independent reviewers screened and extracted data using predefined standard procedures.
Results:
In 12 studies (N = 1787), researchers relying on a categorical diagnosis showed that both VP/VLBW and EP/ELBW subjects have a higher ADHD risk (odds ratio [OR] = 3.04 higher than controls; 95% confidence interval [CI] 2.19 to 4.21). In subgroup analyses, we demonstrated that the more extreme the cases, the higher the ORs (VP/VLBW: OR = 2.25 [95% CI 1.56 to 3.26]; EP/ELBW: OR = 4.05 [95% CI 2.38 to 6.87]). We drew data from 29 studies (N = 3504) on ADHD symptomatology and found significant associations with inattention (standardized mean difference [SMD] = 1.31, 95% CI 0.66 to 1.96), hyperactivity and impulsivity (SMD = 0.74, 95% CI 0.35 to 1.13), and combined symptoms (SMD = 0.55, 95% CI 0.42 to 0.68) when compared with controls.
Limitations:
Heterogeneity was significantly high for all analyses involving the 3 ADHD dimensions.
Conclusions:
With our results, we provide evidence that VP/VLBW subjects have an increased risk of ADHD diagnosis and symptomatology compared with controls, and these findings are even stronger in the EP/ELBW group. Future researchers should address which risk factors related to prematurity or low birth weight lead to ADHD.
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