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Neonatal jaundice and autism spectrum disorder: a systematic review and meta-analysis
Monica L Kujabi1, Jesper P Petersen2, Mette V Pedersen2
1Perinatal Epidemiology Research Unit, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark. monica.kujabi@gmail.com.
Insights
Previous studies suggested a link between neonatal jaundice and autism. However, a meta-analysis of low risk of bias studies found no association, indicating no need for aggressive jaundice treatment to prevent autism.
Area of Science:
- Neonatal care
- Neurodevelopmental disorders
- Epidemiology
Background:
- Previous meta-analyses suggested an association between neonatal jaundice and an increased risk of autism.
- These findings may be attributed to methodological limitations and biases in the included studies.
- Neonatal jaundice is common, and concerns about potential long-term morbidity may influence treatment decisions.
Purpose of the Study:
- To systematically review and meta-analyze the association between neonatal jaundice and autism.
- To specifically focus on studies with a low risk of bias.
- To provide evidence-based guidance on the management of neonatal jaundice in relation to autism risk.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Scopus, Embase, Cochrane, Google Scholar) up to February 2019.
- Data extraction utilized pre-piloted structured sheets.
- Low risk of bias studies were identified using predefined criteria.
Main Results:
- A total of 32 studies met the inclusion criteria.
- Meta-analysis of six low risk of bias studies revealed no significant association between neonatal jaundice and autism (cohort RR 1.09, 95% CI 0.99-1.20; case-control OR 1.29, 95% CI 0.95-1.76).
- A funnel plot indicated a high risk of publication bias across all included studies.
Conclusions:
- Significant risks of publication bias, selection bias, and confounding were identified in the overall body of literature.
- Evidence from low risk of bias studies does not support a link between neonatal jaundice and autism.
- Current evidence does not support more aggressive treatment of jaundice to prevent autism spectrum disorder.
Background:
Two meta-analyses concluded that jaundice was associated with an increased risk of autism. We hypothesize that these findings were due to methodological limitations of the studies included. Neonatal jaundice affects many infants and risks of later morbidity may prompt physicians towards more aggressive treatment.
Methods:
To conduct a systematic literature review and a meta-analysis of the association between neonatal jaundice and autism with particular attention given to low risk of bias studies. Pubmed, Scopus, Embase, Cochrane, and Google Scholar were searched for publications until February 2019. Data was extracted by use of pre-piloted structured sheets. Low risk of bias studies were identified through predefined criteria.
Results:
A total of 32 studies met the inclusion criteria. The meta-analysis of six low risk of bias studies showed no association between neonatal jaundice and autism; cohort studies risk ratio 1.09, 95% CI, 0.99-1.20, case-control studies odds ratio 1.29 95% CI 0.95, 1.76. Funnel plot of all studies suggested a high risk of publication bias.
Conclusions:
We found a high risk of publication bias, selection bias, and potential confounding in all studies. Based on the low risk of bias studies there was no convincing evidence to support an association between neonatal jaundice and autism.
Impact:
Meta-analysis of data from six low risk of bias studies indicated no association between neonatal jaundice and autism spectrum disorder. Previous studies show inconsistent results, which may be explained by unadjusted confounding and selection bias. Funnel plot suggested high risk of publication bias when including all studies. There is no evidence to suggest jaundice should be treated more aggressively to prevent autism.
