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Incidence of Autism Spectrum Disorder and Global Developmental Delay in Infants With Brachial Plexus Birth Injury: An
Thomas J McQuillan1, Daniel Gabriel2, Patricia E Miller3
1Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS.
Insights
Birth asphyxia is linked to autism spectrum disorder (ASD) and global developmental delay (GDD) in children with brachial plexus birth injury (BPBI). This suggests a connection between birth complications and these neurodevelopmental conditions in infants with BPBI.
Area of Science:
- Pediatric Neurology
- Neonatal Medicine
- Developmental Pediatrics
Background:
- Autism spectrum disorder (ASD) and global developmental delay (GDD) are common pediatric central nervous system (CNS) diagnoses.
- Brachial plexus birth injury (BPBI) is a known birth complication.
- The study investigated a potential link between BPBI and CNS diagnoses.
Purpose of the Study:
- To determine if the incidence of ASD and GDD is higher in children with BPBI.
- To identify maternal risk factors and birth complications associated with co-occurring BPBI and CNS diagnoses.
Main Methods:
- A prospective cohort study of 849 patients with BPBI was conducted.
- Demographic, perinatal, maternal, and treatment data were collected.
- Patients were analyzed for concomitant GDD and ASD diagnoses, with age and sex-matched comparisons for risk factors.
Main Results:
- The incidence of GDD or ASD in patients with BPBI was 2.2%, not significantly different from the general population.
- A history of birth asphyxia was significantly more common in patients with BPBI and GDD/ASD (58% vs. 15%, P<0.05).
- Shoulder dystocia and surgical management rates did not differ between groups.
Conclusions:
- Birth complications, particularly birth asphyxia, are associated with GDD/ASD in children with BPBI.
- Healthcare providers should consider the potential coexistence of BPBI and GDD/ASD in infants with complicated birth histories.
Background:
Autism spectrum disorder (ASD) and global developmental delay (GDD) are 2 common central nervous system (CNS) diagnoses in children. We hypothesized that the incidence of ASD and GDD is higher among patients with brachial plexus birth injury (BPBI), and that the subgroup of patients with BPBI and CNS diagnoses would have increased rates of maternal risk factors and birth-related complications.
Methods:
A single institution prospective cohort of 849 patients with BPBI was used. Demographics, perinatal history, maternal factors and treatment, and patient outcomes were recorded. Charts were reviewed for concomitant diagnoses of GDD and ASD. Cohorts were compared regarding demographics and treatment data, and then age and sex-matched to analyze for risk factors.
Results:
Of 834 unique patients seen for BPBI, 772 met inclusion criteria. Seventeen subjects had a diagnosis of GDD (13) or ASD (4) before the age of 5 years, an incidence of 2.2%, which is not different from the general population incidence of ASD and GDD. After age and sex-matching, a history of birth asphyxia (58% vs. 15%, P <0.05) was most associated with an increased likelihood of ASD or GDD diagnosis. Rates of shoulder dystocia and eventual surgical management did not differ between cohorts.
Conclusions:
Birth complications, especially birth asphyxia, are associated with GDD/ASD in patients with BPBI. Providers should consider that BPBI and GDD/ASD may coexist in children with a history of a complicated birth.
Level Of Evidence:
Level IV.
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