Elsevier

The Journal of Pediatrics

Volume 156, Issue 4, April 2010, Pages 525-531.e2
The Journal of Pediatrics

Original Article
Autism Spectrum Disorders in Extremely Preterm Children

https://doi.org/10.1016/j.jpeds.2009.10.041Get rights and content

Objectives

To investigate the prevalence, correlates, and antecedents of autism spectrum disorders (ASD) in extremely preterm children.

Study design

We conducted a prospective study of all births <26 weeks gestation in the United Kingdom and Ireland in 1995. Of 307 survivors at 11 years, 219 (71%) were assessed and compared with 153 term-born classmates. Parents completed the Social Communication Questionnaire (SCQ) to assess autism spectrum symptoms, and ASD were diagnosed by using a psychiatric evaluation. An IQ test and clinical evaluation were also administered. Longitudinal outcome data were available for extremely preterm children.

Results

Extremely preterm children had significantly higher SCQ scores than classmates (mean difference, 4.6 points; 95% CI, 3.4-5.8). Sixteen extremely preterm children (8%) were assigned an ASD diagnosis, compared with none of the classmates. By hospital discharge, male sex, lower gestation, vaginal breech delivery, abnormal cerebral ultrasound scanning results, and not having had breast milk were independently associated with autism spectrum symptoms. By 6 years, independent associates were cognitive impairment, inattention and peer problems, withdrawn behavior at 2.5 years, and not having had breast milk.

Conclusions

Extremely preterm children are at increased risk for autism spectrum symptoms and ASD in middle childhood. These symptoms and disorders were associated with neurocognitive outcomes, suggesting that ASD may result from abnormal brain development in this population.

Section snippets

Methods

All babies born <26 weeks gestation in the United Kingdom and Ireland from March through December 1995 were recruited to the EPICure Study. Of 307 survivors at 11 years of age, 11 (4%) moved abroad, and the parents of 77 (25%) did not respond or declined consent. The remaining 219 children (71%) were assessed (median age, 10 years 11 months; age range, 121-145 months). Longitudinal data were available for 213 and 202 children who were also assessed at 2.5 years and 6 years, respectively.

At 6

Results

Extremely preterm children not assessed (n = 89) at 11 years of age were more likely to be born at 25 weeks to unemployed parents of non-white ethnic origin and to have more frequent cognitive impairment at 2.5 years of age and 6 years of age than children who underwent assessment (n = 219).20 Extremely preterm children with missing SCQ (n = 36) and DAWBA (n = 18) assessments had lower IQ scores (15 and 5 points, respectively); these differences were 0 (n = 16) and 4 (n = 10) points for

Discussion

This large population-based study confirms that extremely preterm children are at increased risk for autism spectrum symptoms and disorders. The prevalence of narrowly defined autistic disorder is approximately 65-times higher than community populations, and the prevalence of ASD are 4- to 12- times higher.2, 24 As hypothesized, the prevalence of diagnoses in this study is higher than in other studies of ASD in VLBW/LBW children.10, 11 This is likely because of the increased risk of cognitive

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    Funded by the Medical Research Council, London, UK. The study sponsor was not involved in design, data collection, analysis and interpretation, writing of the report or decision to submit for publication. The authors declare no conflicts of interest.

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