Abstract
BackgroundLower gestational age may increase autism spectrum disorder (ASD) vulnerability; however, the incidence of ASD diagnosis through a direct assessment on every very preterm birth child on the population base remains unclear. Moreover, the behavioral characteristics of preterm birth ASD are unknown.MethodsEvery very preterm birth child (gestational age < 32 weeks; birth weight < 1500 g) who was discharged from neonatal intensive care units in Southern Taiwan and prospectively followed to 5 years of age was evaluated using the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R). The term birth (gestational age > 37 weeks) ASD children characterized by ADOS and ADI-R were group matched to the preterm birth ASD by age at examination for comparison. ADOS severity scores were calculated by the Mann–Whitney U test and ADI-R by multivariate analysis of variance and canonical discriminant analysis.ResultsTwo hundred forty-six (87%) of the 283 very preterm survivors were followed prospectively to 5 years of age. Nineteen (7.7%) of the 246 children fulfilled the diagnostic criteria of ASD. After excluding 1 patient with cerebral palsy and profound mental disability, 18 preterm ASD children were compared with 44 term birth ASD children. The two ASD groups were comparable for age at examination, gender, and intelligence quotient. The two groups showed comparable ADOS severity scores in social affect deficits, restricted repetitive behaviors, and total score, but had differences in qualitative abnormalities in reciprocal social interaction (Wilks lambda F value = 6.2, P < 0.001) of ADI-R. Compared to term birth ASD children, preterm birth ASD children exhibited worse nonverbal behaviors that regulate social interaction (OR 2.59, 95% CI 1.41–4.73, P = 0.002) but more favorable peer relationships (OR 0.58, 95% CI 0.38–0.90, P = 0.01) and socioemotional reciprocity (OR 0.55, 95% CI 0.33–0.92, P = 0.02). In contrast to the heterogeneous severity of social reciprocity in the term ASD group, the behavioral characteristics of the preterm ASD group showed a homogeneous reciprocal social interaction pattern.ConclusionsThe 5-year incidence rate of ASD was high in very preterm birth children. Preterm birth ASD exhibited a specific behavioral phenotype of reciprocal social interaction.
Highlights
Lower gestational age may increase autism spectrum disorder (ASD) vulnerability; the incidence of ASD diagnosis through a direct assessment on every very preterm birth child on the population base remains unclear
Large-scale ASD studies have mainly focused on children in the general population, who are mostly born at term, while relatively few studies have focused on the low gestational age preterm infants
The Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule (ADOS) severity scores of the 227 pretermbirth children who did not have ASD were presented in Additional file 1: Table S1
Summary
Lower gestational age may increase autism spectrum disorder (ASD) vulnerability; the incidence of ASD diagnosis through a direct assessment on every very preterm birth child on the population base remains unclear. Large-scale ASD studies have mainly focused on children in the general population, who are mostly born at term, while relatively few studies have focused on the low gestational age preterm infants. Advances in neonatal intensive care have greatly improved the survival rate of very preterm infants; the incidence of neurodevelopmental impairments in these infants is a major concern [6]. Severe neurodevelopmental disabilities, such as cerebral palsy and sensory impairments, show a declining trend. Limited studies have performed direct ASD assessments prospectively on every child in the population-based very preterm birth cohort
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