Incidence and risk factors for autism spectrum disorder among infants born <29 weeks' gestation

Andrée-Anne Busque; Elias Jabbour; Sharina Patel; Élise Couture; Jarred Garfinkle; May Khairy; Martine Claveau; Marc Beltempo

doi:10.1093/pch/pxac065

Incidence and risk factors for autism spectrum disorder among infants born <29 weeks' gestation

Paediatr Child Health. 2022 Jul 10;27(6):346-352. doi: 10.1093/pch/pxac065. eCollection 2022 Oct.

Authors

Andrée-Anne Busque¹, Elias Jabbour², Sharina Patel^{1

2}, Élise Couture³, Jarred Garfinkle^{2

3}, May Khairy³, Martine Claveau³, Marc Beltempo^{2

3}

Affiliations

¹ McGill University, Montreal, Quebec, Canada.
² McGill University Health Center, Research Institute, Montreal, Quebec, Canada.
³ Department of Pediatrics, Montreal Children's Hospital - McGill University Health Centre, Montreal, Quebec, Canada.

Abstract

Objective: This study was aimed to assess the incidence of and risk factors for autism spectrum disorder (ASD) among preterm infants born <29 weeks' gestational age (GA).

Methods: A retrospective cohort study of infants born <29 weeks' GA admitted to two tertiary neonatal intensive care units (2009 to 2017) and followed ≥18 months corrected age (CA) at a neonatal follow-up clinic. The primary outcome was ASD, diagnosed using standardized testing or provisional diagnosis at ≥18 months CA. Patient data and 18-month CA developmental outcomes were obtained from the local Canadian Neonatal Follow Up Network database and chart review. Stepwise logistic regression assessed factors associated with ASD.

Results: Among 300 eligible infants, 26 (8.7%) were diagnosed with confirmed and 21 (7.0%) with provisional ASD for a combined incidence of 15.7% (95% confidence interval [CI] 11.7 to 20.3). The mean follow-up duration was 3.9 ± 1.4 years and the mean age of diagnosis was 3.7 ± 1.5 years. Male sex (adjusted odds ratio [aOR] 4.63, 95% CI 2.12 to 10.10), small for gestational age status (aOR 3.03, 95% CI 1.02 to 9.01), maternal age ≥35 years at delivery (aOR 2.22, 95% CI 1.08 to 4.57) and smoking during pregnancy (aOR 5.67, 95% CI 1.86 to 17.29) were significantly associated with ASD. Among ASD infants with a complete 18-month CA developmental assessment, 46% (19/41) had no neurodevelopmental impairment (Bayley-III<70, deafness, blindness, or cerebral palsy).

Conclusions: ASD is common among infants born <29 weeks' GA and possibly associated with identified risk factors. Such findings emphasize the importance of ASD evaluation among infants <29 weeks' GA and for continued reporting of developmental outcomes beyond 18-months of corrected age.

Keywords: Autism spectrum disorder; Neurodevelopmental outcomes; Prematurity.