PEDIATRICS Vol. 121 No. 4 April 2008, pp. 758-765 (doi:10.1542/peds.2007-2158)
ARTICLE |
Positive Screening for Autism in Ex-preterm Infants: Prevalence and Risk Factors
a Department of Neurology and Neurosurgery, School of Physical and Occupational Therapy, and Department of Pediatrics, McGill University, Montreal, Quebec, Canada
b Fetal-Neonatal Neurology Research Program, Department of Neurology
c Developmental Medicine Center
d Department of Radiology, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts
e Department of Neonatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
OBJECTIVE. The survival of very low birth weight infants has increased markedly in recent years. Unfortunately, the prevalence of significant and lifelong motor, cognitive, and behavioral dysfunction has remained a major problem confronting these children. The objective of this study was to perform screening tests for early autistic features in children with a history of very low birth weight and to identify risk factors associated with a positive screening result.
METHODS. We studied 91 ex-preterm infants 
1500 g at birth. Infants underwent conventional MRI studies at preterm and/or term-adjusted age. We collected pertinent demographic, prenatal, intrapartum, acute postnatal, and short-term outcome data for all infants. Follow-up assessments were performed at a mean age of 21.9 ± 4.7 months, using the Modified Checklist for Autism in Toddlers, the Vineland Adaptive Behavior Scale, and the Child Behavior Checklist.
RESULTS. Twenty-six percent of ex-preterm infants had a positive result on the autism screening tool. Abnormal scores correlated highly with internalizing behavioral problems on the Child Behavior Checklist and socialization and communication deficits on the Vineland Scales. Lower birth weight, gestational age, male gender, chorioamnionitis, acute intrapartum hemorrhage, illness severity on admission, and abnormal MRI studies were significantly associated with an abnormal autism screening score.
CONCLUSIONS. Early autistic behaviors seem to be an underrecognized feature of very low birth weight infants. The results from this study suggest that early screening for signs of autism may be warranted in this high-risk population followed by definitive autism testing in those with positive screening results.
Key Words: autism • prematurity • MRI • risk factors • outcome
Abbreviations: VLBW—very low birth weight • M-CHAT—Modified Checklist for Autism in Toddlers • CBCL—Child Behavior Checklist • VABS—Vineland Adaptive Behavior Scale • SNAP-II—Score of Neonatal Acute Physiology II • PVL—periventricular leukomalacia • PVHI—periventricular hemorrhagic infarction
Accepted Aug 23, 2007.
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