Early Medical and Behavioral Characteristics of NICU Infants Later Classified With ASD

Abstract

OBJECTIVES Recent evidence suggests higher prevalence of autism spectrum disorder (ASD) in NICU graduates. This aim of this study was to identify retrospectively early behaviors found more frequently in NICU infants who went on to develop ASD. METHODS Twenty-eight NICU graduates who later received a diagnosis of ASD were compared with 2169 other NICU graduates recruited from 1994 to 2005. They differed in gender, gestational age, and birth cohort. These characteristics were used to draw a matched control sample (n = 112) to determine which, if any, early behaviors discriminated subsequent ASD diagnosis. Behavioral testing at targeted ages (adjusted for gestation) included the Rapid Neonatal Neurobehavioral Assessment (hospital discharge, 1 month), Arousal-Modulated Attention (hospital discharge, 1 and 4 months), and Bayley Scales of Infant Development (multiple times, 4–25 months). RESULTS At 1 month, children with ASD but not control children had persistent neurobehavioral abnormalities and higher incidences of asymmetric visual tracking and arm tone deficits. At 4 months, children with ASD had continued visual preference for higher amounts of stimulation than did control children, behaving more like newborns. Unlike control children, children with ASD had declining mental and motor performance by 7 to 10 months, resembling infants with severe central nervous system involvement. CONCLUSIONS Differences in specific behavior domains between NICU graduates who later receive a diagnosis of ASD and matched NICU control children may be identified in early infancy. Studies with this cohort may provide insights to help understand and detect early disabilities, including ASD.

Head Lag in Infancy: What Is It Telling Us?

“…This finding coincides with previous findings of head lag being associated with lower motor scores at age 12 wk but not at later time points (Bentzley et al, 2015). Findings from this study differ from those of a previous study that found an association between head lag at age 6 mo and risk for autism (Flanagan et al, 2012) and from other literature showing a relationship between early headrighting responses and poor motor outcome and autism (Barbosa et al, 2005;Karmel et al, 2010).…”

“…Preterm infants have a heightened risk for motor problems, and early postural control, related to head lag in pull-to-sit, can be an important predictor of developmental outcome (Samsom & de Groot, 2000;Viholainen et al, 2006). Persistent head lag beyond age 4 mo has been linked to poor outcomes (Flanagan, Landa, Bhat, & Bauman, 2012), but few studies have investigated head lag during the neonatal period (Barbosa, Campbell, Smith, & Berbaum, 2005;Karmel et al, 2010). Although head lag has been reported to be common in preterm infants up to termequivalent age (Allen & Capute, 1990), most full-term infants and preterm infants at term-equivalent age can maintain the head in line with the body during pull-to-sit (Dubowitz et al, 1999), making head lag in the neonatal period a marker of poor neurobehavior.…”

Personality of adults who were born very preterm

“…Similarly, autistic features in the general population have been found to have a strong genetic component23 as well as being related to environmental events that may alter brain development such as severe early deprivation24 and very preterm birth 20. In preterm children, autistic features are also related to cognitive deficits 25. Thus, it is important to control for general cognitive abilities as done here.…”

Unraveling the Miswired Connectome: A Developmental Perspective

“…Over the past two decades, the prevalence of preterm births has increased in response to an array of factors, including in vitro fertilization, increasing parental age of conception, and earlier detection of fetal distress. Preterm neonates requiring intensive care following birth have increased risks for later life cognitive and learning impairments (3–5 times higher than the general population; Karmel et al, 2010) and signs of neurological damage (e.g., diffuse white matter injury, reduced grey matter volume, intraventricular hemorrhage, periventricular leukomalacia). Initial connectomics studies in preterm infants have highlighted disruptions in thalamocortical connections implicated in cortical organization (Groppo et al, 2014; Smyser et al, 2012).…”