Psychiatric outcomes in low-birth-weight children at age 6 years: relation to neonatal cranial ultrasound abnormalities.
BACKGROUND
This study examined the relation of neonatal cranial ultrasound abnormalities to psychiatric disorder at age 6 years in a regional birth cohort of low-birth-weight children.


METHODS
Neonatal cranial ultrasound abnormalities were classified as (1) isolated germinal matrix and/or intraventricular hemorrhage (suggestive of injury to glial precursors) or (2) parenchymal lesions and/or ventricular enlargement (suggestive of white matter injury) with or without germinal matrix-intraventricular hemorrhage. Psychiatric disorders by DSM-III-R at age 6 years were assessed by means of a structured parent interview. Children with severe mental retardation were excluded. Analyses were conducted first in the entire sample and then in children with normal intelligence.


RESULTS
Twenty-two percent of the cohort had at least 1 psychiatric disorder, the most common being attention deficit hyperactivity disorder (15.6%). In the entire sample, parenchymal lesions and/or ventricular enlargement increased risk relative to no abnormality, independently of other biological and social predictors, for any disorder (odds ratio [OR], 4.4; 95% confidence interval [CI], 1.8-10.3; P < .001), attention deficit hyperactivity disorder (OR, 3.4; CI, 1.3-8.7; P = .02), and tic disorders (OR, 8.7; CI, 1.3-57.7; P = .02). In children of normal intelligence, parenchymal lesions/ventricular enlargement independently increased risk for any disorder (OR, 4.8; CI, 1.6-12.0; P < .01), attention deficit hyperactivity disorder (OR, 4.5; CI, 1.3-16.0; P = .02), and separation anxiety (OR, 5.3; CI, 1.1-24.8; P = .03). These effects were not ameliorated by female sex or social advantage. Isolated germinal matrix/intraventricular hemorrhage was not related to psychiatric disorder at age 6 years.


CONCLUSIONS
Neonatal cranial ultrasound abnormalities suggestive of white matter injury significantly increased risk for some psychiatric disorders at age 6 years in low-birth-weight children.
Whitaker
A H
AH
Division of Child and Adolescent Psychiatry, Columbia University, New York, NY, USA.
Van Rossem
R
R
Feldman
J F
JF
Schonfeld
I S
IS
Pinto-Martin
J A
JA
Tore
C
C
Shaffer
D
D
Paneth
N
N
D000367:Age Factors; D001034:Apgar Score; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology / Q000209:etiology; D001720:Birth Injuries / Q000175:diagnosis / Q000453:epidemiology; D001921:Brain / Q000473:pathology*; D001930:Brain Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002653:Child Behavior Disorders / Q000453:epidemiology / Q000209:etiology; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D013981:Tic Disorders / Q000453:epidemiology / Q000209:etiology; D014463:Ultrasonography