Positive screening for autism in ex-preterm infants: prevalence and risk factors.
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 < or = 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.
Limperopoulos
Catherine
C
Department of Neurology and Neurosurgery, School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada. catherine.limperopoulos@childrens.harvard.edu
Bassan
Haim
H
Sullivan
Nancy R
NR
Soul
Janet S
JS
Robertson
Richard L
RL
Moore
Marianne
M
Ringer
Steven A
SA
Volpe
Joseph J
JJ
du Plessis
Adré J
AJ
D001321:Autistic Disorder / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D002658:Developmental Disabilities / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000453:epidemiology*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008403:Mass Screening; D015999:Multivariate Analysis; D015997:Neonatal Screening; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis