Neonatal intensive care unit (NICU) survivors and greater risk of autism?

"In term NICU [neonatal intensive care unit] survivors, ASD [autism spectrum disorder] occurs with a greater frequency than in the general population and often develops alongside comorbid conditions". That was the conclusion from the study by Alexander Winkler-Schwartz and colleagues [1] looking at term at-risk infants who survived NICU.

"You were only meant to blow the bloody doors off"

'Surviving' their earliest days spent in NICU brings a bit of lump to my throat. As a parent, I can only imagine how worrying and daunting a prospect it must be to watch your child, your baby, spending what is meant to be the very happiest of occasions housed in an incubator with every aspect of their being monitored and controlled. I appreciate that with the technology and medical advances available these days, the prospects for many infants 'surviving' NICU are pretty good compared to even a few decades ago. But still, I imagine it can be an overwhelming prospect.

The Winkler-Schwartz paper reported that out of 180 infants analysed as part of their study, 12 of them (6%) were later diagnosed with an ASD. This compared with ~40% diagnosed with global developmental delay and between 25-30% diagnosed with cerebral palsy (CP) and epilepsy. The authors also noted that: "Nine patients with ASD (75%) were diagnosed with at least one other adverse outcome", a point which ties in with their comorbidity finding.

At least one of the authors on the Winkler-Schwartz paper has some interest in looking at the cognitive-behavioural profile of neonates under adverse conditions. A quick trawl of the peer-reviewed literature base confirms that Michael Shevell has some research form specifically focused in areas such as neurodevelopment associated with congenital heart defects for example [2]. The word 'autism' has also been discussed in some of his previous research investigations too [3].

Aside from the primary conclusion included in the Winkler-Schwartz paper on NICU survivors and autism risk, the other important message is on how comorbidities might fit in with the presentation of autism. Autism and epilepsy has been an oft-discussed topic on this blog so I don't really need to say much more there. CP and autism is something of increasing interest (see here) particularly so when taking into account the findings from Christensen and colleagues [4] seemingly suggesting different autism risk profiles according to different types of CP.

I close with another quote from the Winkler-Schwartz paper on: "the importance of screening term NICU survivors for ASD, particularly when comorbidities are present". Yes another group where screening for autism might be preferentially indicated...

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[1] Winkler-Schwartz A. et al. Autism spectrum disorder in a term birth neonatal intensive care unit population. Pediatric Neurology. 2014. July 16.

[2] Limperopoulos C. et al. Neurologic status of newborns with congenital heart defects before open heart surgery. Pediatrics. 1999 Feb;103(2):402-8.

[3] Webster RI. et al. The clinical spectrum of developmental language impairment in school-aged children: language, cognitive, and motor findings. Pediatrics. 2006 Nov;118(5):e1541-9.

[4] Christensen D. et al. Prevalence of cerebral palsy, co-occurring autism spectrum disorders, and motor functioning - Autism and Developmental Disabilities Monitoring Network, USA, 2008. Dev Med Child Neurol. 2014 Jan;56(1):59-65.

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Winkler-Schwartz, A., Garfinkle, J., & Shevell, M. (2014). Autism spectrum disorder in a term birth neonatal intensive care unit population Pediatric Neurology DOI: 10.1016/j.pediatrneurol.2014.07.009