Presented at the Neonatal Society 2009 Autumn Meeting.
Moore T1, Johnson S1,2, Marlow N1 for the EPICure Study Group
1 Academic Neonatology, Institute for Women’s Health, University College London, London, UK
2 School of Clinical Sciences, University of Nottingham, Nottingham, UK
Objectives: Recent studies using screening tests have raised concern about a high prevalence of autism in extremely preterm children. However, the specificity of screening in infancy may be confounded by the high prevalence of neuro-developmental sequelae in this population. We have investigated neuro-developmental correlates of positive autism screening in extremely preterm infants.
Methods: All babies born <27 weeks gestational age in England in 2006 were recruited to the EPICure-2 study. Parents of 559 (55%) survivors completed the Modified Checklist for Autism in Toddlers (M-CHAT) to screen for autistic features, the Parent Report of Children’s Abilities-Revised (PARCA-R) to screen for cognitive impairment and questionnaire items to assess motor and sensory impairment at 2 years corrected age.
Results: Based on parent report, cognitive impairment was present in 340 (61%), motor impairment in 71 (13%), visual impairment in 10 (2%) and hearing impairment in 6 (1%) of survivors. 216 (41%) screened positive for autistic features. Males were twice as likely to screen positive compared with females (OR 1.9; 95%CI 1.3 to 2.7). Risk of a positive M-CHAT screen was significantly associated with motor (41.7; 12.9 to 135) cognitive (5.3; 3.5 to 8.0) and sensory impairment (p<0.001). Among 200 children without neuro-developmental disability, 33 (16.5%) had positive M-CHAT screens.
Conclusion: A high proportion of extremely preterm infants screened positive for autistic features. Positive screens were significantly associated with neuro-developmental impairment potentially yielding a high false positive rate. Caution should be observed when screening for autism in this population and results should be interpreted in light of other clinical findings. Follow-up at school age is necessary to establish the prevalence of autism spectrum disorder diagnoses.
References
1. Limperopoulos, C., Bassan, H., Sullivan, N. R., Soul, J. S., Robertson, R. L., Moore, M., et al. (2008). Positive screening for autism in ex-preterm infants: Prevalence and risk factors. Pediatrics, 121, 758-765.
2. Johnson, S., & Marlow, N. (2009). Positive Screening Results on the Modified Checklist for Autism in Toddlers: Implications for Very Preterm Populations The Journal of Pediatrics, 154, 478-480.