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Molani-Gol R, Alizadeh M, Kheirouri S, Hamedi-Kalajahi F. The early life growth of head circumference, weight, and height in infants with autism spectrum disorders: a systematic review. BMC Pediatr 2023; 23:619. [PMID: 38066466 PMCID: PMC10704616 DOI: 10.1186/s12887-023-04445-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUNDS The Autism spectrum disorder (ASD) prevalence has increased significantly over the past two decades. This review summarizes the current knowledge of the association between the early life growth of head circumference (HC), weight, and height with ASD in infants. METHODS PubMed, Scopus, Science Direct, and Google Scholar databases were searched up to November 2021 using relevant keywords. All original articles are written in English evaluating the early life growth of HC, weight, and height in infants with ASD were eligible for the present review. RESULTS Totally, 23 articles involving 4959 infants were included in this review. Of 13 studies that evaluated HC of infants at birth, 10 studies (83.33%) showed that the HC at the birth of autistic children was similar to that of the average found in the control group. Among 21 studies that evaluated the HC and weight status in infants, 19 studies (90.47%) showed that autistic children had larger HC and weight than the control group or abnormal acceleration of head growth during infancy. Height growth of infants was investigated in 13 studies, of which 10 cases (76.92%) reported that infants with ASD were significantly longer than control groups. Most of he included studies had a good quality. CONCLUSIONS The findings suggest that in infants with ASD, without the contribution of birth growth factors and sex of the child, the growth of HC, weight, and height probably was faster than in infants with normal development, in early life. Therefore, these measurements might be useful as initial predictive biomarkers for the risk of developing ASD.
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Affiliation(s)
- Roghayeh Molani-Gol
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Attar Nishabouri St, 14711, Tabriz, 5166614711, Iran
| | - Mohammad Alizadeh
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Attar Nishabouri St, 14711, Tabriz, 5166614711, Iran
| | - Sorayya Kheirouri
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Attar Nishabouri St, 14711, Tabriz, 5166614711, Iran.
| | - Fatemeh Hamedi-Kalajahi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Attar Nishabouri St, 14711, Tabriz, 5166614711, Iran
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Mendez AI, Tokish H, McQueen E, Chawla S, Klin A, Maitre NL, Klaiman C. A Comparison of the Clinical Presentation of Preterm Birth and Autism Spectrum Disorder: Commonalities and Distinctions in Children Under 3. Clin Perinatol 2023; 50:81-101. [PMID: 36868715 PMCID: PMC10842306 DOI: 10.1016/j.clp.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Premature infants and infants later diagnosed with autism spectrum disorder (ASD) share many commonalities in clinical presentations. However, prematurity and ASD also have differences in clinical presentation. These overlapping phenotypes can lead to misdiagnoses of ASD or missing a diagnosis of ASD in preterm infants. We document these commonalities and differences in various developmental domains with the hope of aiding in the accurate early detection of ASD and timely intervention implementation in children born premature. Given the degree of similarities in presentation, evidence-based interventions designed specifically for preterm toddlers or toddlers with ASD may ultimately aid both populations.
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Affiliation(s)
- Adriana I Mendez
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, USA; Marcus Autism Center, 1920 Briarcliff Road, Atlanta, GA 30329, USA; Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322, USA; Children's Healthcare of Atlanta, 1405 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Hannah Tokish
- Marcus Autism Center, 1920 Briarcliff Road, Atlanta, GA 30329, USA; Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322, USA; Children's Healthcare of Atlanta, 1405 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Emma McQueen
- Marcus Autism Center, 1920 Briarcliff Road, Atlanta, GA 30329, USA; Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322, USA; Children's Healthcare of Atlanta, 1405 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Shivaang Chawla
- Marcus Autism Center, 1920 Briarcliff Road, Atlanta, GA 30329, USA; Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322, USA; Children's Healthcare of Atlanta, 1405 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Ami Klin
- Marcus Autism Center, 1920 Briarcliff Road, Atlanta, GA 30329, USA; Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322, USA; Children's Healthcare of Atlanta, 1405 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Nathalie L Maitre
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322, USA; Children's Healthcare of Atlanta, 1405 Clifton Road Northeast, Atlanta, GA 30322, USA
| | - Cheryl Klaiman
- Marcus Autism Center, 1920 Briarcliff Road, Atlanta, GA 30329, USA; Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA 30322, USA; Children's Healthcare of Atlanta, 1405 Clifton Road Northeast, Atlanta, GA 30322, USA.
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3
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Preterm birth and weight-for-gestational age for risks of autism spectrum disorder and intellectual disability: A nationwide population-based cohort study. J Formos Med Assoc 2022; 122:493-504. [DOI: 10.1016/j.jfma.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/11/2022]
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DeMauro SB, Merhar SL, Peralta-Carcelen M, Vohr BR, Duncan AF, Hintz SR. The critical importance of follow-up to school age: Contributions of the NICHD Neonatal Research Network. Semin Perinatol 2022; 46:151643. [PMID: 35850744 PMCID: PMC10983779 DOI: 10.1016/j.semperi.2022.151643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Follow-up studies are essential for understanding outcomes and informing the care of infants with high risk for medical and developmental consequences because of extreme prematurity or perinatal illness. Studies that extend to school age often identify sequelae that go unrecognized in neonatal or short-term follow-up studies. Many critical neurocognitive, behavioral, functional, and health outcomes are best assessed beginning at school age. The Eunice Kennedy Shriver National Institute of Child Health and Development Neonatal Research Network (NRN) has performed comprehensive school age evaluations of several key trial cohorts. This manuscript summarizes the important contributions of school age follow-up studies in the NRN, both historically and in ongoing research. We describe in detail the clinical questions that have been answered by the completed studies and new questions about the outcomes of high-risk infants that must be addressed by ongoing and future studies.
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Affiliation(s)
- Sara B DeMauro
- University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, Pennsylvania 19146, United States.
| | - Stephanie L Merhar
- University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | | | - Betty R Vohr
- Warren Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island, Providence, Rhode Island, United States
| | - Andrea F Duncan
- University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
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Bakalar D, O’Reilly JJ, Lacaille H, Salzbank J, Ellegood J, Lerch JP, Sasaki T, Imamura Y, Hashimoto-Torii K, Vacher CM, Penn AA. Lack of placental neurosteroid alters cortical development and female somatosensory function. Front Endocrinol (Lausanne) 2022; 13:972033. [PMID: 36313771 PMCID: PMC9606442 DOI: 10.3389/fendo.2022.972033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/28/2022] [Indexed: 01/24/2023] Open
Abstract
Placental endocrine function is essential to fetal brain development. Placental hormones include neurosteroids such as allopregnanolone (ALLO), a regulator of neurodevelopmental processes via positive allosteric modulation of the GABAA receptor (GABAA-R). Using a mouse model (plKO) in which the gene encoding the ALLO synthesis enzyme is specifically deleted in trophoblasts, we previously showed that placental ALLO insufficiency alters cerebellar white matter development and leads to male-specific autistic-like behavior. We now demonstrate that the lack of placental ALLO causes female-predominant alterations of cortical development and function. Placental ALLO insufficiency disrupts cell proliferation in the primary somatosensory cortex (S1) in a sex-linked manner. Early changes are seen in plKO embryos of both sexes, but persist primarily in female offspring after birth. Adolescent plKO females show significant reduction in pyramidal neuron density, as well as somatosensory behavioral deficits as compared with plKO males and control littermates. Assessment of layer-specific markers in human postmortem cortices suggests that preterm infants may also have female-biased abnormalities in cortical layer specification as compared with term infants. This study establishes a novel and fundamental link between placental function and sex-linked long-term neurological outcomes, emphasizing the importance of the growing field of neuroplacentology.
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Affiliation(s)
- Dana Bakalar
- Center for Neuroscience Research, Children’s Research Institute, Children’s National Health System, Washington, DC, United States
| | - Jiaqi J. O’Reilly
- Division of Neonatology, Department of Pediatrics, NewYork-Presbyterian Morgan Stanley Children’s Hospital, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Helene Lacaille
- Division of Neonatology, Department of Pediatrics, NewYork-Presbyterian Morgan Stanley Children’s Hospital, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Jacquelyn Salzbank
- Division of Neonatology, Department of Pediatrics, NewYork-Presbyterian Morgan Stanley Children’s Hospital, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Jacob Ellegood
- Mouse Imaging Centre (MICe), Hospital for Sick Children, Toronto, ON, Canada
| | - Jason P. Lerch
- Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Toru Sasaki
- Center for Neuroscience Research, Children’s Research Institute, Children’s National Health System, Washington, DC, United States
| | - Yuka Imamura
- Department of Biochemistry and Molecular Biology, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Kazue Hashimoto-Torii
- Center for Neuroscience Research, Children’s Research Institute, Children’s National Health System, Washington, DC, United States
| | - Claire-Marie Vacher
- Division of Neonatology, Department of Pediatrics, NewYork-Presbyterian Morgan Stanley Children’s Hospital, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Anna A. Penn
- Division of Neonatology, Department of Pediatrics, NewYork-Presbyterian Morgan Stanley Children’s Hospital, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
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Vacher CM, Lacaille H, O'Reilly JJ, Salzbank J, Bakalar D, Sebaoui S, Liere P, Clarkson-Paredes C, Sasaki T, Sathyanesan A, Kratimenos P, Ellegood J, Lerch JP, Imamura Y, Popratiloff A, Hashimoto-Torii K, Gallo V, Schumacher M, Penn AA. Placental endocrine function shapes cerebellar development and social behavior. Nat Neurosci 2021; 24:1392-1401. [PMID: 34400844 PMCID: PMC8481124 DOI: 10.1038/s41593-021-00896-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/23/2021] [Indexed: 02/07/2023]
Abstract
Compromised placental function or premature loss has been linked to diverse neurodevelopmental disorders. Here we show that placenta allopregnanolone (ALLO), a progesterone-derived GABA-A receptor (GABAAR) modulator, reduction alters neurodevelopment in a sex-linked manner. A new conditional mouse model, in which the gene encoding ALLO's synthetic enzyme (akr1c14) is specifically deleted in trophoblasts, directly demonstrated that placental ALLO insufficiency led to cerebellar white matter abnormalities that correlated with autistic-like behavior only in male offspring. A single injection of ALLO or muscimol, a GABAAR agonist, during late gestation abolished these alterations. Comparison of male and female human preterm infant cerebellum also showed sex-linked myelination marker alteration, suggesting similarities between mouse placental ALLO insufficiency and human preterm brain development. This study reveals a new role for a placental hormone in shaping brain regions and behaviors in a sex-linked manner. Placental hormone replacement might offer novel therapeutic opportunities to prevent later neurobehavioral disorders.
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Affiliation(s)
- Claire-Marie Vacher
- Department of Pediatrics, Columbia University, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA.
| | - Helene Lacaille
- Department of Pediatrics, Columbia University, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Jiaqi J O'Reilly
- Department of Pediatrics, Columbia University, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Jacquelyn Salzbank
- Department of Pediatrics, Columbia University, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Dana Bakalar
- National Institutes of Health, Bethesda, MD, USA
| | - Sonia Sebaoui
- Center for Neuroscience Research, Children's National Health System, Washington, DC, USA
| | - Philippe Liere
- U1195 INSERM, Paris-Saclay University, Le Kremlin-Bicêtre Cedex, France
| | | | - Toru Sasaki
- Center for Neuroscience Research, Children's National Health System, Washington, DC, USA
| | - Aaron Sathyanesan
- Center for Neuroscience Research, Children's National Health System, Washington, DC, USA
| | - Panagiotis Kratimenos
- Center for Neuroscience Research, Children's National Health System, Washington, DC, USA
- The George Washington University School of Medicine and Health Sciences, Pediatrics, Washington, DC, USA
| | - Jacob Ellegood
- Mouse Imaging Centre (MICe), Hospital for Sick Children, Toronto, ON, Canada
| | - Jason P Lerch
- Mouse Imaging Centre (MICe), Hospital for Sick Children, Toronto, ON, Canada
- Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Yuka Imamura
- Department of Biochemistry and Molecular Biology, Pennsylvania State University College of Medicine, Pittsburgh, PA, USA
| | - Anastas Popratiloff
- The George Washington University, Nanofabrication and Imaging Center, Washington, DC, USA
- The George Washington University, SMHS, Anatomy & Cell Biology, Washington, DC, USA
| | - Kazue Hashimoto-Torii
- Center for Neuroscience Research, Children's National Health System, Washington, DC, USA
- The George Washington University School of Medicine and Health Sciences, Pediatrics, Washington, DC, USA
| | - Vittorio Gallo
- Center for Neuroscience Research, Children's National Health System, Washington, DC, USA
- The George Washington University School of Medicine and Health Sciences, Pediatrics, Washington, DC, USA
| | | | - Anna A Penn
- Department of Pediatrics, Columbia University, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA.
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7
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The microbiome, guard or threat to infant health. Trends Mol Med 2021; 27:1175-1186. [PMID: 34518093 DOI: 10.1016/j.molmed.2021.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/29/2021] [Accepted: 08/11/2021] [Indexed: 11/23/2022]
Abstract
Despite improvements in survival for very low birthweight (VLBW) premature infants, there continues to be significant morbidity for these infants at remarkable cost to the healthcare system. Concurrent development of the preterm infant intestine alongside the gut microbiome in the clinical setting rather than in the protected in utero environment where it would usually occur creates significant vulnerabilities for the infant's immature intestine and immune system, resulting in devastating illness and neurological injury. However, the microbiome also has the capacity to promote healthy development. Studies of parallel gut microbiome and preterm infant development have given key insight into the impact of the microbiome on intestinal as well as neural development and may provide potential therapeutic targets to prevent preterm infant morbidities.
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Mahurin-Smith J, DeThorne LS, Petrill SA. Children Born Prematurely May Demonstrate Catch-Up Growth in Pre-Adolescence. Lang Speech Hear Serv Sch 2021; 52:675-685. [PMID: 33656921 DOI: 10.1044/2020_lshss-20-00111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction Children born prematurely often score lower on standardized tests of language in early childhood. Less is known about longer term outcomes. This investigation considered language outcomes in pre-adolescent children born very preterm/very low birthweight, as assessed by both standardized test scores and language sample measures, and explored attention abilities as a possible moderating factor. Method The present investigation provided a longitudinal follow-up to Mahurin Smith et al. (2014) by examining the language outcomes of 84 children at the 11-year time point (39 with a history of prematurity and 45 born at full term) and a total of 82 at the 12-year time point (37 with a history of prematurity, 45 born at full term). Assessments included subtests of the Clinical Evaluation of Language Fundamentals- Fourth Edition, productive language measures taken from narrative tasks, and parent and examiner ratings of attention. Results Gestational age significantly predicted standardized language scores at age 11 years, but this effect was no longer statistically significant at age 12 years. When parent ratings of attention were considered as additional variables, gestational age was no longer a significant predictor. Gestational age did not serve as a significant predictor for the productive language measures at either time point. Discussion Results indicate that catch-up growth in language may take place in pre-adolescence for many children born prematurely. Clinical implications focus on the need to utilize multiple forms of language assessment and to directly consider the potential role of attention on standard test results.
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Affiliation(s)
- Jamie Mahurin-Smith
- Department of Communication Sciences and Disorders, Illinois State University, Normal
| | - Laura S DeThorne
- Department of Speech, Language, and Hearing Sciences, Western Michigan University, Kalamazoo
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Gabis LV, Attia OL, Roth-Hanania R, Foss-Feig J. Motor delay - An early and more common "red flag" in girls rather than boys with autism spectrum disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 104:103702. [PMID: 32570001 DOI: 10.1016/j.ridd.2020.103702] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Autism and intellectual disability may coincide and be preceded by global developmental delay or by motor delay. HYPOTHESIS Motor delay in the context of global developmental delay is an initial "red flag" for ASD, with added risk in girls. OBJECTIVE To assess early developmental milestones in girls with ASD as compared to diagnosed boys, considering prematurity risk. METHOD Developmental milestones in a cohort of 467 children with ASD - diagnosed at mean age of 3.4 years (SD = 2.2) - were analyzed according to gender and prematurity risk. RESULTS 111 girls (24 %), 356 boys (76 %), presented with motor milestones acquisition grossly within the normal range. However, there was a shift towards acquisition of walking being at the later end of the norm range, with this shift being more prominent in girls. 60 % of girls and 47 % of boys with ASD had motor delay and 49 % of girls and 36 % of boys had global developmental delay. The extent of the delays was greater in the prematurity subgroup. CONCLUSION Global delay of early milestones occurred in half of children with ASD and in 60 % of girls with ASD. Delayed acquisition of independent walking is relatively more common in girls subsequently diagnosed with ASD.
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Affiliation(s)
- Lidia V Gabis
- Weinberg Developmental Center, Safra Children's Hospital, Tel Hashomer, Israel; Sackler School of Medicine at Tel Aviv University, Israel.
| | - Odelia Leon Attia
- Weinberg Developmental Center, Safra Children's Hospital, Tel Hashomer, Israel.
| | | | - Jennifer Foss-Feig
- Seaver Autism Center for Research and Treatment, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States.
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Talmi Z, Mankuta D, Raz R. Birth weight and autism spectrum disorder: A population‐based nested case–control study. Autism Res 2020; 13:655-665. [DOI: 10.1002/aur.2260] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/10/2019] [Accepted: 12/18/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Ziv Talmi
- Braun School of Public Health and Community Medicine The Hebrew University Hadassah Jerusalem Israel
- The Hebrew University Hadassah Medical School Jerusalem Israel
| | - David Mankuta
- The Hebrew University Hadassah Medical School Jerusalem Israel
- Department of Obstetrics and Gynecology Hadassah Ein‐Kerem Hospital Jerusalem Israel
| | - Raanan Raz
- Braun School of Public Health and Community Medicine The Hebrew University Hadassah Jerusalem Israel
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Whiting SE, Carson AM, Clark GD, Schwartz DD. Case report of prenatal bilateral cerebellar infarction: implications for social-behavioral functioning. Clin Neuropsychol 2019; 33:890-904. [DOI: 10.1080/13854046.2018.1563631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sara E. Whiting
- Psychology Section, Department of Pediatrics, Baylor College of Medicine/Texas Children’s Hospital, Houston, TX, USA
| | - Audrey M. Carson
- Psychology Section, Department of Pediatrics, Baylor College of Medicine/Texas Children’s Hospital, Houston, TX, USA
| | - Gary D. Clark
- Department of Neurology, Baylor College of Medicine/Texas Children’s Hospital, Houston, TX, USA
| | - David D. Schwartz
- Psychology Section, Department of Pediatrics, Baylor College of Medicine/Texas Children’s Hospital, Houston, TX, USA
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12
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Long-Term Follow-Up of the Very Preterm Graduate. Neurology 2019. [DOI: 10.1016/b978-0-323-54392-7.00016-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Raghavan R, Zuckerman B, Hong X, Wang G, Ji Y, Paige D, DiBari J, Zhang C, Fallin MD, Wang X. Fetal and Infancy Growth Pattern, Cord and Early Childhood Plasma Leptin, and Development of Autism Spectrum Disorder in the Boston Birth Cohort. Autism Res 2018; 11:1416-1431. [PMID: 30248249 PMCID: PMC6320256 DOI: 10.1002/aur.2011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/15/2018] [Accepted: 07/10/2018] [Indexed: 12/20/2022]
Abstract
Leptin is a proinflammatory cytokine that plays an important role in energy homeostasis. Emerging evidence suggests that leptin levels are altered in children with autism spectrum disorder (ASD); however, this has not been studied prospectively. Rapid growth during infancy and early childhood has been implicated in ASD, but the evidence is inconsistent. As leptin is involved in growth and is a potential risk factor for ASD, we explored the associations between (a) cord, early childhood leptin and ASD; and (b) birth weight for gestational age, early childhood weight gain, and ASD. We also assessed the mediating role of leptin in the relationship between weight gain during infancy and ASD. This study was conducted in a sample of 822 subjects from the Boston Birth Cohort. ASD was defined from diagnostic codes in electronic medical records. Extremely rapid weight gain during infancy was associated with a greater ASD risk and this persisted after adjusting for potential confounders (aOR: 3.11; 95% CI: 1.37, 7.07). Similarly, children that had higher plasma leptin levels, prior to ASD diagnosis, had an increased ASD risk in both unadjusted and adjusted models (aOR: 7.87; 95% CI: 2.06, 30.04). Further, early childhood leptin indirectly mediated the relationship between rapid weight gain and ASD. No associations were found between birth weight for gestational age, cord leptin and risk of ASD. Our findings provide a basis to further explore whether the combination of early life growth pattern and a biomarker such as leptin can predict ASD earlier. Autism Res 2018, 11: 1416-1431. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Is early life growth and a biomarker leptin related to ASD risk? To answer this question, we followed 822 children from birth and found that those who gained weight very quickly in infancy, had higher leptin levels in early childhood, had a greater chance of later ASD diagnosis. More research is needed to see if infant's weight gain pattern along with a biomarker (such as leptin) can be used to identify children with ASD sooner.
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Affiliation(s)
- Ramkripa Raghavan
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe St, Room E4132, Baltimore, MD 21205
| | - Barry Zuckerman
- Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, 850 Harrison Ave, 3 Floor, Suite 324L, Boston, MA 02118
| | - Xiumei Hong
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe St, Room E4132, Baltimore, MD 21205
| | - Guoying Wang
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe St, Room E4132, Baltimore, MD 21205
| | - Yuelong Ji
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe St, Room E4132, Baltimore, MD 21205
| | - David Paige
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe St, Room E4132, Baltimore, MD 21205
| | - Jessica DiBari
- Office of Epidemiology and Research, Maternal & Child Health Bureau, Health Resources & Services Administration, 5600 Fishers Lane, 18N120, Rockville, MD 20857
| | - Cuilin Zhang
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe St, Room E4132, Baltimore, MD 21205
- Division of Intramural Population and Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710 B, Rockledge Dr., Bethesda, MD 20817
| | - M. Daniele Fallin
- Wendy Klag Center for Autism and Developmental Disabilities & Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, HH 850, Baltimore, MD 21205
| | - Xiaobin Wang
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe St, Room E4132, Baltimore, MD 21205
- Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205
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Agrawal S, Rao SC, Bulsara MK, Patole SK. Prevalence of Autism Spectrum Disorder in Preterm Infants: A Meta-analysis. Pediatrics 2018; 142:peds.2018-0134. [PMID: 30076190 DOI: 10.1542/peds.2018-0134] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Evidence is emerging that preterm infants are at risk for autism spectrum disorder (ASD). OBJECTIVES To conduct a systematic review and meta-analysis to estimate the prevalence of ASD in preterm infants. DATA SOURCES Medline (via PubMed and Ovid), Embase, PsycINFO, and relevant conference proceedings were searched in May 2017. STUDY SELECTION Original studies in which researchers report on the prevalence of ASD using diagnostic tests in children born preterm were included. Studies in which researchers used only ASD screening tools were excluded. DATA EXTRACTION Relevant data were extracted independently by 3 authors. RESULTS Researchers in a total of 18 studies (3366 preterm infants) used ASD diagnostic tools. The median gestation, birth weight, and age at assessment were 28.0 weeks (range: 25.1-31.3 weeks), 1055 g (range: 719-1565 g), and 5.7 years (range: 1.5-21 years), respectively. Meta-analysis revealed that the overall prevalence rate for ASD was 7% (95% confidence interval: 4% to 9%). The funnel plot and Egger's test revealed that there was probably no evidence of publication bias. LIMITATIONS The limitations were significant heterogeneity and a lack of studies from middle- and low-income countries. CONCLUSIONS The prevalence of ASD is significantly high in the preterm population. Adequate resources are needed to improve the outcomes of these children.
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Affiliation(s)
- Sachin Agrawal
- Neonatal Unit, King Edward Memorial Hospital for Women and Perth Children Hospital, Nedlands, Western Australia, Australia
| | - Shripada C Rao
- Neonatal Unit, King Edward Memorial Hospital for Women and Perth Children Hospital, Nedlands, Western Australia, Australia; .,School of Medicine, University of Western Australia, Crawley, Australia; and
| | - Max K Bulsara
- Department of Biostatistics, Institute for Health Research, University of Notre Dame, Western Australia, Australia
| | - Sanjay K Patole
- Neonatal Unit, King Edward Memorial Hospital for Women and Perth Children Hospital, Nedlands, Western Australia, Australia.,School of Medicine, University of Western Australia, Crawley, Australia; and
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15
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Peralta-Carcelen M, Schwartz J, Carcelen AC. Behavioral and Socioemotional Development in Preterm Children. Clin Perinatol 2018; 45:529-546. [PMID: 30144853 DOI: 10.1016/j.clp.2018.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Prematurity is a significant risk factor for impaired neurodevelopmental outcomes. These include motor, cognitive, language, behavioral, and socioemotional competence. Long-term overall function depends on healthy socioemotional functioning. The vulnerability of the preterm brain during critical periods of development contributes to behavioral and socioemotional problems in preterm children. Attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) clinical features are more frequent in preterm children compared with their full-term counterparts; however, true rates of ASD and ADHD vary across studies. Early detection of behavioral and socioemotional problems in preterm children would enable timely early intervention to improve long-term functional outcomes.
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Affiliation(s)
- Myriam Peralta-Carcelen
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Alabama at Birmingham, Dearth Tower Suite 5602, McWane. 1600 7th Avenue South, Birmingham, AL 35233-1711, USA.
| | - Justin Schwartz
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Alabama at Birmingham, Dearth Tower Suite 5602, McWane. 1600 7th Avenue South, Birmingham, AL 35233-1711, USA
| | - Andrea C Carcelen
- International Health Department, John Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room 5517, Baltimore, MD, USA
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16
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Altimier L, Phillips R. The Neonatal Integrative Developmental Care Model: Advanced Clinical Applications of the Seven Core Measures for Neuroprotective Family-centered Developmental Care. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.nainr.2016.09.030] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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17
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Darcy-Mahoney A, Minter B, Higgins M, Guo Y, Williams B, Head Zauche LM, Birth K. Probability of an Autism Diagnosis by Gestational Age . NEWBORN AND INFANT NURSING REVIEWS : NAINR 2016; 16:322-326. [PMID: 28989329 PMCID: PMC5627777 DOI: 10.1053/j.nainr.2016.09.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Early preterm infants (EPT) (<33 6/7 weeks) are at increased risk for autism spectrum disorders (ASDs) but prevalence estimates vary widely across studies. Furthermore, there are very few studies addressing the association between late preterm (LPT) births (34-36 6/7 weeks) and ASDs. To address the question of whether LPT infants carry the same risk for ASDs as full-term infants, this study aimed to estimate the relative probability of an ASD diagnosis using Bayes rule. A retrospective cohort analysis of 406 children was undertaken to look at gestational age, ASDs, and birth history. The application of Bayes rule was used, given that there is not sufficient information about the joint probabilities related to prematurity and autism. Using the estimated gestational age proportions within ASD diagnosis, plus national estimates of ASDs, probabilities for ASDs within a given gestational age were calculated. Among these 406 children with ASDs, 6.7% were EPT and 10.6% were LPT. In comparison to full term, EPT children are at 1.9 multiplicative increase in risk (95% CI [1.3, 2.5]). While the probability of ASDs for LPT children was higher than that for term, the estimated relative risk of the LPT infants was not statistically significant (95% CI [0.9, 1.5]). EPT infants were significantly more likely to be diagnosed with ASDs compared to their term peers. While the relative probability of ASD diagnosis among children born LPT was not statistically significant in this limited sample, the results indicate a possible elevated risk. A larger cohort is needed to adequately estimate this risk.
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Affiliation(s)
- Ashley Darcy-Mahoney
- George Washington University School of Nursing, 2030 M St NW Suite 300, Washington, DC 20052
- George Washington University, Autism and Neurodevelopmental Institute, 2121 Eye Street NW Suite 601, Washington, DC 20052
| | - Bonnie Minter
- Marcus Autism Center, Children’s Healthcare of Atlanta, 1920 Briarcliff Road, Atlanta, GA 30329, United States
| | - Melinda Higgins
- Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Rd., Atlanta, GA 30322, United States
| | - Ying Guo
- Emory University Rollins School of Public Health, 1518 Clifton Rd., Atlanta, GA 30322, United States
| | - Bryan Williams
- Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Rd., Atlanta, GA 30322, United States
| | - Lauren M. Head Zauche
- Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Rd., Atlanta, GA 30322, United States
| | - Katie Birth
- Children’s Healthcare of Atlanta, 1405 Clifton Rd., Atlanta, GA 30329, United States
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18
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Bekiesińska-Figatowska M, Helwich E, Rutkowska M, Stankiewicz J, Terczyńska I. Magnetic resonance imaging of neonates in the magnetic resonance compatible incubator. Arch Med Sci 2016; 12:1064-1070. [PMID: 27695498 PMCID: PMC5016588 DOI: 10.5114/aoms.2016.61913] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 06/14/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The authors present the first experience in neonatal magnetic resonance imaging (MRI) examinations using an MR compatible incubator (INC) at the Institute of Mother and Child. MATERIAL AND METHODS Forty-nine examinations of 47 newborns (20 girls, 27 boys) were performed using the GE Signa HDxt 1.5T system and INC Nomag IC 1.5. Demographic data, anesthetic methods and MRI findings in the INC in comparison with previously performed imaging were analyzed. RESULTS Thirty-two neonates were prematurely born (68.1%) at gestational age 23-37 weeks, mean: 29.9 weeks. They were examined at 26 weeks postmenstrual age to 1 month corrected age, mean: 37.5 weeks. Body weight of newborns on the study day was 600-4300 g, mean: 2724 g. Seventeen (34.7%) children were examined in physiological sleep, 32 (65.3%) anesthetized. In none of them did anesthesiological complications or disease worsening occur. In 43 (91.5%) children brain MRI was performed, in 4 (8.5%) MRI of the spinal cord and canal and of the abdomen/pelvis. In children prenatally examined by MRI, the INC provided new diagnostic information in 5 (83.3%) cases, in neonates studied after birth by ultrasound in 32 (82%). Magnetic resonance imaging in the INC did not entail additional knowledge in 9 (18.7%) cases. CONCLUSIONS The INC enables MRI in preterm newborns and those with low/extremely low body weight. These studies are necessary to assess the extent of changes in the central nervous system and other organs. Incubator coils, designed specifically for neonates, allow more accurate diagnosis than previously used coils for adults. MRI results allow one to determine prognosis, for more accurate planning of diagnostics, helping to make appropriate therapeutic decisions.
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Affiliation(s)
| | - Ewa Helwich
- Clinic of Neonatology and Neonatal Intensive Care, Institute of Mother and Child, Warsaw, Poland
| | - Magdalena Rutkowska
- Clinic of Neonatology and Neonatal Intensive Care, Institute of Mother and Child, Warsaw, Poland
| | - Joanna Stankiewicz
- Intensive Care and Anesthesiology Clinic, Institute of Mother and Child, Warsaw, Poland
| | - Iwona Terczyńska
- Clinic of Neurology of Children and Adolescents, Institute of Mother and Child, Warsaw, Poland
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19
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Ure AM, Treyvaud K, Thompson DK, Pascoe L, Roberts G, Lee KJ, Seal ML, Northam E, Cheong JL, Hunt RW, Inder T, Doyle LW, Anderson PJ. Neonatal brain abnormalities associated with autism spectrum disorder in children born very preterm. Autism Res 2015; 9:543-52. [PMID: 26442616 DOI: 10.1002/aur.1558] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/08/2015] [Accepted: 08/15/2015] [Indexed: 11/11/2022]
Abstract
Very preterm (VP) survivors are at increased risk of autism spectrum disorder (ASD) compared with term-born children. This study explored whether neonatal magnetic resonance (MR) brain features differed in VP children with and without ASD at 7 years. One hundred and seventy-two VP children (<30 weeks' gestation or <1250 g birth weight) underwent structural brain MR scans at term equivalent age (TEA; 40 weeks' gestation ±2 weeks) and were assessed for ASD at 7 years of age. The presence and severity of white matter, cortical gray matter, deep nuclear gray matter, and cerebellar abnormalities were assessed, and total and regional brain volumes were measured. ASD was diagnosed using a standardized parent report diagnostic interview and confirmed via an independent assessment. Eight VP children (4.7%) were diagnosed with ASD. Children with ASD had more cystic lesions in the cortical white matter at TEA compared with those without ASD (odds ratio [OR] 8.7, 95% confidence interval [CI] 1.5, 51.3, P = 0.02). There was also some evidence for smaller cerebellar volumes in children with ASD compared with those without ASD (OR = 0.82, CI = 0.66, 1.00, P = 0.06). Overall, the results suggest that VP children with ASD have different brain structure in the neonatal period compared with those who do not have ASD. Autism Res 2016, 9: 543-552. © 2015 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- Alexandra M Ure
- Murdoch Childrens Research Institute, Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Australia
| | - Karli Treyvaud
- Murdoch Childrens Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Deanne K Thompson
- Murdoch Childrens Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Leona Pascoe
- Murdoch Childrens Research Institute, Melbourne, Australia
| | - Gehan Roberts
- Murdoch Childrens Research Institute, Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Katherine J Lee
- Murdoch Childrens Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Marc L Seal
- Murdoch Childrens Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Elisabeth Northam
- Murdoch Childrens Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Jeanie L Cheong
- Murdoch Childrens Research Institute, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,The Royal Women's Hospital, Melbourne, Australia
| | - Rod W Hunt
- Murdoch Childrens Research Institute, Melbourne, Australia.,The Royal Children's Hospital, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Terrie Inder
- Brigham and Women's Hospital, Boston, United States of America
| | - Lex W Doyle
- University of Melbourne, Melbourne, Australia.,The Royal Women's Hospital, Melbourne, Australia
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20
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Ritchie K, Bora S, Woodward LJ. Social development of children born very preterm: a systematic review. Dev Med Child Neurol 2015; 57:899-918. [PMID: 25914112 DOI: 10.1111/dmcn.12783] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 01/25/2023]
Abstract
AIM To review systematically studies examining the development of social competence in children born very preterm (VPT) (gestation <33 wks) and identify neonatal and family predictors. METHOD Peer-reviewed original articles were extracted from PubMed and PsycINFO following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Selection criteria included children born VPT and comparison children born at term, sample born after 1990, and children assessed between 0 and 17 years on at least one measure of social competence spanning social adjustment, performance, and/or social skills. RESULTS Twenty-three studies were included. Seven focused on social competence and another 16 examined social competence within a range of outcomes. Study quality was low. Limitations included reliance on single informant data, cross-sectional measurement, use of brief screening tools, absence of child or peer report, and no conceptual model. In terms of social adjustment, 16 out of 21 studies found children born VPT had more peer problems and social withdrawal. Findings of social performance were mixed, with some studies suggesting differences in prosocial behavior (4/14) and others not. Social skills were assessed in four studies and showed children born VPT had poorer skills than children born at term. Predictors of social competence included gestational age, neonatal brain abnormalities, and family socio-economic status. INTERPRETATION Children born VPT have poorer social competence. These difficulties emerge early and persist throughout childhood.
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Affiliation(s)
- Kirsten Ritchie
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Samudragupta Bora
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lianne J Woodward
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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21
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22
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Davidson C, O'Hare A, Mactaggart F, Green J, Young D, Gillberg C, Minnis H. Social relationship difficulties in autism and reactive attachment disorder: Improving diagnostic validity through structured assessment. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 40:63-72. [PMID: 25754456 DOI: 10.1016/j.ridd.2015.01.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Autism Spectrum Disorder (ASD) versus Reactive Attachment Disorder (RAD) is a common diagnostic challenge for clinicians due to overlapping difficulties with social relationships. RAD is associated with neglect or maltreatment whereas ASD is not: accurate differential diagnosis is therefore critical. Very little research has investigated the relationship between the two, and it is unknown if standardised measures are able to discriminate between ASD and RAD. The current study aimed to address these issues. METHODS Fifty eight children with ASD, and no history of maltreatment, were group matched on age with 67 children with RAD. Group profiles on multi-informant measures of RAD were investigated and group differences explored. Discriminant function analysis determined assessment features that best discriminated between the two groups. RESULTS Although, according to parent report, children with ASD presented with significantly fewer indiscriminate friendliness behaviours compared to the RAD group (p<0.001), 36 children with ASD appeared to meet core RAD criteria. However, structured observation clearly demonstrated that features were indicative of ASD and not RAD for all but 1 of these 36 children. CONCLUSIONS Children with RAD and children with ASD may demonstrate similar social relationship difficulties but there appears to be a difference in the social quality of the interactions between the groups. In most cases it was possible to differentiate between children with ASD and children with RAD via structured observation. Nevertheless, for a small proportion of children with ASD, particularly those whose difficulties may be more subtle, our current standardised measures, including structured observation, may not be effective in differentiating RAD from ASD.
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Affiliation(s)
- Claire Davidson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Anne O'Hare
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK.
| | - Fiona Mactaggart
- Edinburgh Connect and North Edinburgh Team, Child and Adolescent Mental Health Service, North Edinburgh Team, Edinburgh, UK.
| | - Jonathan Green
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.
| | - David Young
- Department of Mathematics and Statistics, Strathclyde University, Glasgow, UK.
| | - Christopher Gillberg
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK; Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden.
| | - Helen Minnis
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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23
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Gray PH, Edwards DM, O'Callaghan MJ, Gibbons K. Screening for autism spectrum disorder in very preterm infants during early childhood. Early Hum Dev 2015; 91:271-6. [PMID: 25766314 DOI: 10.1016/j.earlhumdev.2015.02.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 02/13/2015] [Accepted: 02/20/2015] [Indexed: 11/28/2022]
Abstract
AIM The aim of the study was to screen very preterm infants for autism spectrum disorder (ASD) with comparisons to a group of term controls. The study also aimed to identify maternal and neonatal risk factors, development and behaviour associated with a positive screen in the preterm group. METHOD Preterm infants born ≤ 30 weeks gestation and term infants were recruited at two years of age. The mothers were posted the questionnaires and completed the Modified Checklist for Autism in Toddlers (M-CHAT), the Child Behaviour Checklist (CBCL) and the Depression, Anxiety and Stress Scales (DASS). Previously collected data from the mothers at 12 months--the Edinburgh Postnatal Depression Scales (EPDS) were analysed. The children had neurodevelopmental assessment including the Bayley-III. Infants positive on M-CHAT screen had an M-CHAT follow-up interview by phone and then were assessed by a developmental paediatrician as indicated with a diagnosis of autism being made on clinical judgement. RESULTS 13 (13.4%) of the 97 preterm infants screened positive on the M-CHAT compared to three (3.9%) of the 77 term infants (p = 0.036). On follow-up interview, three of the preterm infants remained positive (one was diagnosed with autism) compared to none of the term infants. The preterm infants who screened positive were born to younger, non-Caucasian mothers and were of lower birth weight and had a higher incidence of being small for gestational age (SGA). The infants had lower composite scores on Bayley-III and had more internalising and externalising behaviours on the CBCL. The mothers had more emotional problems on the DASS and higher scores on the EPDS. On multivariate analysis, SGA, greater internalising behaviours and higher EPDS scores remained statistically significant. CONCLUSIONS A positive screen on the M-CHAT occurs more commonly in very preterm infants than those born at term. Internalising behaviours and maternal mental health are associated with a positive screen in the preterm cohort.
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Affiliation(s)
- Peter H Gray
- Growth and Development Unit, Mater Mothers' Hospital, South Brisbane, Queensland, Australia; Mater Research Institute, The University of Queensland, Mater Health Services, South Brisbane, Queensland, Australia.
| | - Dawn M Edwards
- Growth and Development Unit, Mater Mothers' Hospital, South Brisbane, Queensland, Australia; Dept. of Social Work, Mater Children's Hospital, South Brisbane, Queensland, Australia.
| | - Michael J O'Callaghan
- Growth and Development Unit, Mater Mothers' Hospital, South Brisbane, Queensland, Australia; Dept. of Paediatrics and Child Health, University of Queensland, Mater Children's Hospital, South Brisbane, Queensland, Australia.
| | - Kristen Gibbons
- Mater Research Institute, The University of Queensland, Mater Health Services, South Brisbane, Queensland, Australia.
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24
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Pyhälä R, Hovi P, Lahti M, Sammallahti S, Lahti J, Heinonen K, Pesonen AK, Strang-Karlsson S, Eriksson JG, Andersson S, Järvenpää AL, Kajantie E, Räikkönen K. Very low birth weight, infant growth, and autism-spectrum traits in adulthood. Pediatrics 2014; 134:1075-83. [PMID: 25367538 DOI: 10.1542/peds.2014-1097] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We examined whether adults born preterm at very low birth weight (VLBW; <1500 g) differ from term-born adults in autism-spectrum traits, and whether among VLBW adults, growth in infancy is associated with these traits. METHODS A total of 110 VLBW and 104 term-born adults of the Helsinki Study of Very Low Birth Weight Adults completed the Autism-Spectrum Quotient yielding total, social interaction, and attention to detail sum scores. Growth in weight, length, and head circumference from birth to term and from term to 1 year of corrected age was determined as standardized residuals reflecting growth conditional on previous history. RESULTS VLBW adults scored higher than term-born controls on social interaction sum score, indicating higher autism-spectrum traits. In contrast, they scored lower on attention to detail sum score, indicating lower autism-spectrum traits. Within the VLBW group, faster growth in weight, length, and head circumference from birth to term was associated with lower total and social interaction sum scores. In this group, growth from term to 1 year was not associated with autism-spectrum traits. CONCLUSIONS Among those born preterm at VLBW, the risk for higher levels of autism-spectrum traits, particularly related to social interaction, may persist into adulthood. Faster growth from birth to term may ameliorate these effects, suggesting that targeted interventions could aid long-term neurodevelopment.
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Affiliation(s)
| | - Petteri Hovi
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland
| | | | | | | | | | | | - Sonja Strang-Karlsson
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland
| | - Johan G Eriksson
- National Institute for Health and Welfare, Helsinki, Finland; Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland; Vasa Central Hospital, Vasa, Finland; Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland; Folkhälsan Research Centre, Helsinki, Finland; and
| | - Sture Andersson
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Anna-Liisa Järvenpää
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Eero Kajantie
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland; Department of Obstetrics and Gynaecology, Medical Research Centre Oulu, Oulu University Central Hospital and University of Oulu, Oulu, Finland
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25
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Williamson KE, Jakobson LS. Social perception in children born at very low birthweight and its relationship with social/behavioral outcomes. J Child Psychol Psychiatry 2014; 55:990-8. [PMID: 24552579 PMCID: PMC4263237 DOI: 10.1111/jcpp.12210] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND Research has shown that children born very prematurely are at substantially elevated risk for social and behavioral difficulties similar to those seen in full-term children with autism spectrum disorders (ASDs). METHODS To gain insight into core deficits that may underlie these difficulties, in this study, we assessed the social perceptual skills of 8- to 11-year-old children born at very low birthweight (VLBW) (<1,500 g) and age-matched, full-term controls, using the Child and Adolescent Social Perception Measure. We also assessed social and behavioral outcomes with two parent-report measures used in ASD screening. RESULTS Children in the preterm group had normal range estimated verbal IQ. However, we found that they were impaired in their ability to use nonverbal cues from moving faces and bodies, and situational cues, to correctly identify the emotions of characters depicted in videotaped social interactions. Their performance on this task was related to the number of 'autistic-like' traits they displayed. CONCLUSIONS This research highlights links between social perceptual deficits and poor social and behavioral outcomes in children born very prematurely. The results also suggest that even those who have escaped major intellectual/language problems are at risk for social and behavioral problems that can be of clinical concern.
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26
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Williamson KE, Jakobson LS, Saunders DR, Troje NF. Local and global aspects of biological motion perception in children born at very low birth weight. Child Neuropsychol 2014; 21:603-28. [PMID: 25103588 PMCID: PMC4566871 DOI: 10.1080/09297049.2014.945407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 07/11/2014] [Indexed: 12/03/2022]
Abstract
Biological motion perception can be assessed using a variety of tasks. In the present study, 8- to 11-year-old children born prematurely at very low birth weight (<1500 g) and matched, full-term controls completed tasks that required the extraction of local motion cues, the ability to perceptually group these cues to extract information about body structure, and the ability to carry out higher order processes required for action recognition and person identification. Preterm children exhibited difficulties in all 4 aspects of biological motion perception. However, intercorrelations between test scores were weak in both full-term and preterm children--a finding that supports the view that these processes are relatively independent. Preterm children also displayed more autistic-like traits than full-term peers. In preterm (but not full-term) children, these traits were negatively correlated with performance in the task requiring structure-from-motion processing, r(30) = -.36, p < .05), but positively correlated with the ability to extract identity, r(30) = .45, p < .05). These findings extend previous reports of vulnerability in systems involved in processing dynamic cues in preterm children and suggest that a core deficit in social perception/cognition may contribute to the development of the social and behavioral difficulties even in members of this population who are functioning within the normal range intellectually. The results could inform the development of screening, diagnostic, and intervention tools.
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Affiliation(s)
- K. E. Williamson
- Department of Psychology, University of Manitoba, WinnipegMB, Canada
| | - L. S. Jakobson
- Department of Psychology, University of Manitoba, WinnipegMB, Canada
| | - D. R. Saunders
- Department of Psychology, Queen’s University, KingstonON, Canada
| | - N. F. Troje
- Department of Psychology, Queen’s University, KingstonON, Canada
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27
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Casanova MF. Autism as a sequence: from heterochronic germinal cell divisions to abnormalities of cell migration and cortical dysplasias. Med Hypotheses 2014; 83:32-8. [PMID: 24780284 PMCID: PMC4070182 DOI: 10.1016/j.mehy.2014.04.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/11/2014] [Accepted: 04/06/2014] [Indexed: 02/07/2023]
Abstract
The considerable heterogeneity in the number and severity of symptoms observed in autism spectrum disorders (ASD) has been regarded as an obstacle to any future research. Some authors believe that clinical heterogeneity results from the complex interplay of the many genetic and environmental factors that themselves define a condition as multifactorial. However, it is important to note that neuropathological findings in both idiopathic and syndromic autism suggests a single pathophysiological mechanism acting during brain development: the heterochronic division of germinal cells and subsequent migrational abnormalities of daughter cells to their target fields. Multiple exogenous (e.g., viruses, drugs) and endogenous (e.g., genetic mutations) factors are known to disrupt the division of germinal cells and provide for an autism phenotype. The variety of endogenous and exogenous factors, their timing of action during brain development, and the genetic susceptibility of affected individuals (a Triple Hit hypothesis) may all account for the clinical heterogeneity of ASD.
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Affiliation(s)
- Manuel F Casanova
- Department of Psychiatry, University of Louisville, 500 South Preston Street, Building A, Room 217, Louisville, KY 40202, United States.
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Abstract
The incidence of preterm birth is on the rise. The outcome of premature birth can vary widely, spanning completely normal development to severe neurologic deficits, with most children showing mild to moderate cognitive delay and increased incidence of neuropsychiatric conditions such as anxiety, attention deficit hyperactivity, and autism spectrum disorders. Several animal models have been employed to study the consequences of prematurity, one of the most promising being chronic perinatal hypoxia in mouse, which recapitulates the cognitive impairments, partial recovery over time and enhanced recovery with environmental enrichment.
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Neggers YH. Increasing prevalence, changes in diagnostic criteria, and nutritional risk factors for autism spectrum disorders. ISRN NUTRITION 2014; 2014:514026. [PMID: 24967269 PMCID: PMC4045304 DOI: 10.1155/2014/514026] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 12/09/2013] [Indexed: 12/31/2022]
Abstract
The frequency of autism spectrum disorders (ASD) diagnoses has been increasing for decades, but researchers cannot agree on whether the trend is a result of increased awareness, improved detection, expanding definition, or an actual increase in incidence or a combination of these factors. Though both genetic and multiple environmental risk factors have been studied extensively, many potentially modifiable risk factors including nutritional and immune function related risk factors such as vitamin D, folic acid, and metabolic syndrome have not received sufficient attention. Several recent studies have put forward hypotheses to explain the mechanism of association between both folic acid and vitamin D and autism. A continuous rise in the prevalence of autism in the USA has coincided with a significant enhancement of maternal folate status with FDA mandated folic acid fortification of certain foods starting in 1998. There is also a growing body of research that suggests that vitamin D status either in utero or early in life may be a risk for autism. In this communication, controversies regarding increase in estimate of prevalence, implications of changes in definition, and possible association between some modifiable nutritional risk factors such as folic acid and vitamin D and ASD will be discussed.
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Affiliation(s)
- Yasmin H. Neggers
- Department of Human Nutrition, University of Alabama, P.O. Box 870311, Tuscaloosa, AL 35487, USA
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Kuzniewicz MW, Wi S, Qian Y, Walsh EM, Armstrong MA, Croen LA. Prevalence and neonatal factors associated with autism spectrum disorders in preterm infants. J Pediatr 2014; 164:20-5. [PMID: 24161222 DOI: 10.1016/j.jpeds.2013.09.021] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 08/07/2013] [Accepted: 09/06/2013] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To determine the prevalence of autism spectrum disorders (ASD) across gestational age, examine the risk of ASD by gestational age controlling for other risk factors, and identify potential risk factors in the neonatal intensive care unit. STUDY DESIGN A retrospective cohort of infants born at ≥ 24 weeks between January 1, 2000, and December 31, 2007 at 11 Kaiser Permanente Northern California hospitals (n = 195,021). ASD cases were defined by a diagnosis made at a Kaiser Permanente ASD evaluation center, by a clinical specialist, or by a pediatrician. Cox proportional hazards regression models were used to evaluate the association between gestational age and ASD as well as potential risk factors in the neonatal intensive care unit and ASD. RESULTS The prevalence of ASD in infants <37 weeks was 1.78% compared with 1.22% in infants born ≥ 37 weeks (P < .001). Compared with term infants, infants born at 24-26 weeks had an adjusted hazard ratio (HR) for a diagnosis of ASD of 2.7 (95% CI 1.5-5.0). Infants born at 27-33 weeks (adjusted HR 1.4, 95% CI 1.1-1.8) and 34-36 weeks (adjusted HR 1.3, 95% CI 1.1-1.4) were also at increased risk. High frequency ventilation and intracranial hemorrhage were associated with ASD in infants < 34 weeks. CONCLUSIONS ASD was ~ 3 times more prevalent in infants <27 weeks compared with term infants. Each week of shorter gestation was associated with an increased risk of ASD. High frequency ventilation and intracranial hemorrhage were associated with ASD among infants <34 weeks.
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Affiliation(s)
- Michael W Kuzniewicz
- Division of Research, Kaiser Permanente Northern California, Oakland, CA; Division of Neonatology, Department of Pediatrics, University of California-San Francisco, San Francisco, CA
| | - Soora Wi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Yinge Qian
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Eileen M Walsh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Lisa A Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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31
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Affiliation(s)
- Lonnie Zwaigenbaum
- Department of Pediatrics, Glenrose Rehabilitation Hospital, University of Alberta, Edmonton, AB, Canada
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32
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Abstract
Autism spectrum conditions (ASCs) are defined behaviorally, but they also involve multileveled disturbances of underlying biology that find striking parallels in the physiological impacts of electromagnetic frequency and radiofrequency radiation exposures (EMF/RFR). Part I (Vol 776) of this paper reviewed the critical contributions pathophysiology may make to the etiology, pathogenesis and ongoing generation of behaviors currently defined as being core features of ASCs. We reviewed pathophysiological damage to core cellular processes that are associated both with ASCs and with biological effects of EMF/RFR exposures that contribute to chronically disrupted homeostasis. Many studies of people with ASCs have identified oxidative stress and evidence of free radical damage, cellular stress proteins, and deficiencies of antioxidants such as glutathione. Elevated intracellular calcium in ASCs may be due to genetics or may be downstream of inflammation or environmental exposures. Cell membrane lipids may be peroxidized, mitochondria may be dysfunctional, and various kinds of immune system disturbances are common. Brain oxidative stress and inflammation as well as measures consistent with blood-brain barrier and brain perfusion compromise have been documented. Part II of this paper documents how behaviors in ASCs may emerge from alterations of electrophysiological oscillatory synchronization, how EMF/RFR could contribute to these by de-tuning the organism, and policy implications of these vulnerabilities. It details evidence for mitochondrial dysfunction, immune system dysregulation, neuroinflammation and brain blood flow alterations, altered electrophysiology, disruption of electromagnetic signaling, synchrony, and sensory processing, de-tuning of the brain and organism, with autistic behaviors as emergent properties emanating from this pathophysiology. Changes in brain and autonomic nervous system electrophysiological function and sensory processing predominate, seizures are common, and sleep disruption is close to universal. All of these phenomena also occur with EMF/RFR exposure that can add to system overload ('allostatic load') in ASCs by increasing risk, and can worsen challenging biological problems and symptoms; conversely, reducing exposure might ameliorate symptoms of ASCs by reducing obstruction of physiological repair. Various vital but vulnerable mechanisms such as calcium channels may be disrupted by environmental agents, various genes associated with autism or the interaction of both. With dramatic increases in reported ASCs that are coincident in time with the deployment of wireless technologies, we need aggressive investigation of potential ASC-EMF/RFR links. The evidence is sufficient to warrant new public exposure standards benchmarked to low-intensity (non-thermal) exposure levels now known to be biologically disruptive, and strong, interim precautionary practices are advocated.
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Rogers CE, Lenze SN, Luby JL. Late preterm birth, maternal depression, and risk of preschool psychiatric disorders. J Am Acad Child Adolesc Psychiatry 2013; 52:309-18. [PMID: 23452687 PMCID: PMC3589137 DOI: 10.1016/j.jaac.2012.12.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 11/19/2012] [Accepted: 12/07/2012] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Preterm children are at greater risk for psychiatric disorders, including anxiety disorders and attention-deficit/hyperactivity disorder (ADHD), than their term-born peers. Prior research has focused primarily on children born at early gestational ages. Less is known about the rate of psychiatric disorders among late preterm or early term children. In addition, whether a history of maternal depression also associated with prematurity has an impact on the risk for psychiatric disorders remains underexplored. METHOD Preschoolers between ages 3 and 6 years (N = 306) were recruited for a study examining preschool depression that included healthy and disruptive preschoolers. Preschoolers were placed in the following groups: late preterm (34-36 weeks, n = 39), early term (37-39 weeks, n = 78), and full term (40-41 weeks, n = 154). DSM-IV psychiatric disorders were assessed via the Preschool Age Psychiatric Assessment. Maternal history of psychiatric disorders was assessed using the Family Interview for Genetic Studies. RESULTS Late preterm children had higher rates of any Axis I psychiatric diagnosis (odds ratio = 3.18, 95% confidence interval = 1.09-4.76) and of any anxiety disorder (odds ratio = 3.74, 95% confidence interval = 1.59-8.78) than full term children after adjusting for gender, ethnicity, family income, and IQ. There were no differences in rates of psychiatric diagnoses between early term and full term children. A history of maternal depression mediated the relationship between late preterm birth and anxiety disorders in preschoolers. CONCLUSIONS Late preterm children were at increased risk for anxiety disorders at preschool age. A history of maternal depression mediated this association. Findings confirm the extension of the risk of psychiatric disorders associated with prematurity to the late preterm group, and suggest that maternal depression may play a key role in this risk trajectory.
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Altimier L, Phillips RM. The Neonatal Integrative Developmental Care Model: Seven Neuroprotective Core Measures for Family-Centered Developmental Care. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.nainr.2012.12.002] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Leavey A, Zwaigenbaum L, Heavner K, Burstyn I. Gestational age at birth and risk of autism spectrum disorders in Alberta, Canada. J Pediatr 2013; 162:361-8. [PMID: 22947654 DOI: 10.1016/j.jpeds.2012.07.040] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 05/07/2012] [Accepted: 07/17/2012] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To examine the association between autism spectrum disorders (ASD) and each completed week of gestation using a graphical method of presenting results at all possible categorizations of gestational age (GA). STUDY DESIGN The risk of ASD in a total of 218110 singleton live births with complete data from Alberta, Canada between 1998 and 2004 was examined through linkage to health insurance records. The relative risk of developing ASD according to the 21 dichotomizations of shorter gestation (GA ≤ 23 weeks vs >23 weeks to ≤ 43 weeks vs >43 weeks, in 1-week increments) was calculated using log-binomial regression and adjusted for fetal sex, socioeconomic status, and birth year. RESULTS We observed a gradual increased risk of ASD with shorter gestation. Cutoffs only between 29 and 40 weeks clearly denoted an elevated risk of developing ASD compared with longer gestation, and the risk increased with earlier GA cutoff. The results were not affected by sex or measures of fetal growth. CONCLUSION Our data confirm the role of shortened gestation in ASD risk. We warn against the use of prespecified or a data-driven GA cutoff, however; instead, we recommend systematically examining all plausible cutoffs for GA to avoid overstating the homogeneity of risk in children on either side of a given cutoff, as well as to increase the comparability of studies.
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Affiliation(s)
- Anna Leavey
- Aerosol and Air Quality Research Laboratory, Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, St. Louis, MO, USA
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36
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Abstract
Research has shown a high rate of autism spectrum disorders among very low birth weight children over the past decade. This paper proposes a literature review on this topic. Two generations of research have followed one another. The first retrospective studies found a high rate of ASD among premature babies. The second generation of prospective studies underlined and relativized this risk. Prospective research using screening tools (M-CHAT) have found around 20 % ASD, whereas 2 studies assessing the actual diagnosis found 5 % and 8 % ASD, 10 to 12 times more than in the general population. A number of hypotheses have been put forward to explain these high rates of ASD: sensory impairment associated with prematurity, white matter abnormalities, and cerebellar impairment. The authors propose complex models that take into account neurological deficits and the effects of perinatal events on interactive dynamics between infants and their caregivers. These models aim to allow suitable prevention and care for premature children with autism, a heavy additional handicap.
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Angelidou A, Asadi S, Alysandratos KD, Karagkouni A, Kourembanas S, Theoharides TC. Perinatal stress, brain inflammation and risk of autism-review and proposal. BMC Pediatr 2012; 12:89. [PMID: 22747567 PMCID: PMC3496584 DOI: 10.1186/1471-2431-12-89] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 05/28/2012] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Autism Spectrum Disorders (ASD) are neurodevelopmental disorders characterized by varying deficits in social interactions, communication, and learning, as well as stereotypic behaviors. Despite the significant increase in ASD, there are few if any clues for its pathogenesis, hampering early detection or treatment. Premature babies are also more vulnerable to infections and inflammation leading to neurodevelopmental problems and higher risk of developing ASD. Many autism "susceptibility" genes have been identified, but "environmental" factors appear to play a significant role. Increasing evidence suggests that there are different ASD endophenotypes. DISCUSSION We review relevant literature suggesting in utero inflammation can lead to preterm labor, while insufficient development of the gut-blood-brain barriers could permit exposure to potential neurotoxins. This risk apparently may increase in parents with "allergic" or autoimmune problems during gestation, or if they had been exposed to stressors. The presence of circulating auto-antibodies against fetal brain proteins in mothers is associated with higher risk of autism and suggests disruption of the blood-brain-barrier (BBB). A number of papers have reported increased brain expression or cerebrospinal fluid (CSF) levels of pro-inflammatory cytokines, especially TNF, which is preformed in mast cells. Recent evidence also indicates increased serum levels of the pro-inflammatory mast cell trigger neurotensin (NT), and of extracellular mitochondrial DNA (mtDNA), which is immunogenic. Gene mutations of phosphatase and tensin homolog (PTEN), the negative regulator of the mammalian target of rapamycin (mTOR), have been linked to higher risk of autism, but also to increased proliferation and function of mast cells. SUMMARY Premature birth and susceptibility genes may make infants more vulnerable to allergic, environmental, infectious, or stress-related triggers that could stimulate mast cell release of pro-inflammatory and neurotoxic molecules, thus contributing to brain inflammation and ASD pathogenesis, at least in an endophenotype of ASD patients.
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Affiliation(s)
- Asimenia Angelidou
- Molecular Immunopharmacology and Drug Discovery Laboratory, Department of Molecular Physiology and Pharmacology, Tufts University School of Medicine and Tufts Medical Center, Boston, MA 02111, USA
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Losh M, Esserman D, Anckarsäter H, Sullivan PF, Lichtenstein P. Lower birth weight indicates higher risk of autistic traits in discordant twin pairs. Psychol Med 2012; 42:1091-1102. [PMID: 22132806 PMCID: PMC3658607 DOI: 10.1017/s0033291711002339] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a neurodevelopmental disorder of complex etiology. Although strong evidence supports the causal role of genetic factors, environmental risk factors have also been implicated. This study used a co-twin-control design to investigate low birth weight as a risk factor for ASD. METHOD We studied a population-based sample of 3715 same-sex twin pairs participating in the Child and Adolescent Twin Study of Sweden (CATSS). ASD was assessed using a structured parent interview for screening of ASD and related developmental disorders, based on DSM-IV criteria. Birth weight was obtained from medical birth records maintained by the Swedish Medical Birth Registry. RESULTS Twins lower in birth weight in ASD-discordant twin pairs (n=34) were more than three times more likely to meet criteria for ASD than heavier twins [odds ratio (OR) 3.25]. Analyses of birth weight as a continuous risk factor showed a 13% reduction in risk of ASD for every 100 g increase in birth weight (n=78). Analysis of the effect of birth weight on ASD symptoms in the entire population (most of whom did not have ASD) showed a modest association. That is, for every 100 g increase in birth weight, a 2% decrease in severity of ASD indexed by scores on the Autism - Tics, attention-deficit hyperactivity disorder (AD/HD), and other Comorbidities (A-TAC) inventory would be expected in the sample as a whole. CONCLUSIONS The data were consistent with the hypothesis that low birth weight confers risk to ASD. Thus, although genetic effects are of major importance, a non-genetic influence associated with birth weight may contribute to the development of ASD.
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Affiliation(s)
- M Losh
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL 60208, USA.
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Moore GS, Kneitel AW, Walker CK, Gilbert WM, Xing G. Autism risk in small- and large-for-gestational-age infants. Am J Obstet Gynecol 2012; 206:314.e1-9. [PMID: 22464070 PMCID: PMC9884028 DOI: 10.1016/j.ajog.2012.01.044] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 01/14/2012] [Accepted: 01/30/2012] [Indexed: 01/31/2023]
Abstract
OBJECTIVE We sought to determine whether small-for-gestational age (SGA) and large-for-gestational age (LGA) birthweights increase autism risk. STUDY DESIGN This was a retrospective cohort analysis comparing children with autism (n = 20,206) within a birth cohort (n = 5,979,605). Stratification by sex and birthweight percentile (SGA, <5th or 5-10th percentile; appropriate size for gestational age [GA], >10th to <90th percentile; LGA, either 90-95th or >95th percentile) preceded Cochran-Mantel-Haenszel analysis for GA effect, and multivariate analysis. RESULTS Autism risk was increased in preterm SGA (<5th percentile) infants 23-31 weeks (adjusted odds ratio [aOR], 1.60; 95% confidence interval [CI], 1.09-2.35) and 32-33 weeks (aOR, 1.83; 95% CI, 1.16-2.87), and term LGA (>95th percentile) infants 39-41 weeks (aOR, 1.16; 95% CI, 1.08-1.26), but was decreased in preterm LGA infants 23-31 weeks (aOR, 0.45; 95% CI, 0.21-0.95). CONCLUSION SGA was associated with autism in preterm infants, while LGA demonstrated dichotomous risk by GA, with increased risk at term, and decreased risk in the premature infants. These findings likely reflect disparate pathophysiologies, and should influence prenatal counseling, pediatric autism screening, and further autism research.
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Affiliation(s)
- Gaea Schwaebe Moore
- Department of Obstetrics and Gynecology, University of California Davis,Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, Aurora, CO
| | | | - Cheryl K. Walker
- Department of Obstetrics and Gynecology, University of California Davis
| | - William M. Gilbert
- Department of Obstetrics and Gynecology, University of California Davis,Department of Obstetrics and Gynecology, Sutter Medical Center
| | - Guibo Xing
- Department of Obstetrics and Gynecology, University of California Davis,Center for Healthcare Policy and Research, University of California Davis, Sacramento, CA
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40
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Is neonatal jaundice associated with Autism Spectrum Disorders: a systematic review. J Autism Dev Disord 2012; 41:1455-63. [PMID: 22009628 DOI: 10.1007/s10803-010-1169-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Using guidelines of the Meta-analysis of Observational Studies in Epidemiology Group, we systematically reviewed the literature on neonatal jaundice (unconjugated hyperbilirubinemia) and Autism Spectrum Disorder (ASD) in term and preterm infants. Thirteen studies were included in a meta-analysis. Most used retrospective matched case-control designs. There was significant heterogeneity (Q = 31, p = 0.002) and no evidence of publication bias (p = 0.12). Overall, jaundice, assessed by total serum bilirubin (TSB), was associated with ASD (OR, 1.43, 95% CI 1.22-1.67, random effect model). This association was not found in preterms (OR 0.7, 95% CI 0.38-1.02) but deserves further investigation since other measures of bilirubin such as unbound unconjugated bilirubin may be better predictors of neurotoxicity than TSB in preterms.
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Rogers CE, Anderson PJ, Thompson DK, Kidokoro H, Wallendorf M, Treyvaud K, Roberts G, Doyle LW, Neil JJ, Inder TE. Regional cerebral development at term relates to school-age social-emotional development in very preterm children. J Am Acad Child Adolesc Psychiatry 2012; 51:181-91. [PMID: 22265364 PMCID: PMC3411187 DOI: 10.1016/j.jaac.2011.11.009] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 11/17/2011] [Accepted: 11/22/2011] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Preterm children are at risk for social-emotional difficulties, including autism and attention-deficit/hyperactivity disorder. We assessed the relationship of regional brain development in preterm children, evaluated via magnetic resonance imaging (MRI) at term-equivalent postmenstrual age (TEA), to later social-emotional difficulties. METHOD MR images obtained at TEA from 184 very preterm infants (gestation <30 weeks or birth weight <1,250 g) were analyzed for white matter abnormalities, hippocampal volume, and brain metrics. A total of 111 infants underwent diffusion tensor imaging, which provided values for fractional anisotropy and apparent diffusion coefficient. Social-emotional development was assessed with the Infant Toddler Social and Emotional Assessment (ITSEA) at age 2 and the Strengths and Difficulties Questionnaire (SDQ) at age 5 years. RESULTS Higher apparent diffusion coefficient in the right orbitofrontal cortex was associated with social-emotional problems at age 5 years (peer problems, p < .01). In females, smaller hippocampal volume was associated with increased hyperactivity (p < .01), peer problems (p < .05), and SDQ total score (p < .01). In males, a smaller frontal region was associated with poorer prosocial (p < .05) scores. Many of the hippocampal findings remained significant after adjusting for birthweight z score, intelligence, social risk, immaturity at birth, and parental mental health. These associations were present in children who had social-emotional problems in similar domains at age 2 and those who did not. CONCLUSIONS Early alterations in regional cerebral development in very preterm infants relate to specific deficits in social-emotional performance by school-age. These results vary by gender. Our results provide further evidence for a neuroanatomical basis for behavioral challenges found in very preterm children.
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Volpe JJ. Systemic inflammation, oligodendroglial maturation, and the encephalopathy of prematurity. Ann Neurol 2012; 70:525-9. [PMID: 22028217 DOI: 10.1002/ana.22533] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Browne JV. Developmental care for high-risk newborns: emerging science, clinical application, and continuity from newborn intensive care unit to community. Clin Perinatol 2011; 38:719-29. [PMID: 22107900 DOI: 10.1016/j.clp.2011.08.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Neonatology has optimized medical outcomes for high-risk newborns yet neurodevelopmental outcomes continue to be a concern. Basic science, clinical research, and environmental design perspectives have shown the impact of the caregiving environment on the developing brain and the role of professional caregivers in providing supportive intervention to both infants and their families. This recognition has prompted a focus on early developmentally supportive care (DSC) for high-risk newborns both in the hospital and in community follow up. DSC has emerged as a recognized standard of care in most neonatal intensive care units. Still, many questions remain and much integrative research is needed.
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Affiliation(s)
- Joy V Browne
- JFK Partners Center for Family and Infant Interaction, University of Colorado Anschutz Medical Campus, 13121 East 19th Avenue, Aurora, CO USA.
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44
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Volpe JJ, Kinney HC, Jensen FE, Rosenberg PA. Reprint of "The developing oligodendrocyte: key cellular target in brain injury in the premature infant". Int J Dev Neurosci 2011; 29:565-82. [PMID: 21802506 DOI: 10.1016/j.ijdevneu.2011.07.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Brain injury in the premature infant, a problem of enormous importance, is associated with a high risk of neurodevelopmental disability. The major type of injury involves cerebral white matter and the principal cellular target is the developing oligodendrocyte. The specific phase of the oligodendroglial lineage affected has been defined from study of both human brain and experimental models. This premyelinating cell (pre-OL) is vulnerable because of a series of maturation-dependent events. The pathogenesis of pre-OL injury relates to operation of two upstream mechanisms, hypoxia-ischemia and systemic infection/inflammation, both of which are common occurrences in premature infants. The focus of this review and of our research over the past 15-20 years has been the cellular and molecular bases for the maturation-dependent vulnerability of the pre-OL to the action of the two upstream mechanisms. Three downstream mechanisms have been identified, i.e., microglial activation, excitotoxicity and free radical attack. The work in both experimental models and human brain has identified a remarkable confluence of maturation-dependent factors that render the pre-OL so exquisitely vulnerable to these downstream mechanisms. Most importantly, elucidation of these factors has led to delineation of a series of potential therapeutic interventions, which in experimental models show marked protective properties. The critical next step, i.e., clinical trials in the living infant, is now on the horizon.
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Affiliation(s)
- Joseph J Volpe
- Department of Neurology, Children's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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45
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McCormick MC, Litt JS, Smith VC, Zupancic JAF. Prematurity: an overview and public health implications. Annu Rev Public Health 2011; 32:367-79. [PMID: 21219170 DOI: 10.1146/annurev-publhealth-090810-182459] [Citation(s) in RCA: 165] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The high rate of premature births in the United States remains a public health concern. These infants experience substantial morbidity and mortality in the newborn period, which translate into significant medical costs. In early childhood, survivors are characterized by a variety of health problems, including motor delay and/or cerebral palsy, lower IQs, behavior problems, and respiratory illness, especially asthma. Many experience difficulty with school work, lower health-related quality of life, and family stress. Emerging information in adolescence and young adulthood paints a more optimistic picture, with persistence of many problems but with better adaptation and more positive expectations by the young adults. Few opportunities for prevention have been identified; therefore, public health approaches to prematurity include assurance of delivery in a facility capable of managing neonatal complications, quality improvement to minimize interinstitutional variations, early developmental support for such infants, and attention to related family health issues.
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Affiliation(s)
- Marie C McCormick
- Department of Society, Human Development and Health, School of Public Health, Harvard University, Boston, Massachusetts 02115, USA.
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46
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Current World Literature. Curr Opin Neurol 2011; 24:183-90. [DOI: 10.1097/wco.0b013e32834585ec] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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47
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Volpe JJ, Kinney HC, Jensen FE, Rosenberg PA. The developing oligodendrocyte: key cellular target in brain injury in the premature infant. Int J Dev Neurosci 2011; 29:423-40. [PMID: 21382469 DOI: 10.1016/j.ijdevneu.2011.02.012] [Citation(s) in RCA: 258] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 02/10/2011] [Accepted: 02/27/2011] [Indexed: 01/16/2023] Open
Abstract
Brain injury in the premature infant, a problem of enormous importance, is associated with a high risk of neurodevelopmental disability. The major type of injury involves cerebral white matter and the principal cellular target is the developing oligodendrocyte. The specific phase of the oligodendroglial lineage affected has been defined from study of both human brain and experimental models. This premyelinating cell (pre-OL) is vulnerable because of a series of maturation-dependent events. The pathogenesis of pre-OL injury relates to operation of two upstream mechanisms, hypoxia-ischemia and systemic infection/inflammation, both of which are common occurrences in premature infants. The focus of this review and of our research over the past 15-20 years has been the cellular and molecular bases for the maturation-dependent vulnerability of the pre-OL to the action of the two upstream mechanisms. Three downstream mechanisms have been identified, i.e., microglial activation, excitotoxicity and free radical attack. The work in both experimental models and human brain has identified a remarkable confluence of maturation-dependent factors that render the pre-OL so exquisitely vulnerable to these downstream mechanisms. Most importantly, elucidation of these factors has led to delineation of a series of potential therapeutic interventions, which in experimental models show marked protective properties. The critical next step, i.e., clinical trials in the living infant, is now on the horizon.
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Affiliation(s)
- Joseph J Volpe
- Department of Neurology, Children's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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Alvarez L, Cayol V, Magny JF, Morisseau L. L'ombre des traumatismes périnatals sur les premiers liens. PSYCHIATRIE DE L ENFANT 2010. [DOI: 10.3917/psye.532.0609] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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