Extremely preterm infants, those born at less than 28 weeks of gestation, are more susceptible to a variety of complications, including neurodevelopmental disorders. ROP, a retinal disorder that affects premature infants, has been examined for its association with long-term developmental impairments. The study included children without perinatal brain injuries or genetic disorders, in an attempt to control the association between ROP and autism spectrum disorder.
The study analyzed data from children born extremely premature (<28 weeks) in the Region Västra Götaland between 2013 and 2017. Of 266 children evaluated for neurodevelopmental outcomes, 143 were included after excluding cases with documented brain injuries or genetic disorders. These children were categorized based on the severity of their ROP: no or mild ROP (stage <1) and moderate-to-severe ROP (stage ≥2). Neurodevelopmental diagnoses diagnosed included ASD, attention deficit hyperactivity disorder (ADHD), and intellectual disability. Statistical adjustments for this analysis were made for gestational age and sex.
Key Findings Overall Neurodevelopmental Outcomes:
• 18% of 143 children had an autism spectrum disorder diagnosis
• ADHD was diagnosed in 15%, and intellectual disability in 7%
ROP Severity and Risk of Autism:
• For patients with no or mild ROP (stage <1), 10% met the criteria for an autism spectrum disorder diagnosis.
• On the contrary, 27% of those with moderate-to-severe ROP (stage ≥2) were diagnosed with ASD (p = 0.008).
High Risk of ASD:
• The risk of ASD diagnosis was threefold increased in cases of moderate-to-severe ROP even after adjustment for gestational age and sex (p = 0.011).
It is established that moderate-to-severe retinopathy of prematurity was significantly associated with higher risks of later autism spectrum disorder in extremely preterm children without documented brain injuries or genetic disorders. Integrated approaches to care should thus not only emphasize ophthalmologic health but also neurodevelopmental health, and indeed, both approaches must target improving outcomes for such a vulnerable group.
Reference:
Lundgren P, Olsson HBK, Pivodic A, Jacobson L, Vallin L, Smith LE, Sävman K, Hellström A. Increased risk of autism in extremely preterm children with a history of retinopathy of prematurity. Acta Paediatr. 2024 Dec 19. doi: 10.1111/apa.17539. Epub ahead of print. PMID: 39698790.
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