1Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70403 Taiwan.
2Graduate Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Mol Autism. 2019 Jul 22;10:32. doi: 10.1186/s13229-019-0282-4. eCollection 2019.
Lower gestational age may increase autism spectrum disorder (ASD) vulnerability; however, the incidence of ASD diagnosis through a direct assessment on every very preterm birth child on the population base remains unclear. Moreover, the behavioral characteristics of preterm birth ASD are unknown.
Every very preterm birth child (gestational age < 32 weeks; birth weight < 1500 g) who was discharged from neonatal intensive care units in Southern Taiwan and prospectively followed to 5 years of age was evaluated using the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R). The term birth (gestational age > 37 weeks) ASD children characterized by ADOS and ADI-R were group matched to the preterm birth ASD by age at examination for comparison. ADOS severity scores were calculated by the Mann-Whitney test and ADI-R by multivariate analysis of variance and canonical discriminant analysis.
Two hundred forty-six (87%) of the 283 very preterm survivors were followed prospectively to 5 years of age. Nineteen (7.7%) of the 246 children fulfilled the diagnostic criteria of ASD. After excluding 1 patient with cerebral palsy and profound mental disability, 18 preterm ASD children were compared with 44 term birth ASD children. The two ASD groups were comparable for age at examination, gender, and intelligence quotient. The two groups showed comparable ADOS severity scores in social affect deficits, restricted repetitive behaviors, and total score, but had differences in qualitative abnormalities in reciprocal social interaction (Wilks lambda value = 6.2, < 0.001) of ADI-R. Compared to term birth ASD children, preterm birth ASD children exhibited worse nonverbal behaviors that regulate social interaction (OR 2.59, 95% CI 1.41-4.73, = 0.002) but more favorable peer relationships (OR 0.58, 95% CI 0.38-0.90, = 0.01) and socioemotional reciprocity (OR 0.55, 95% CI 0.33-0.92, = 0.02). In contrast to the heterogeneous severity of social reciprocity in the term ASD group, the behavioral characteristics of the preterm ASD group showed a homogeneous reciprocal social interaction pattern.
The 5-year incidence rate of ASD was high in very preterm birth children. Preterm birth ASD exhibited a specific behavioral phenotype of reciprocal social interaction.
较低的胎龄可能会增加自闭症谱系障碍（ASD）的易感性；然而，通过对每一个极低出生体重儿进行直接评估，在人群基础上诊断 ASD 的发生率仍不清楚。此外，早产儿 ASD 的行为特征尚不清楚。
对台湾南部新生儿重症监护病房出院的每一个极早产儿（胎龄 < 32 周；出生体重 < 1500 克）进行前瞻性随访至 5 岁，使用自闭症诊断观察量表（ADOS）和自闭症诊断访谈修订版（ADI-R）进行评估。以 ADOS 和 ADI-R 为特征的足月出生（胎龄 > 37 周）ASD 儿童与早产儿 ASD 按检查年龄进行组间匹配比较。ADOS 严重程度评分采用 Mann-Whitney 检验，ADI-R 采用多元方差分析和典型判别分析。
283 例极早产儿中有 246 例（87%）前瞻性随访至 5 岁。246 例儿童中有 19 例（7.7%）符合 ASD 的诊断标准。排除 1 例脑瘫和严重精神发育迟滞后，18 例早产儿 ASD 儿童与 44 例足月出生 ASD 儿童进行比较。两组 ASD 儿童在检查年龄、性别和智商方面具有可比性。两组 ADOS 社会情感缺陷、受限重复行为和总分严重程度评分相当，但 ADI-R 中互惠性社会互动的定性异常存在差异（Wilks lambda 值=6.2，<0.001）。与足月出生 ASD 儿童相比，早产儿 ASD 儿童的非言语行为调节社会互动能力较差（OR 2.59，95%CI 1.41-4.73，=0.002），但同伴关系较好（OR 0.58，95%CI 0.38-0.90，=0.01），社会情绪互惠性较好（OR 0.55，95%CI 0.33-0.92，=0.02）。与足月 ASD 组社会互惠性严重程度不均一相反，早产儿 ASD 组的行为特征表现出一种同质的互惠性社会互动模式。
极低出生体重儿的 ASD 5 年发生率较高。早产儿 ASD 表现出特定的互惠性社会互动行为表型。
