Weinberg Child Development Center at Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
Arrow Project, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
PLoS One. 2020 Aug 27;15(8):e0236994. doi: 10.1371/journal.pone.0236994. eCollection 2020.
Prematurity has been identified as a risk factor for Autism Spectrum Disorder (ASD). The link between Autism Spectrum Disorder (ASD) and birth-week has not been strongly evidenced. We evaluated the correlation between the degree of prematurity and the incidence of autism in a cohort of 871 children born prematurely and followed from birth. The cohort was reduced to 416 premature infants born between 2011-2017 who were followed for 2-14 years, and analyzed according to birth week (degree of prematurity), and according to gender.
43 children (10.3%) received a definite diagnosis of ASD. There was a significant correlation between birth week and the risk of ASD, with 22.6% of children diagnosed with ASD when born at 25 weeks, versus 6% of ASD diagnoses at 31 weeks of prematurity. For children born after 32 weeks, the incidence decreased to 8-12.5%. A strong link was found between earlier birth week and increased autism risk; the risk remained elevated during near-term prematurity in boys. A correlation between early birth week and an elevated risk for ASD was seen in all children, but accentuated in females, gradually decreasing as birth week progresses; in males the risk for ASD remains elevated for any birth week.
A statistically significant increase in rates of autism was found with each additional week of prematurity. Females drove this direct risk related to degree of prematurity, while males had an elevated risk throughout prematurity weeks, even at near-term. We recommend including ASD screening in follow up of infants born prematurely, at all levels of prematurity.
早产已被确定为自闭症谱系障碍（ASD）的一个风险因素。自闭症谱系障碍（ASD）与出生周之间的联系尚未得到强有力的证据支持。我们评估了 871 名早产儿队列中早产程度与自闭症发病率之间的相关性，并对从出生开始进行随访的队列进行了研究。该队列减少至 416 名在 2011-2017 年期间出生的早产儿，随访时间为 2-14 年，根据出生周（早产程度）和性别进行分析。
43 名儿童（10.3%）被明确诊断为 ASD。出生周与 ASD 风险之间存在显著相关性，当出生于 25 周时，有 22.6%的儿童被诊断为 ASD，而在 31 周的早产中，有 6%的儿童被诊断为 ASD。对于出生后 32 周的儿童，发病率下降至 8-12.5%。早产周越早，自闭症风险越高；在男孩中，近足月的早产仍存在较高的自闭症风险。早产周与 ASD 风险升高之间存在很强的相关性，在所有儿童中均可见，但在女性中更为明显，随着早产周的进展逐渐减少；对于任何早产周，男性的 ASD 风险仍然升高。
随着每周额外的早产，自闭症的发病率呈统计学显著增加。女性推动了与早产程度直接相关的这种直接风险，而男性在整个早产周内都存在较高的风险，即使在近足月时也是如此。我们建议在所有早产程度的早产儿随访中包括 ASD 筛查。
