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      Screening for Autism Spectrum Disorder in Premature Subjects Hospitalized in a Neonatal Intensive Care Unit

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          Abstract

          Considering that the average age for diagnosis of autism spectrum disorder (ASD) is 4–5 years, testing screening methods for ASD risk in early infancy is a public health priority. This study aims to identify the risks for development of ASD in children born prematurely and hospitalized in a neonatal intensive care unit (NICU) and explore the association with pre-, peri- and postnatal factors. Methods: The children’s families were contacted by telephone when their child was between 18 and 24 months of age, to apply the Modified Checklist for Autism in Toddlers (M-CHAT). The sample consisted of 40 children (57.5% boys). M-CHAT screening revealed that 50% of the sample showed early signs of ASD. Although the frequency of delayed development was higher in boys, this difference was not statistically significant between the sexes ( p = 0.11). Assessment of the association between perinatal conditions and early signs of autism in children hospitalized in an NICU exhibited no correlation between the factors analyzed (birth weight and type of delivery). The findings indicate a high risk of ASD in premature children, demonstrating no associations with gestational and neonatal variables or the hospitalization conditions of the NICUs investigated.

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          Neonatal intensive care unit stress is associated with brain development in preterm infants.

          Although many perinatal factors have been linked to adverse neurodevelopmental outcomes in very premature infants, much of the variation in outcome remains unexplained. The impact on brain development of 1 potential factor, exposure to stressors in the neonatal intensive care unit, has not yet been studied in a systematic, prospective manner. In this prospective cohort study of infants born at <30 weeks gestation, nurses were trained in recording procedures and cares. These recordings were used to derive Neonatal Infant Stressor Scale scores, which were employed to measure exposure to stressors. Magnetic resonance imaging (brain metrics, diffusion, and functional magnetic resonance imaging) and neurobehavioral examinations at term equivalent postmenstrual age were used to assess cerebral structure and function. Simple and partial correlations corrected for confounders, including immaturity and severity of illness, were used to explore these relations. Exposure to stressors was highly variable, both between infants and throughout a single infant's hospital course. Exposure to a greater number of stressors was associated with decreased frontal and parietal brain width, altered diffusion measures and functional connectivity in the temporal lobes, and abnormalities in motor behavior on neurobehavioral examination. Exposure to stressors in the Neonatal Intensive Care Unit is associated with regional alterations in brain structure and function. Further research into interventions that may decrease or mitigate exposure to stressors in the neonatal intensive care unit is warranted. Copyright © 2011 American Neurological Association.
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            Prenatal, perinatal, and postnatal factors associated with autism

            Abstract Background: The aim of this meta-analysis was to investigate the prenatal, perinatal, and postnatal risk factors for children autism. Methods: PubMed, Embase, Web of Science were used to search for studies that examined the prenatal, perinatal, and postnatal risk factors for children autism. A fixed-effects model or random-effects model was used to pool the overall effect estimates. Results: Data from 37,634 autistic children and 12,081,416 nonautistic children enrolled in 17 studies were collated. During the prenatal period, the factors associated with autism risk were maternal and paternal age≥35 years, mother's and father's race: White and Asian, gestational hypertension, gestational diabetes, maternal and paternal education college graduate+, threatened abortion, and antepartum hemorrhage. During perinatal period, the factors associated with autism risk were caesarian delivery, gestational age≤36 weeks, parity≥4, spontaneous labor, induced labor, no labor, breech presentation, preeclampsia, and fetal distress. During the postnatal period, the factors associated with autism risk were low birth weight, postpartum hemorrhage, male gender, and brain anomaly. Parity≥4 and female were associated with a decreased risk of autism. In addition, exposure to cigarette smoking, urinary infection, mother's and father's race: Black and Hispanic, mother's country of birth outside Europe and North America, umbilical cord around neck, premature membrane rupture, 5-minutes Apgar score<7, and respiratory infection were not associated with increased risk of autism. Conclusion: The present meta-analysis confirmed the relation between some prenatal, perinatal, and postnatal factors with autism. All these factors were examined individually, thus it was still unclear that whether these factors are causal or play a secondary role in the development of autism. Further studies are needed to verify our findings, and investigate the effects of multiple factors on autism, rather than the single factor.
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              Perinatal and neonatal risk factors for autism: a comprehensive meta-analysis.

              The etiology of autism is unknown, although perinatal and neonatal exposures have been the focus of epidemiologic research for over 40 years. To provide the first review and meta-analysis of the association between perinatal and neonatal factors and autism risk. PubMed, Embase, and PsycInfo databases were searched for studies that examined the association between perinatal and neonatal factors and autism through March 2007. Forty studies were eligible for the meta-analysis. For each exposure, a summary effect estimate was calculated using a random-effects model. Heterogeneity in effect estimates across studies was examined, and, if found, a meta-regression was conducted to identify measured methodological factors that could explain between-study variability. Over 60 perinatal and neonatal factors were examined. Factors associated with autism risk in the meta-analysis were abnormal presentation, umbilical-cord complications, fetal distress, birth injury or trauma, multiple birth, maternal hemorrhage, summer birth, low birth weight, small for gestational age, congenital malformation, low 5-minute Apgar score, feeding difficulties, meconium aspiration, neonatal anemia, ABO or Rh incompatibility, and hyperbilirubinemia. Factors not associated with autism risk included anesthesia, assisted vaginal delivery, postterm birth, high birth weight, and head circumference. There is insufficient evidence to implicate any 1 perinatal or neonatal factor in autism etiology, although there is some evidence to suggest that exposure to a broad class of conditions reflecting general compromises to perinatal and neonatal health may increase the risk. Methodological variations were likely sources of heterogeneity of risk factor effects across studies.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                21 October 2020
                October 2020
                : 17
                : 20
                : 7675
                Affiliations
                [1 ]Physiotherapy Course, Universidade Federal do Rio Grande do Norte (UFRN), Natal 59078-970, Rio Grande do Norte, Brazil; scarlyttnorrara23@ 123456gmail.com (N.S.d.O.H.); lididelgado@ 123456gmail.com (L.D.O.d.C.); apsilvana@ 123456gmail.com (S.A.P.)
                [2 ]Post-graduation Program of Physiotherapy, Universidade Federal do Rio Grande do Norte (UFRN), Natal 59078-970, Rio Grande do Norte, Brazil; sabrinne.suelen@ 123456gmail.com (S.S.S.S.); gentilfonsecafisio@ 123456gmail.com (G.G.d.F.F.)
                [3 ]Instituto Santos Dumont, Macaíba 59280-000, Rio Grande do Norte, Brazil
                [4 ]Rehabilitation Sciences Graduate Program, Faculty of Health Sciences of Trairi/ Universidade Federal do Rio Grande do Norte (FACISA/UFRN), Santa Cruz 59200-000, Rio Grande do Norte, Brazil; ruthbezerrafisio@ 123456gmail.com
                [5 ]Department of Therapeutic Processes, Universidad Católica de Temuco, Temuco 4813302, La Araucania, Chile
                Author notes
                [* ]Correspondence: iguerra@ 123456uct.cl
                Author information
                https://orcid.org/0000-0003-3451-7799
                https://orcid.org/0000-0002-6315-5419
                https://orcid.org/0000-0001-7305-7583
                https://orcid.org/0000-0002-6226-2837
                Article
                ijerph-17-07675
                10.3390/ijerph17207675
                7589640
                33096698
                fc5ccce5-5495-43bb-a594-a12c5468b7e6
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 04 August 2020
                : 16 October 2020
                Categories
                Article

                Public health
                autism spectrum disorder,risk factors,newborn,neonatal intensive care units
                Public health
                autism spectrum disorder, risk factors, newborn, neonatal intensive care units

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