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Screening positivo para autismo em ex-pré-termos : Prevalência e risco (Positive Screening for Autism in Ex-preterm Infants: Prevalence and Risk) Catherine.

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Apresentação em tema: "Screening positivo para autismo em ex-pré-termos : Prevalência e risco (Positive Screening for Autism in Ex-preterm Infants: Prevalence and Risk) Catherine."— Transcrição da apresentação:

1 Screening positivo para autismo em ex-pré-termos : Prevalência e risco (Positive Screening for Autism in Ex-preterm Infants: Prevalence and Risk) Catherine Limperopoulos, PhDa,b, Haim Bassan, MDb, Nancy R. Sullivan, PhDc, Janet S. Soul, MDb, Richard L. Robertson, Jr, MDd, Marianne Moore, BA, RNb, Steven A. Ringer, MD, PhDe, Joseph J. Volpe, MDb and Adré J. du Plessis, MBChB, MPHb a Department of Neurology and Neurosurgery, School of Physical and Occupational Therapy, and Department of Pediatrics, McGill University, Montreal, Quebec, Canada b Fetal-Neonatal Neurology Research Program, Department of Neurology c Developmental Medicine Center d Department of Radiology, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts e Department of Neonatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts Apresentação:Juliana Sobral Coutinho Paulo Henrique G. Pereira Coordenação: Paulo R. Margotto Pediatrics 2008;121; ( April 2008) 14/4/2008

2 Introdução Avanços no tratamento intensivo de neonatologia aumentaram a sobrevivência de pré-termos, no entanto houve redução da morbidade neurológica e do desenvolvimento a longo prazo. 50% de ex-pré-termos apresentam dificuldades na função executiva, atenção e comportamento. Baixo peso e idade gestacional são fatores de risco perinatais. A prevalência dos distúrbios do expectro do autismo ainda não foi sistematicamente explorada na população dos pré-termos.

3 Objetivo Aplicar testes de rastreamento para características autísticas em crianças com história de muito baixo peso ao nascer e identificar fatores de risco associados ao resultado positivo do rastreamento.

4 Metodologia Coorte de recém-nascidos fazia parte de um estudo prospectivo sobre função cerebrovascular numa série consecutiva de pré-termos menores de 1500g Foram excluídos aqueles com disgenesia cerebral, síndromes dismórficas e cromossomopatias Total: 91 RN.

5 Metodologia Modified Checklist for Autism in Toddler (M- CHAT) foi aplicado nos RN entre as idades de 18 a 24 meses ajustados pela prematuridade. A informação psicométrica do M-CHAT demonstra altas especificidade e sensibilidade. Child Behavior Checklist (CBCL) foi aplicada para avaliar problemas comportamentais e emocionais. Vineland Adaptive Behavior Scale (VARS) foi aplicada para avaliar as funções adaptativas: comunicação, socialização, motricidade

6 Metodologia Amostra caracterizada quanto aos aspectos demográficos, pré- natais, intra-parto, pós-parto imediato, resultado a curto prazo. Dentre tais variáveis, foram identificados como possíveis variáveis preditoras de positividade no rastreio de autismo –Idade materna –Temperatura materna –Hemorragia intra ou ante-parto –Parto prematuro –Infecção da placenta –Idade gestacional –Peso ao nascer –Sexo –Pontuação no SNAP II –Duração da necessidade de oxigênio –Ressonância Magnética alterada Realizada Análise da Regressão Logística Multivariada para identificar o modelo predictivo final

7 Resultados Idade gestacional variou de 23 a 30 semanas Peso variou de 460 a 1490g

8 Resultados Correlação altamente positiva entre pontuação anormal no M- CHAT com problemas de introspecção do CBCL Correlação positiva entre dificuldades de socialização e de habilidades de comunicação com resultado positivo do M- CHAT.

9 Resultados

10 Análise da Regressão Logística Univariada

11 Resultados Análise da Regressão Logística Multivariada

12 Discussão Elevada prevalência de características autísticas nos pré-termos extremos sobreviventes. Correlação positiva entre resultado positivo do M-CHAT e introspecção e problemas de socialização e déficits de comunicação. Primeira descrição desse fenômeno em prematuros extremos

13 Discussão Estudos populacionais identificaram prematuridade, baixo peso e necessidade de tratamento intensivo neonatal como fatores de risco perinatais para espectro autista. Tais fatores atuariam independentemente ou interagiriam com a predisposição genética por interferir em pontos críticos do desenvolvimento.

14 Discussão Corioamnionite e sexo masculino são fatores já identificados como fatores associados a autismo Limitações: –M-CHAT é um instrumento de rastreio, não fecha o diagnóstico –Como foi aplicado aos 18 meses, as alterações podem ser transitórias ou podem emergir a partir dessa idade. –Ausência de dados socioeconômicos, já que estes podem justificar atraso do desenvolvimento. –Amostra altamente selecionada.

15 Conclusão Os resultados desse estudo sugerem que o rastreamento precoce para sinais de autismo são justificados em uma população de prematuros extremos seguido por um teste definitivo para autismo naqueles com teste inicial positivo.

16 ABSTRACT OBJECTIVE. The survival of very low birth weight infants has increased markedly in recent years. Unfortunately, the prevalence of significant and lifelong motor, cognitive, and behavioral dysfunction has remained a major problem confronting these children. The objective of this study was to perform screening tests for early autistic features in children with a history of very low birth weight and to identify risk factors associated with a positive screening result. METHODS. We studied 91 ex-preterm infants 1500 g at birth. Infants underwent conventional MRI studies at preterm and/or term-adjusted age. We collected pertinent demographic, prenatal, intrapartum, acute postnatal, and short-term outcome data for all infants. Follow-up assessments were performed at a mean age of 21.9 ± 4.7 months, using the Modified Checklist for Autism in Toddlers, the Vineland Adaptive Behavior Scale, and the Child Behavior Checklist. RESULTS. Twenty-six percent of ex-preterm infants had a positive result on the autism screening tool. Abnormal scores correlated highly with internalizing behavioral problems on the Child Behavior Checklist and socialization and communication deficits on the Vineland Scales. Lower birth weight, gestational age, male gender, chorioamnionitis, acute intrapartum hemorrhage, illness severity on admission, and abnormal MRI studies were significantly associated with an abnormal autism screening score. CONCLUSIONS. Early autistic behaviors seem to be an underrecognized feature of very low birth weight infants. The results from this study suggest that early screening for signs of autism may be warranted in this high-risk population followed by definitive autism testing in those with positive screening results. Key Words: autism prematurity MRI risk factors outcome Abbreviations: VLBWvery low birth weight M-CHATModified Checklist for Autism in Toddlers CBCLChild Behavior Checklist VABSVineland Adaptive Behavior Scale SNAP-IIScore of Neonatal Acute Physiology II PVLperiventricular leukomalacia PVHIperiventricular hemorrhagic infarction

17 Referências do artigo: Msall ME. The limits of viability and the uncertainty of neuroprotection: challenges in optimizing outcomes in extreme prematurity. Pediatrics. 2007;119 (1):158 –160[Free Full Text][Free Full Text] Tommiska V, Heinonen K, Lehtonen L, et al. No improvement in outcome of nationwide extremely low birth weight infant populations between 1996–1997 and 1999–2000. Pediatrics. 2007;119 (1):29 –36[Abstract/Free Full Text][Abstract/Free Full Text] Ment LR, Allan WC, Makuch RW, Vohr B. Grade 3 to 4 intraventricular hemorrhage and Bayley scores predict outcome. Pediatrics. 2005;116 (6):1597 –1598; author reply 1598[Free Full Text][Free Full Text] Rushing S, Ment LR. Preterm birth: a cost benefit analysis. Semin Perinatol. 2004;28 (6):444 – 450[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Saigal S. Follow-up of very low birthweight babies to adolescence. Semin Neonatol. 2000;5 (2):107 –118[CrossRef][Medline][CrossRef][Medline] Hack M, Flannery DJ, Schluchter M, Cartar L, Borawski E, Klein N. Outcomes in young adulthood for very-low-birth-weight infants. N Engl J Med. 2002;346 (3):149 – 157[Abstract/Free Full Text][Abstract/Free Full Text] Dahl LB, Kaaresen PI, Tunby J, Handegard BH, Kvernmo S, Ronning JA. Emotional, behavioral, social, and academic outcomes in adolescents born with very low birth weight. Pediatrics. 2006;118 (2). Available at: Pharoah PO, Stevenson CJ, West CR. General Certificate of Secondary Education performance in very low birthweight infants. Arch Dis Child. 2003;88 (4):295 – 298[Abstract/Free Full Text][Abstract/Free Full Text] Anderson PJ, Doyle LW. Executive functioning in school-aged children who were born very preterm or with extremely low birth weight in the 1990s. Pediatrics. 2004;114 (1):50 – 57[Abstract/Free Full Text][Abstract/Free Full Text] Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJ. Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis. JAMA. 2002;288 (6):728 – 737[Abstract/Free Full Text][Abstract/Free Full Text]

18 Harvey JM, O'Callaghan MJ, Mohay H. Executive function of children with extremely low birthweight: a case control study. Dev Med Child Neurol. 1999;41 (5):292 –297[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Msall ME, Tremont MR. Measuring functional outcomes after prematurity: developmental impact of very low birth weight and extremely low birth weight status on childhood disability. Ment Retard Dev Disabil Res Rev. 2002;8 (4):258 –272[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Msall ME. Supporting vulnerable preschool children: connecting the dots before kindergarten. Pediatrics. 2004;114 (4):1086[Free Full Text][Free Full Text] Sigurdsson E, Van Os J, Fombonne E. Are impaired childhood motor skills a risk factor for adolescent anxiety? Results from the 1958 U.K. birth cohort and the National Child Development Study. Am J Psychiatry. 2002;159 (6):1044 –1046 Pine D, Shaffer D, Schonfeld IS. Persistent emotional disorder in children with neurological soft signs. J Am Acad Child Adolesc Psychiatry. 1993;32 (6):1229 –1236[ISI][Medline][ISI][Medline] Buka SL, Fan AP. Association of prenatal and perinatal complications with subsequent bipolar disorder and schizophrenia. Schizophr Res. 1999;39 (2):113 –119; discussion 160–161[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Wahlbeck K, Osmond C, Forsen T, Barker DJ, Eriksson JG. Associations between childhood living circumstances and schizophrenia: a population-based cohort study. Acta Psychiatr Scand. 2001;104 (5):356 –360[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Jones PB, Rantakallio P, Hartikainen AL, Isohanni M, Sipila P. Schizophrenia as a long-term outcome of pregnancy, delivery, and perinatal complications: a 28-year follow-up of the 1966 north Finland general population birth cohort. Am J Psychiatry. 1998;155 (3):355 –364[Abstract/Free Full Text][Abstract/Free Full Text] Botting N, Powls A, Cooke RW, Marlow N. Attention deficit hyperactivity disorders and other psychiatric outcomes in very low birthweight children at 12 years. J Child Psychol Psychiatry. 1997;38 (8):931 – 941[ISI][Medline][ISI][Medline] Whitaker AH, Van Rossem R, Feldman JF, et al. Psychiatric outcomes in low-birth-weight children at age 6 years: relation to neonatal cranial ultrasound abnormalities. Arch Gen Psychiatry. 1997;54 (9):847 – 856[Abstract][Abstract] Saigal S, Pinelli J, Hoult L, Kim MM, Boyle M. Psychopathology and social competencies of adolescents who were extremely low birth weight. Pediatrics. 2003;111 (5 pt 1):969 –975[Abstract/Free Full Text][Abstract/Free Full Text]

19 McCormick MC, Brooks-Gunn J, Workman-Daniels K, Turner J, Peckham GJ. The health and developmental status of very low-birth-weight children at school age. JAMA. 1992;267 (16):2204 –2208[Abstract][Abstract] Breslau N, Johnson EO, Lucia VC. Academic achievement of low birthweight children at age 11: the role of cognitive abilities at school entry. J Abnorm Child Psychol. 2001;29 (4):273 –279[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Nadeau L, Boivin M, Tessier R, Lefebvre F, Robaey P. Mediators of behavioral problems in 7-year-old children born after 24 to 28 weeks of gestation. J Dev Behav Pediatr. 2001;22 (1):1 –10[ISI][Medline][ISI][Medline] Weisglas-Kuperus N, Koot HM, Baerts W, Fetter WP, Sauer PJ. Behaviour problems of very low-birthweight children. Dev Med Child Neurol. 1993;35 (5):406 – 416[ISI][Medline][ISI][Medline] Hoy EA, Sykes DH, Bill JM, Halliday HL, McClure BG, Reid MM. The social competence of very-low-birthweight children: teacher, peer, and self-perceptions. J Abnorm Child Psychol. 1992;20 (2):123 –150[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Kuehn BM. CDC: autism spectrum disorders common. JAMA. 2007;297 (9):940[Free Full Text][Free Full Text] Leslie DL, Martin A. Health care expenditures associated with autism spectrum disorders. Arch Pediatr Adolesc Med. 2007;161 (4):350 –355[Abstract/Free Full Text][Abstract/Free Full Text] Fombonne E. Autism and newborn encephalopathy. Dev Med Child Neurol. 2006;48 (2):84[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Robins DL, Dumont-Mathieu TM. Early screening for autism spectrum disorders: update on the modified checklist for autism in toddlers and other measures. Dev Behav Pediatr. 2006;27 (2 Suppl):S111 –S119[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Soul JS, Hammer PE, Tsuji M, et al. Fluctuating pressure-passivity is common in the cerebral circulation of sick premature infants. Pediatr Res. 2007;61 (4):467 – 473[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Limperopoulos C, Bassan H, Kalish L, et al. Current definitions of hypotension do not predict abnormal cranial ultrasound in preterm infants. Pediatrics. 2007;120 (5):966 – 977[Abstract/Free Full Text][Abstract/Free Full Text]

20 Robins DL, Fein D, Barton ML, Green JA. The Modified Checklist for Autism in Toddlers: an initial study investigating the early detection of autism and pervasive developmental disorders. J Autism Dev Disord. 2001;31 (2):131 –144[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Wong V, Hui LH, Lee WC, et al. A modified screening tool for autism (Checklist for Autism in Toddlers [CHAT-23]) for Chinese children. Pediatrics. 2004;114 (2). Available at: Rescorla LA. Assessment of young children using the Achenbach System of Empirically Based Assessment (ASEBA). Ment Retard Dev Disabil Res Rev. 2005;11 (3):226 – 237[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Achenbach TM, Rescorla L. Manual for the Child Behavior Checklist. Preschool Forms and Profiles. Burlington, VT: University of Vermont Department of Psychiatry; 2000 Sparrow S, Balla D, Cicchetti D. Vineland Adaptive Behavior Scales (Interview Edition) Survey Form Manual: A Revision of the Vineland Social Maturity Scale. Circle Pines, MN: American Guidance Service; 1984 Richardson DK, Corcoran JD, Escobar GJ, Lee SK. SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr. 2001;138 (1):92 –100[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Hultman CM, Sparen P, Cnattingius S. Perinatal risk factors for infantile autism. Epidemiology. 2002;13 (4):417 –423[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Badawi N, Dixon G, Felix JF, et al. Autism following a history of newborn encephalopathy: more than a coincidence? Dev Med Child Neurol. 2006;48 (2):85 –89[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Fombonne E. The epidemiology of autism: a review. Psychol Med. 1999;29 (4):769 – 786[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Bolton PF, Murphy M, Macdonald H, Whitlock B, Pickles A, Rutter M. Obstetric complications in autism: consequences or causes of the condition? J Am Acad Child Adolesc Psychiatry. 1997;36 (2):272 –281[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Maimburg RD, Vaeth M. Perinatal risk factors and infantile autism. Acta Psychiatr Scand. 2006;114 (4):257 –264[CrossRef][ISI][Medline][CrossRef][ISI][Medline]

21 Brimacombe M, Ming X, Lamendola M. Prenatal and birth complications in autism. Matern Child Health J. 2007;11 (1):73 –79[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Matsuishi T, Yamashita Y, Ohtani Y, et al. Brief report: incidence of and risk factors for autistic disorder in neonatal intensive care unit survivors. J Autism Dev Disord. 1999;29 (2):161 – 166[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Juul-Dam N, Townsend J, Courchesne E. Prenatal, perinatal, and neonatal factors in autism, pervasive developmental disorder-not otherwise specified, and the general population. Pediatrics. 2001;107 (4). Available at: Courchesne E, Karns CM, Davis HR, et al. Unusual brain growth patterns in early life in patients with autistic disorder: an MRI study. Neurology. 2001;57 (2):245 –254[Abstract/Free Full Text][Abstract/Free Full Text] Sparks BF, Friedman SD, Shaw DW, et al. Brain structural abnormalities in young children with autism spectrum disorder. Neurology. 2002;59 (2):184 –192[Abstract/Free Full Text][Abstract/Free Full Text] Levitt JG, Blanton RE, Smalley S, et al. Cortical sulcal maps in autism. Cereb Cortex. 2003;13 (7):728 –735[Abstract/Free Full Text][Abstract/Free Full Text] Carper RA, Moses P, Tigue ZD, Courchesne E. Cerebral lobes in autism: early hyperplasia and abnormal age effects. Neuroimage. 2002;16 (4):1038 –1051[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Kates WR, Burnette CP, Eliez S, et al. Neuroanatomic variation in monozygotic twin pairs discordant for the narrow phenotype for autism. Am J Psychiatry. 2004;161 (3):539 – 546[Abstract/Free Full Text][Abstract/Free Full Text] Herbert MR, Ziegler DA, Deutsch CK, et al. Dissociations of cerebral cortex, subcortical and cerebral white matter volumes in autistic boys. Brain. 2003;126 (Pt 5):1182 – 1192[Abstract/Free Full Text][Abstract/Free Full Text] Rippon G, Brock J, Brown C, Boucher J. Disordered connectivity in the autistic brain: challenges for the "new psychophysiology. " Int J Psychophysiol. 2007;63 (2):164 – 172[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Courchesne E, Redcay E, Morgan JT, Kennedy DP. Autism at the beginning: microstructural and growth abnormalities underlying the cognitive and behavioral phenotype of autism. Dev Psychopathol. 2005;17 (3):577 –597[ISI][Medline][ISI][Medline]

22 Courchesne E. Brainstem, cerebellar and limbic neuroanatomical abnormalities in autism. Curr Opin Neurobiol. 1997;7 (2):269 –278[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Courchesne E. Brain development in autism: early overgrowth followed by premature arrest of growth. Ment Retard Dev Disabil Res Rev. 2004;10 (2):106 – 111[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Hashimoto T, Tayama M, Murakawa K, et al. Development of the brainstem and cerebellum in autistic patients. J Autism Dev Disord. 1995;25 (1):1 – 18[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Bauman ML, Kemper TL. Neuroanatomic observations of the brain in autism: a review and future directions. Int J Dev Neurosci. 2005;23 (2–3):183 – 187[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Limperopoulos C, Bassan H, Gauvreau K, et al. Does cerebellar injury in premature infants contribute to the high prevalence of long-term cognitive, learning, and behavioral disability in survivors? Pediatrics. 2007;120 (3):584 – 593[Abstract/Free Full Text][Abstract/Free Full Text] Limperopoulos C, Soul JS, Gauvreau K, et al. Late gestation cerebellar growth is rapid and impeded by premature birth. Pediatrics. 2005;115 (3):688 – 695[Abstract/Free Full Text][Abstract/Free Full Text] Ventola P, Kleinman J, Pandey J, et al. Differentiating between autism spectrum disorders and other developmental disabilities in children who failed a screening instrument for ASD. J Autism Dev Disord. 2007;37 (3):425 – 436[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Trillingsgaard A, Ulsted Sorensen E, Nemec G, Jorgensen M. What distinguishes autism spectrum disorders from other developmental disorders before the age of four years? Eur Child Adolesc Psychiatry. 2005;14 (2):65 –72[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Lord C. Follow-up of two-year-olds referred for possible autism. J Child Psychol Psychiatry. 1995;36 (8):1365 –1382[ISI][Medline[ISI][Medline

23 Lord C, Rutter M, Le Couteur A. Autism Diagnostic Interview- Revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. J Autism Dev Disord. 1994;24 (5):659 –685[CrossRef][ISI][Medline][CrossRef][ISI][Medline] Lord C, Risi S, Lambrecht L, et al. The autism diagnostic observation schedule-generic: a standard measure of social and communication deficits associated with the spectrum of autism. J Autism Dev Disord. 2000;30 (3):205 –223[CrossRef][ISI][Medline][CrossRef][ISI][Medline] American Psychiatric Association. Diagnostic criteria for autistic disorder. In: Diagnostic and Statistical Manual of Mental Disorders. 4th ed, Text Revision (DSM-IV-TR). American Psychiatric Association; 2000 Committee on Educational Interventions for Children with Autism, National Research Council. Educating Children With Autism. Washington, DC: National Academy Press; 2001 Bryson SE, Rogers SJ, Fombonne E. Autism spectrum disorders: early detection, intervention, education, and psychopharmacological management. Can J Psychiatry. 2003;48 (8):506 –516[Medline][Medline]

24 Obrigado!!! Ddo Paulo Henrique, Dra. Juliana e Dr. Paulo R. Margotto 14/4/2008


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