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Article |

Psychiatrie Outcomes in Low-Birth-Weight Children at Age 6 Years: Relation to Neonatal Cranial Ultrasound Abnormalities

Agnes H. Whitaker, MD; Ronan Van Rossem, PhD; Judith F. Feldman, PhD; Irvin Sam Schonfeld, PhD, MPH; Jennifer A. Pinto-Martin, PhD; Carolyn Torre, RN, MA; David Shaffer, MD; Nigel Paneth, MD, MPH
Arch Gen Psychiatry. 1997;54(9):847-856. doi:10.1001/archpsyc.1997.01830210091012.
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Background:  This study examined the relation of neonatal cranial ultrasound abnormalities to psychiatric disorder at age 6 years in a regional birth cohort of lowbirth-weight children.

Methods:  Neonatal cranial ultrasound abnormalities were classified as (1) isolated germinal matrix and/or intraventricular hemorrhage (suggestive of injury to glial precursors) or (2) parenchymal lesions and/or ventricular enlargement (suggestive of white matter injury) with or without germinal matrix-intraventricular hemorrhage. Psychiatric disorders by DSM-ÍÍI-R at age 6 years were assessed by means of a structured parent interview. Children with severe mental retardation were excluded. Analyses were conducted first in the entire sample and then in children with normal intelligence.

Results:  Twenty-two percent of the cohort had at least 1 psychiatric disorder, the most common being attention deficit hyperactivity disorder (15.6%). In the entire sample, parenchymal lesions and/or ventricular enlargement increased risk relative to no abnormality, independently of other biological and social predictors, for any disorder (odds ratio [OR], 4.4; 95% confidence interval [CI], 1.8-10.3; P<.001), attention deficit hyperactivity disorder (OR, 3.4; CI, 1.3-8.7; P=.02), and tic disorders (OR, 8.7; CI, 1.3-57.7; P=.02). In children of normal intelligence, parenchymal lesions/ventricular enlargement independently increased risk for any disorder (OR, 4.8; CI, 1.6-12.0; P<.01), attention deficit hyperactivity disorder (OR, 4.5; CI, 1.3-16.0; P=.02), and separation anxiety (OR, 5.3; CI, 1.1-24.8; P=.03). These effects were not ameliorated by female sex or social advantage. Isolated germinal matrix/intraventricular hemorrhage was not related to psychiatric disorder at age 6 years.

Conclusion:  Neonatal cranial ultrasound abnormalities suggestive of white matter injury significantly increased risk for some psychiatric disorders at age 6 years in low-birth-weight children.

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