Neonatal Autonomic Regulation as a Predictor of Autism Spectrum Disorder in Very Preterm Infants

Infants born preterm are at a significantly higher likelihood of having autism spectrum disorder (ASD), with reports of a 10-fold increase in the rate of ASD for very preterm infants (VPT, born <32 weeks gestation) [1] and a 20-fold increase for extremely preterm infants (born <28 weeks gestation) [2]. Yet, the etiological link between preterm birth and ASD remains unknown. Preterm birth and ASD are both associated with neurological differences, notably autonomic nervous system (ANS) dysfunction. ANS dysfunction can be measured using abnormal heart rate characteristics (HRCs) and thermal gradients (TGs), and previous research has linked ANS dysfunction to neurodevelopmental impairment and autism-specific outcomes. As such, ANS dysfunction is a promising early biomarker and potential pathway to ASD, particularly in VPT infants. ASD biomarkers for VPTs would enable earlier access to tailored interventions that improve outcomes for this vulnerable population. The current study describes preliminary findings from a prospective, longitudinal trial of VPT infants with continuous measures of autonomic dysregulation in the first month of life, comprehensive neurodevelopmental monitoring, and ASD follow-up at age 1 year.