Risk factors for autism spectrum disorder among infants and children admitted in a neonatal intensive care unit

Autism Spectrum Disorder (ASD) is a diverse neurodevelopmental condition. This study aimed to highlight the prevalence and risk factors associated with the development of ASD in infants and children who have been admitted to the NICU. A cross-sectional study was conducted on 66 pediatric outpatient clinic infants and children <3 years of age with a history of admission to NICU. CARS-2St questionnaire and Auditory brain response (ABR) were used. The percentage of ASD was 9.1% (6/66) and the mean total CARS-2-St-test score of ASD vs non-ASD cases was 35 ± 2.7 vs 18.58 ± 2.74, p = 0.001. Significant risk factors for ASD included premature rupture of membranes (p = 0.001), prematurity ( p = 0.002), longer duration of admission ( p = 0.038), and increased need for respiratory support ( p = 0.034). The mean values of the absolute latencies of ABR waves III, IV, and V and the I-III and I-V intervals of the right and left ear were significantly increased in those with ASD. This study is exploratory and hypothesis-generating and highlights the importance of screening infants and children with a history of admission to NICU who have an increased risk of ASD, and should be screened even if they have no other neurological manifestations. • The study identified maternal, neonatal, and environmental risk factors for ASD in NICU graduates. • Future research on ABR as a potential early identification tool for ASD is suggested. • Even infants without apparent neurological abnormalities may still develop ASD. What is known and what is new? • Known: - ASD is a heterogeneous neurodevelopmental disorder. - Cultural challenges and the level of awareness hinder diagnosis/treatment in developing countries. - Risk factors for ASD are not fully understood. • New: - The study identified specific maternal, neonatal, and environmental risk factors. - Proposed ASD screening for NICU-admitted infants/children. - Suggested ABR future research as a potential early identification tool for ASD. What is the implication, and what should change now? • Implications: Early screening and intervention are critical for NICU graduates, even if no overt neurological issues. • Changes Needed: - Implement routine ASD screening for NICU graduates. - Further explore ABR's role in ASD risk assessment. - Address cultural barriers to improve ASD diagnosis and care in developing regions.