Neonatal jaundice: A risk factor for infantile autism?

Department of Epidemiology, Institute of Public Health, University of Aarhus, Aarhus, Denmark.
Paediatric and Perinatal Epidemiology (Impact Factor: 3.13). 11/2008; 22(6):562-8. DOI: 10.1111/j.1365-3016.2008.00973.x
Source: PubMed

ABSTRACT In a previous study, we found that infants transferred to a neonatal ward after delivery had an almost twofold increased risk of being diagnosed with infantile autism later in childhood in spite of extensive controlling of obstetric risk factors. We therefore decided to investigate other reasons for transfer to a neonatal ward, in particular hyperbilirubinaemia and neurological abnormalities. We conducted a population-based matched case-control study of 473 children with autism and 473 matched controls born from 1990 to 1999 in Denmark. Cases were children reported with a diagnosis of infantile autism in the Danish Psychiatric Central Register. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals [CI] and likelihood ratio tests were used to test for effect modification. We found an almost fourfold risk for infantile autism in infants who had hyperbilirubinaemia after birth (OR 3.7 [95% CI 1.3, 10.5]). In stratified analysis, the association appeared limited to term infants (>or=37 weeks gestation). A strong association was also observed between abnormal neurological signs after birth and infantile autism, especially hypertonicity (OR 6.7 [95% CI 1.5, 29.7]). No associations were found between infantile autism and low Apgar scores, acidosis or hypoglycaemia. Our findings suggest that hyperbilirubinaemia and neurological abnormalities in the neonatal period are important factors to consider when studying causes of infantile autism.

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    • "Supplementary thiamine resulted in cessation of these episodes in both children. The boy in our case report had neonatal hyperbilirubinemia, indicating an almost fourfold risk for infantile autism and oxidative stress [34, 35]. He had prolonged colic, an early expression of some of the most common disorders in childhood [36], including hyperactivity and academic difficulties [37]. "
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    ABSTRACT: Case histories of a mother and her two children are reported. The mother was a recovered alcoholic. She and her two children, both of whom had symptoms that are typical of autistic spectrum disorder, had dysautonomia. All had intermittently abnormal erythrocyte transketolase studies indicating abnormal thiamine pyrophosphate homeostasis. Both children had unusual concentrations of urinary arsenic. All had symptomatic improvement with diet restriction and supplementary vitamin therapy but quickly relapsed after ingestion of sugar, milk, or wheat. The stress of a heavy metal burden, superimposed on existing genetic or epigenetic risk factors, may be important in the etiology of autism spectrum disorder when in combination. Dysautonomia has been associated with several diseases, including autism, without a common etiology. It is hypothesized that oxidative stress results in loss of cellular energy and causes retardation of hard wiring of the brain in infancy, affecting limbic system control of the autonomic nervous system.
    05/2011; 2011:129795. DOI:10.1155/2011/129795
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    • "Neonatal complications including apnoea and jaundice were extremely rare in our control group but much more common in our case group, consistent with the findings of Maimburg et al. that an almost fourfold increased risk for infantile autism was observed in newborns exposed to hyperbilirubinaemia (Maimburg et al. 2008). Neonatal jaundice is caused by accumulated bilirubin (mostly conjugated) physiologically or pathologically; it can, in the pathologic case, damage the central nervous system and result in bilirubin encephalopathy. "
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    ABSTRACT: We conducted a case-control study using 190 Han children with and without autism to investigate prenatal and perinatal risk factors for autism in China. Cases were recruited through public special education schools and controls from regular public schools in the same region (Tianjin), with frequency matching on sex and birth year. Unadjusted analyses identified seven prenatal and seven perinatal risk factors significantly associated with autism. In the adjusted analysis, nine risk factors showed significant association with autism: maternal second-hand smoke exposure, maternal chronic or acute medical conditions unrelated to pregnancy, maternal unhappy emotional state, gestational complications, edema, abnormal gestational age (<35 or >42 weeks), nuchal cord, gravidity >1, and advanced paternal age at delivery (>30 year-old).
    Journal of Autism and Developmental Disorders 04/2010; 40(11):1311-21. DOI:10.1007/s10803-010-0992-0 · 3.06 Impact Factor
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    • "Metabolic disorders. Maimburg et al. [81] studied 473 children with autism and reported that infants who had hyperbilirubinemia after birth had an almost fourfold risk for autism. Also, a strong association was observed between abnormal neurological signs after birth, especially hypertonicity, and autism. "
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    ABSTRACT: This publication, by reviewing 1300 studies published on autism in 2008, represents an update on this topic. Results include possible parental influences, maternal conditions, and studies on genes and chromosomes. Possible etiological factors involve the “extreme male brain,” defects in the mirror neuron system, vaccines, underconnectivity, disorders of central coherence, and many other more specific etiologies. Assessments or tests for autism are also reviewed. Characteristics of autistic individuals include repetitive behavior, language disorders, sleep disturbances, social problems, joint attention disorders, seizures, allergic reactions, and various behavioral changes. Cognitive changes involve IQ, reasoning, and verbal and language disorders. The savant syndrome is a fascinating phenomenon, at times seen in autistic individuals. Neurophysiological and neuroanatomical changes are also reviewed, as are comorbid conditions. Finally, treatment involves various medications including risperidone, ziprasidone, and antipsychotic drugs, as well as different procedures such as magnetic stimulation, acupuncture, and hyperbaric oxygen therapy. As mentioned in the 2007 survey, nearly every conceivable problem that a child can have may be found in these unfortunate children and nearly every conceivable etiology has been mentioned to account for this serious disorder.
    Epilepsy & Behavior 12/2009; 16(4-16):569-589. DOI:10.1016/j.yebeh.2009.09.023 · 2.26 Impact Factor
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