NICU admission linked to increased risk for psychiatric disorders
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Children and adolescents who were admitted to a NICU at birth have a greater risk for developing psychiatric disorders, psychiatric comorbidity and oppositional defiant disorder, according to results of a cross-sectional observational study published in Archives of Disease in Childhood.
“It may be that all NICU graduates, regardless of gestational age at birth, are at increased risk for mental health problems as children and adolescents,” Ryan J. Van Lieshout, MD, PhD, FRCPC, associate professor of psychiatry and behavioral neurosciences at McMaster University in Canada, told Healio Psychiatry. “Although existing guidelines suggest that preterm survivors should be monitored for these problems, it is important that clinicians and families also be aware that others who have faced the stresses associated with a NICU admission may be at increased risk.”
According to Van Lieshout and colleagues, reasons for NICU admission include but also extend beyond those immediately related to underdeveloped premature and low birthweight infants. They noted sepsis, respiratory problems and asphyxia as being associated with admission. Prior research has established a link between neonatal stress and pain experienced by infants in the NICU and negative neurodevelopmental consequences, but it remains unclear whether the mental health outcomes of these infants apply to the broader population of NICU graduates, they wrote.
To investigate this potential broader association, the researchers used a provincially representative cohort from the 2014 Ontario Child Health study to obtain parent-provided data for 3,141 children aged 4 to 11 years and 2,379 children aged 12 to 17 years, with both of these populations including NICU and control groups. An additional 2,235 adolescents aged 12 to 17 years provided data themselves. The researchers compared odds of psychiatric disorder between those admitted to NICU and controls.
They found that NICU graduates aged 4 to 11 years were nearly twice as likely to have any psychiatric disorder (adjusted OR = 1.78; 95% CI, 1.39-2.28) compared with controls. Graduates had a marginal prevalence of 32.4% compared with 27.6% for controls. NICU graduates of this age also had increased risk for psychiatric comorbidity (OR = 1.74; 95% CI, 1.25-2.4), oppositional defiant disorder (OR = 1.48; 95% CI, 1.04-2.11), ADHD (OR = 1.61; 95% CI, 1.19-2.19), separation anxiety disorder (OR = 4.11; 95% CI, 2.33-7.25) and specific phobia (OR = 2.13; 95% CI, 1.37-3.31).
Among graduates aged 12 to 17 years, 40.5% and 30.5% had any psychiatric disorder as reported by parents and self-report, respectively, compared with 30.6% and 17.9% for controls. Respectively, parents and adolescents reported increased odds for any disorder (aORs = 1.63 [95% CI, 1.18-2.26] and 1.55 [95% CI, 1.13-2.11]), psychiatric comorbidity (aORs = 1.64 [95% CI, 1.06-2.54] and 1.74 [95% CI, 1.11-2.73]) and oppositional defiant disorder (aORs = 1.89 [95% CI, 1.22-2.93] and 3.17 [95% CI, 2.03-4.95]).
“Just one in three NICU graduates will go on to develop a psychiatric problem during childhood and adolescence, and parents and health care professionals should try to take a balanced approach to optimizing the mental health of these young people,” Van Lieshout said. “For example, routine screening is not indicated at this time, and it may be wise for families, clinicians and educators to focus on helping these youth build their resilience. A tangible way that this can be accomplished is by supporting the mental health of parents who face many stresses during the postpartum period and beyond.” – by Joe Gramigna
Disclosures: The authors report no relevant financial disclosures.