Attention-Deficit/Hyperactivity Disorder and Very Preterm/Very Low Birth Weight: A Meta-analysis

• Published in: Pediatrics (Evanston) 2018-01, Vol.141 (1), p.1
• Main Authors: Franz, Adelar Pedro, Bolat, Gul Unsel, Bolat, Hilmi, Matijasevich, Alicia, Santos, Iná Silva, Silveira, Rita C, Procianoy, Renato Soibelmann, Rohde, Luis Augusto, Moreira-Maia, Carlos Renato
• Format: Article
• Language: English
• Subjects: Attention Deficit Disorder with Hyperactivity - drug therapy; Attention Deficit Disorder with Hyperactivity - epidemiology; Attention Deficit Disorder with Hyperactivity - etiology; Attention deficit hyperactivity disorder; Birth weight; Birth weight, Low; Care and treatment; Central Nervous System Stimulants - therapeutic use; Cross-Sectional Studies; Diagnosis; Female; Gestational Age; Health aspects; Humans; Hyperactivity; Impulsive behavior; Infant, Extremely Premature; Infant, Newborn; Infant, Very Low Birth Weight; Infants (Premature); Low birth weight; Male; Medical diagnosis; Meta-analysis; Neonates; Neuropsychological Tests; Newborn babies; Pediatrics; Pregnancy; Premature birth; Premature infants; Prevalence; Prognosis; Prospective Studies; Risk Assessment; Risk factors; Severity of Illness Index; Treatment Outcome
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2017-1645

Although very preterm (VP), extremely preterm (EP), very low birth weight (VLBW), and extremely low birth weight (ELBW) newborns seem to have a higher risk of later attention-deficit/hyperactivity disorder (ADHD), the magnitude of the risk is not well-defined. To systematically review and meta-analyze the risk of VP/VLBW and EP/ELBW individuals to develop a ADHD categorical diagnosis or dimensional symptomatology compared with controls with normal weight and/or birth age. We used PsycINFO, Medline, Embase, and Cochrane databases. We selected cross-sectional, prospective, or retrospective studies with no time or language restriction. Independent reviewers screened and extracted data using predefined standard procedures. In 12 studies ( = 1787), researchers relying on a categorical diagnosis showed that both VP/VLBW and EP/ELBW subjects have a higher ADHD risk (odds ratio [OR] = 3.04 higher than controls; 95% confidence interval [CI] 2.19 to 4.21). In subgroup analyses, we demonstrated that the more extreme the cases, the higher the ORs (VP/VLBW: OR = 2.25 [95% CI 1.56 to 3.26]; EP/ELBW: OR = 4.05 [95% CI 2.38 to 6.87]). We drew data from 29 studies ( = 3504) on ADHD symptomatology and found significant associations with inattention (standardized mean difference [SMD] = 1.31, 95% CI 0.66 to 1.96), hyperactivity and impulsivity (SMD = 0.74, 95% CI 0.35 to 1.13), and combined symptoms (SMD = 0.55, 95% CI 0.42 to 0.68) when compared with controls. Heterogeneity was significantly high for all analyses involving the 3 ADHD dimensions. With our results, we provide evidence that VP/VLBW subjects have an increased risk of ADHD diagnosis and symptomatology compared with controls, and these findings are even stronger in the EP/ELBW group. Future researchers should address which risk factors related to prematurity or low birth weight lead to ADHD.