September 1997

Psychiatrie Outcomes in Low-Birth-Weight Children at Age 6 Years: Relation to Neonatal Cranial Ultrasound Abnormalities

Author Affiliations

From the Division ofChdd and Adolescent Psychiatry, Columbia University and New York State Psychiatric Institute (Drs Whitaker, Van Rossem, Feldman, and Shaffer and Ms Torre) and Gertrude H. Sergievsky Center, Columbia L/niversiiy (Dr Whitaker) New York, NY; Department of Sociology and Criminal Justice, University of Delaware, Newark (Dr Van Rossem); City College of the City University of New York (Dr Schonfeld); School of Nursing and Division o/Biostaiistics and Epidemiology, Department of Pediatrics, School of Medicine, University of Pennsylvania, Philadelphia (Dr Pinto-Martin); Program in Epidemiology and Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing (DrPaneth).

Arch Gen Psychiatry. 1997;54(9):847-856. doi:10.1001/archpsyc.1997.01830210091012

Background:  This study examined the relation of neonatal cranial ultrasound abnormalities to psychiatric disorder at age 6 years in a regional birth cohort of lowbirth-weight children.

Methods:  Neonatal cranial ultrasound abnormalities were classified as (1) isolated germinal matrix and/or intraventricular hemorrhage (suggestive of injury to glial precursors) or (2) parenchymal lesions and/or ventricular enlargement (suggestive of white matter injury) with or without germinal matrix-intraventricular hemorrhage. Psychiatric disorders by DSM-ÍÍI-R at age 6 years were assessed by means of a structured parent interview. Children with severe mental retardation were excluded. Analyses were conducted first in the entire sample and then in children with normal intelligence.

Results:  Twenty-two percent of the cohort had at least 1 psychiatric disorder, the most common being attention deficit hyperactivity disorder (15.6%). In the entire sample, parenchymal lesions and/or ventricular enlargement increased risk relative to no abnormality, independently of other biological and social predictors, for any disorder (odds ratio [OR], 4.4; 95% confidence interval [CI], 1.8-10.3; P<.001), attention deficit hyperactivity disorder (OR, 3.4; CI, 1.3-8.7; P=.02), and tic disorders (OR, 8.7; CI, 1.3-57.7; P=.02). In children of normal intelligence, parenchymal lesions/ventricular enlargement independently increased risk for any disorder (OR, 4.8; CI, 1.6-12.0; P<.01), attention deficit hyperactivity disorder (OR, 4.5; CI, 1.3-16.0; P=.02), and separation anxiety (OR, 5.3; CI, 1.1-24.8; P=.03). These effects were not ameliorated by female sex or social advantage. Isolated germinal matrix/intraventricular hemorrhage was not related to psychiatric disorder at age 6 years.

Conclusion:  Neonatal cranial ultrasound abnormalities suggestive of white matter injury significantly increased risk for some psychiatric disorders at age 6 years in low-birth-weight children.