Preterm Birth and Autism / Medical and Ethical Disaster

Positive Screening for Autism in Ex-preterm Infants: Prevalence and Risk Factors

Pediatrics. (Click for full paper.) Author manuscript; available in PMC 2009 Jun 29.
Published in final edited form as: Pediatrics. 2008 Apr; 121(4): 758–765. (Click for a synopsis of paper.)



Early autistic behaviors seem to be an under-recognized feature of very low birth weight infants. The results from this study suggest that early screening for signs of autism may be warranted in this high-risk population followed by definitive autism testing in those with positive screening results.

Advances in neonatal intensive care have dramatically increased survival in preterm infants, most strikingly among the sickest and most preterm.1 Unfortunately, this decrease in mortality has not been matched by a comparable decrease in long-term neurodevelopmental morbidity.1,2 These trends underlie the increasing population of very low birth weight (VLBW) children with significant and costly disabilities.3,4 Recently, a growing body of data has pointed to an astonishing prevalence of higher order neurodevelopmental impairment by the time these children reach school age. In some studies, up to 50% of ex-preterm infants experience difficulties in executive functioning, as well as in the areas of attention and behavior, often requiring special academic support.513


Despite recent progress, our understanding of the behavioral and psychosocial health of ex-preterm infants remains limited. Low birth weight and gestational age have been identified in several studies as important perinatal risk factors for disturbances in social interaction, communication, and behavior14,15 as well as later psychoaffective disorders in adulthood.1618 During childhood and adolescence, VLBW children are reported to exhibit greater internalizing and externalizing behavior problems than their peers, as well as attentional difficulties and hyperactivity. 1923 Difficulties with social integration including excessive shyness, withdrawn behavior, and poor social skills are also described.2426

Despite these reports of atypical psychosocial development in VLBW children, the prevalence of autism spectrum disorders has not been systematically explored in this population.

Our anecdotal experience in the clinical follow-up of ex-preterm infants has suggested that a subgroup of these infants exhibit distinctly atypical behavioral features, many of which are similar to those typically seen in children with autism spectrum disorders.

Autism spectrum disorders are increasingly recognized as a public health problem of major importance.27,28 According to a recent report from the Centers for Disease Control and Prevention, the prevalence of autism spectrum disorders is now 1 in 150.27The contribution from increasing survivors of extreme prematurity to this growing population of children with autism spectrum disorders is not well studied. Recently, major advances have been made in the field of early detection of signs of autism in infants, and validated screening tools now exist to facilitate the early and accurate screening of infants so as to prompt appropriate referrals for specialized autism diagnostic testing.29,30 To begin addressing these questions, we decided to screen for early autistic features in a cohort of children with a history of VLBW. In addition, we sought to identify clinical predictors of positive autism screening results.


Photos, with original captions from a news article about how wonderful it is to ‘save’ extreme preemies. The long-term consequences are utterly ignored. The suffering of these “fetuses” is denied; so is the damage done by extreme medical “treatments” in the ICU that leave the survivors permanently disabled. Our society is S-I-C-K.

“Adorable: XX was born severely premature on April 25, weighing just one pound and three ounces”

“Tiny baby: Little XX weighed just 15 ounces when she was born and was smaller than an iPhone.” (Yes, that’s an iPhone next to the fetus)

“Little ballerina: Baby XX weighed just 1 lb. 5.9 oz. when she was born at 27 weeks and four days due to preeclampsia. She was in the NICU for 84 days” (Just like Toy Dogs, Preemies are so “cute” when forced to wear “costumes.”

Is there any mystery as to why there is no “medical diagnosis, cure or effective treatment” for Autism? Because doctors and hospitals don’t want to be held responsible for the consequences of causing brain damage and other severe, life-long disabilities due to their actions in the delivery room and the ICU.

NEW YORKER Article: A Child in Time / New frontiers in treating premature babies.

EXCERPT: The uncertain and agonizing decisions made in the NICU can cause a rift between parents and caregivers. The parents of Sidney Miller, who, in 1990, was delivered at twenty-three weeks in a hospital in Houston, filed a lawsuit in which they claimed that they had not wanted any “extraordinary, heroic” measures to be taken, because of the girl’s extreme prematurity. The neonatologist present at the delivery treated the infant with intubation, surfactant administration, and blood transfusions, after which she was transferred to the NICU. On the fourth day after birth, the baby had a major brain hemorrhage; ultimately, a shunt was put in to relieve the pressure. Sidney was discharged after six months, and her parents have cared for her at home ever since. She has had numerous operations to repair or replace the shunt in her brain, and she has cerebral palsy, is unable to talk or walk, and is blind and incontinent. During the trial, it was stated that with proper care Sidney Miller could live to the age of seventy.

The parents sued the hospital and its corporate owners for treating the baby at birth without their consent. In January, 1998, a jury awarded the family thirty million dollars in compensatory damages and thirteen million dollars in punitive damages. But the Texas Supreme Court reversed the decision, and found in favor of the hospital, saying that the care was appropriate given the circumstances.

After the reversal, Mark Miller wrote, “My daughter was not born disabled. The treatment protocol chosen and inflicted by the hospital, over our express objection, caused the damage, pain and disabilities Sidney endures today. The hospital’s decision . . . was little more than a rescue fantasy that doomed my daughter to the very conditions we attempted to protect her from. . . . Many parents, informed of the grueling, experimental and damaging measures involved in resuscitation of these near-viable fetal-infants, make the decision to provide supportive comfort care only, without invasive high-tech heroics. It is the very kind of humane care my wife and I would want for ourselves if we were in our daughter’s situation, facing excruciating treatments that would lead merely to a life of suffering.”



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