Increased frequency of autism by previous diagnosis and screening in children with fetal-neonatal alloimmune thrombocytopenia with and without an intracranial hemorrhage.
Academic Article
Overview
abstract
BACKGROUND: Fetal-neonatal alloimmune thrombocytopenia is caused by parental platelet antigen incompatibility and maternal alloimmunization, most commonly to human platelet antigen-1a. De Vos et al identified mild-moderate neurologic injury in 26% of 31 children, aged 6 to 14 years, who were affected by fetal-neonatal alloimmune thrombocytopenia without previous intracranial hemorrhage. Suspicions from NAITbabies members, along with the observations of De Vos et al, led to a survey evaluation of autism in children affected by fetal-neonatal alloimmune thrombocytopenia. OBJECTIVE: This study explored the frequency of autism, as determined both by previous diagnosis and by screening, among children affected by fetal-neonatal alloimmune thrombocytopenia with and without having had intracranial hemorrhage. STUDY DESIGN: A de-identified survey was made available to mothers in NAITbabies to assess the risk for autism using 4 age-specific autism screening scales, namely the Quantitative Checklist for Autism in Toddlers-10 for ages 18 to 24 months (n=18); the Modified Checklist for Autism in Toddlers, Revised for ages 2 to 4 years (n=61); the Autism Spectrum Quotient 10 items for children for ages 4 to 11 years (n=175); and the Autism Spectrum Quotient 10 items for adolescents for ages >12 years (n=66). Mothers reported their child's intracranial hemorrhage status and prescreening autism diagnoses. Survey responses were scored using specific questionnaire algorithms. RESULTS: Among 320 children affected by fetal-neonatal alloimmune thrombocytopenia, 24 (7.5%) had a previous autism diagnosis and 64 (20%) were determined to be at risk during screening. Among 182 children with a known intracranial hemorrhage status that could be linked to an autism questionnaire response, 33 had suffered an intracranial hemorrhage and 149 had not. Both preexisting and screening autism diagnoses increased with age in both the intracranial hemorrhage and non-intracranial hemorrhage groups, peaking in the ≥12-year age group at 67% with intracranial hemorrhage and 36% without intracranial hemorrhage. Autism findings were higher among children with intracranial hemorrhage but were most striking in the non-intracranial hemorrhage group. A total of 7.5% of the 4 to 11-year age group (no intracranial hemorrhage) and 18% of the ≥12 year age group (no intracranial hemorrhage) already had been diagnosed with autism. With screening for a high risk for autism, these numbers more than doubled to 19% (4-11-year age group) and 36% (≥12-year age group). The positive predictive values of the latter 2 questionnaires were 0.94 and 0.86, respectively. CONCLUSION: Among children affected by fetal-neonatal alloimmune thrombocytopenia without an intracranial hemorrhage, the rates of autism were surprisingly high and became more apparent with increasing age. These findings highlight the need for early screening and ongoing careful monitoring of children affected by fetal-neonatal alloimmune thrombocytopenia, even without known intracranial hemorrhage, who can no longer be considered consequence free.
