伴有颅内出血(ICH)的胎儿-新生儿同种免疫性血小板减少症(FNAIT)患儿的既往诊断和筛查增加了自闭症的频率。

IF 8.7 1区 医学 Q1 OBSTETRICS & GYNECOLOGY
Katherine A Knightly, Eleanore A McFarland, Emilie Vander Haar, Margaret H McKelvy, Thea D Palmer, Stephanie V Volpe, Stacy Corke, James B Bussel
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引用次数: 0

摘要

背景:胎儿-新生儿同种免疫性血小板减少症(FNAIT)是由亲代血小板抗原不相容和母体同种免疫引起的,最常见的是血小板抗原HPA-1a。De Vos等人在31名6-14岁无脑出血病史的fnait患儿中发现26%有轻中度神经损伤。来自NAITbabies成员的怀疑,以及De Vos的观察,导致了一项关于fnait影响儿童自闭症的调查评估。目的:本研究通过对有或没有脑出血的fnait影响儿童的先前诊断和筛查,探讨了自闭症的频率。研究设计:对nait婴儿的母亲进行去识别调查,使用四种年龄特异性自闭症筛查量表评估自闭症风险:Q-CHAT-10适用于18-24个月(n=18);M-CHAT-R 2-4年(n=61);4 -11岁儿童(n=175);iq -10青春期为10 ~ 12岁(n=66)。母亲报告了她们孩子的非ICH状况和筛查前的自闭症诊断。使用特定的问卷算法对调查结果进行评分。结果:在320名受fnait影响的儿童中,24名(7.5%)曾有过自闭症诊断,64名(20%)有筛查风险。在182名已知有脑出血状况的儿童中,有33名患有脑出血,149名没有。在脑出血和非脑出血组中,已有自闭症和筛查自闭症的诊断都随着年龄的增长而增加,在12岁以上年龄组中达到顶峰:有脑出血的占67%,没有脑出血的占36%。自闭症的发现在脑出血儿童中较高,但在非脑出血组中最为显著。7.5%的4-11岁年龄组(无脑出血)和18%的12岁以上年龄组(无脑出血)已被诊断患有自闭症。在进行高风险自闭症筛查后,这些数字翻了一倍多,达到19%(4-11岁年龄组)和36%(12岁以上年龄组)。后两份问卷的阳性预测值分别为0.94和0.86。结论:在没有脑出血的fnait患儿中,自闭症的发生率高得惊人,并且随着年龄的增长变得更加明显。这些发现强调了对受FNAIT影响的儿童进行早期筛查和持续仔细监测的必要性,即使没有已知的ICH,也不能再被认为是“没有后果”。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Increased Frequency of Autism by Previous Diagnosis and Screening in Children with Fetal-Neonatal Alloimmune Thrombocytopenia (FNAIT) with and without an Intracranial Hemorrhage (ICH).

Background: Fetal-Neonatal AlloImmune Thrombocytopenia (FNAIT) results from parental platelet antigen incompatibility and maternal alloimmunization, most commonly to platelet antigen HPA-1a. De Vos et al. identified mild-moderate neurologic injury in 26% of 31 FNAIT-affected children aged 6-14 without past ICH. Suspicions from NAITbabies members, along with the De Vos observations, led to a survey evaluation of autism in FNAIT-affected children.

Objective(s): This study explored the frequency of autism both by previous diagnosis and by screening in FNAIT-affected children with and without having had an ICH.

Study design: A de-identified survey was made available to mothers in NAITbabies, assessing risk of autism using four age-specific autism screening scales: Q-CHAT-10 for ages 18-24 months (n=18); M-CHAT-R 2-4 years(n=61); AQ-10-Child 4 -11 years (n=175); and AQ-10-Adolescent for >12 years (n=66). Mothers reported their child's ICH status and pre-screening autism diagnoses. Survey responses were scored using specific questionnaire algorithms.

Results: Among 320 FNAIT-affected children, 24 (7.5%) had a previous autism diagnosis and 64 (20%) screened at risk. Among 182 children with known ICH status, that could be linked to an autism questionnaire response, 33 had suffered an ICH and 149 had not. Both pre-existing and screening autism diagnoses increased with age in both ICH and non-ICH groups, peaking in the 12+ age group: 67% with ICH and 36% without ICH. Autism findings were higher among ICH children but were most striking in the non-ICH group. 7.5% of the 4-11 age group (no ICH) and 18% of the 12+ age group (no ICH) already had been diagnosed with autism. With screening for high risk of autism, these numbers more than doubled to 19% (4-11 age group) and 36% (12+ age group). Positive predictive values of the latter two questionnaires were 0.94 and 0.86, respectively.

Conclusions: In FNAIT-affected children without an ICH, rates of autism were surprisingly high and became more apparent with age. These findings highlight the need for early screening and ongoing careful monitoring of children affected by FNAIT, even without known ICH, who can no longer be considered "consequence-free."

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来源期刊
CiteScore
15.90
自引率
7.10%
发文量
2237
审稿时长
47 days
期刊介绍: The American Journal of Obstetrics and Gynecology, known as "The Gray Journal," covers the entire spectrum of Obstetrics and Gynecology. It aims to publish original research (clinical and translational), reviews, opinions, video clips, podcasts, and interviews that contribute to understanding health and disease and have the potential to impact the practice of women's healthcare. Focus Areas: Diagnosis, Treatment, Prediction, and Prevention: The journal focuses on research related to the diagnosis, treatment, prediction, and prevention of obstetrical and gynecological disorders. Biology of Reproduction: AJOG publishes work on the biology of reproduction, including studies on reproductive physiology and mechanisms of obstetrical and gynecological diseases. Content Types: Original Research: Clinical and translational research articles. Reviews: Comprehensive reviews providing insights into various aspects of obstetrics and gynecology. Opinions: Perspectives and opinions on important topics in the field. Multimedia Content: Video clips, podcasts, and interviews. Peer Review Process: All submissions undergo a rigorous peer review process to ensure quality and relevance to the field of obstetrics and gynecology.
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