Associations between neonatal jaundice and autism spectrum disorder or attention deficit hyperactivity disorder: Nationwide population based cohort study

Hung-Chieh Chou; Hung-Chih Lin; Kuang-Hua Huang; Yu-Chia Chang

doi:10.1016/j.jfma.2023.05.010

Associations between neonatal jaundice and autism spectrum disorder or attention deficit hyperactivity disorder: Nationwide population based cohort study

J Formos Med Assoc. 2023 Nov;122(11):1150-1157. doi: 10.1016/j.jfma.2023.05.010. Epub 2023 May 22.

Authors

Hung-Chieh Chou¹, Hung-Chih Lin², Kuang-Hua Huang³, Yu-Chia Chang⁴

Affiliations

¹ Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan.
² Division of Neonatology, China Medical University Children's Hospital, Taichung, Taiwan; School of Chinese Medicine, China Medical University, Taichung, Taiwan; Asia University Hospital, Asia University, Taichung, Taiwan.
³ Department of Health Services Administration, China Medical University, Taichung, Taiwan.
⁴ Department of Long Term Care, College of Health and Nursing, National Quemoy University, Kinmen County, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan. Electronic address: ycchang@email.nqu.edu.tw.

PMID: 37225632
DOI: 10.1016/j.jfma.2023.05.010

Abstract

Background/purpose: Neonatal jaundice might result brain insults. Both autistic spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are developmental disorders, which might result from early brain injury at neonatal period. We aimed to explore the association between neonatal jaundice treated with phototherapy and the ASD or ADHD.

Methods: This retrospective nationwide population cohort study was based on a nationally representative database of Taiwan, and neonates born from 2004 to 2010 were enrolled. All eligible infants were divided into 4 groups, without jaundice, jaundice with no treatment, jaundice with simple phototherapy only and jaundice with intensive phototherapy or blood exchange transfusion (BET). Each infant was follow-up until the date of incident primary outcomes, death, or 7-year-old, whichever occurred first. Primary outcomes were ASD, ADHD. Using cox proportional hazard model to analyze their associations.

Results: In total, 118,222 infants with neonatal jaundice were enrolled, including diagnosed only (7260), simple phototherapy (82,990), intensive phototherapy or BET (27,972 infants). The cumulative incidences of ASD in each group was 0.57%, 0.81%, 0.77%, and 0.83%, respectively. The cumulative incidences of ADHD in each group was 2.83%, 4.04%, 3.52% and 3.48%, respectively. Jaundice groups were significantly associated with ASD, ADHD, or either one, even after all other extraneous maternal and neonatal variables were adjusted. After stratification, the associations were still existed in subgroup with birth weights ≥2500 grams and in male subgroup.

Conclusion: Neonatal jaundice correlated with the ASD and ADHD. The associations were significant in infants of both sexes and with birth weights larger than 2500 grams.

Keywords: Attention deficit hyperactivity disorder; Autistic spectrum disorder; Nationwide population cohort; Neonatal jaundice; Phototherapy.

MeSH terms

Attention Deficit Disorder with Hyperactivity* / complications
Attention Deficit Disorder with Hyperactivity* / epidemiology
Autism Spectrum Disorder* / complications
Autism Spectrum Disorder* / epidemiology
Autism Spectrum Disorder* / therapy
Birth Weight
Child
Cohort Studies
Female
Humans
Infant
Infant, Newborn
Jaundice* / complications
Jaundice, Neonatal* / complications
Jaundice, Neonatal* / epidemiology
Jaundice, Neonatal* / therapy
Male
Retrospective Studies
Risk Factors