NICU Stay Associated With Later Mental-Health Problems

By Anne Harding

February 06, 2020

NEW YORK (Reuters Health) - Spending time in the neonatal intensive-care unit (NICU) is associated with an increased risk of psychiatric disorders in childhood and adolescence, according to a new population-based study.

"In childhood, the risks of separation anxiety, specific phobia, oppositional defiant disorder and ADHD (attention-deficit/hyperactivity disorder) were particularly pronounced while adolescents tended to struggle more with oppositional defiant disorder," Dr. Andreea Chiorean of McMaster University in Hamilton, Canada, told Reuters Health by email.

Premature and low-birthweight infants appear to have worse mental health in childhood and beyond, Dr. Chiorean and her team note in the Archives of Disease in Childhood. However, they add, a substantial number of NICU patients are born at term and at normal weight.

To investigate the mental health of NICU graduates overall, the authors looked at a cohort of 3,141 children 4-11 years old, including 389 NICU graduates, whose parents provided data; 2,379 children aged 12 to 17, including 298 former NICU patients, also with parent-reported data; and 2,235 adolescents who self-reported data, including 285 NICU patients.

In the younger cohort, the prevalence of any psychiatric disorder was 32.4% for the NICU group and 27.6% for the control group, for an adjusted odds ratio of 1.78 (P<0.0001).

The NICU group also had a significantly higher prevalence of psychiatric comorbidity (aOR, 1.74), oppositional defiant disorder (aOR, 1.48), ADHD (aOR, 1.61), separation-anxiety disorder (aOR, 4.11) and specific phobia (aOR, 2.13).

Among the 12- to 17-year-olds, based on parent report, the prevalence of any psychiatric disorder was 40.5% for the NICU graduates and 30.6% for the controls, and 30.5% and 17.9%, respectively, based on self-report.

Adjusted ORs for any psychiatric disorder were 1.63 based on parent report and 1.55 based on self-report; 1.64 and 1.74, respectively, for psychiatric comorbidity; and 1.89 and 3.17, respectively, for oppositional-defiant disorder. All increases were statistically significant.

"More data are needed before definitive conclusions about the causes of psychiatric problems can be made, but NICU graduates are exposed to greater adversity and stress from a very early stage and this may predispose them to mental health problems later in life," Dr. Chiorean said.

"It is important to highlight that roughly one in three infants admitted to NICUs in our study had a psychiatric problem during childhood and adolescence," she added. "Parents and healthcare professionals may consider taking a balanced approach to optimize the mental health of these individuals. Currently, routine screening is not indicated and it could be helpful for families, clinicians, and educators to focus on building resilience in these youth."

SOURCE: Archives of Disease in Childhood, online January 23, 2020.