Jaundice at birth linked to autism
Babies diagnosed with jaundice soon after birth may be more likely to be diagnosed with autism later.
Environmental exposures prior to, during and shortly after birth are emerging as important risk factors for the development of autism, in addition to genetic factors. Jaundice is a common condition among newborns that results when the yellow pigment found in bile, called bilirubin, accumulates faster than the immature liver can process it. More than half of babies born full-term have some of the characteristic yellowing of the skin and eyes, but it usually resolves on its own and is rarely harmful.
Previous studies have found that children diagnosed with autism were twice as likely to have been admitted to the neonatal care unit as newborns, most commonly for jaundice. Researchers retrieved detailed information from national registries on nearly all babies born in Denmark between 1994 and 2004. Of the 733,826 children born during that period, 35,766 were born with jaundice, 1,721 were later diagnosed with a psychological disorder of some kind and 577 developed autism.
After adjusting for other factors such as birth weight and mother's smoking status, the team found that children born full-term with jaundice had a 56 percent greater chance of developing an autistic spectrum disorder later on than those without jaundice. These same children also had a significantly higher risk of developing a range of other developmental psychological problems, such as learning or speech disorders. Looking more closely at the data, the researchers found that first-born children and babies born earlier than the 37th week of pregnancy seemed to be protected from the apparent effects of jaundice. Those born during spring and summer months also seemed to be unaffected. They speculate that whatever damage the jaundice may be inflicting occurs during the last few weeks of gestation, and that seasonal environmental factors after birth may lessen or worsen the problem.
The best guess as to how jaundice causes changes in psychological development is that bilirubin crosses the blood-brain barrier and destroys brain cells, as it does in cerebral palsy. Increased brain development in the last weeks of gestation as well as a higher rate of infections and less sunlight (which can help in the breakdown of bilirubin) during winter months might explain some of the differences observed. Antibodies accumulated during previous pregnancies could also contribute to the greater effect seen in children who were not first-borns.
Jaundice is a common exposure during the neonatal period and should not be ignored. Identification and treatment of jaundice is important for both pre-term and full term newborns. Post-birth classes with lectures on how parents can observe their newborns and recognise when jaundice requires attention could help to minimise the potential risk. But parents shouldn't be alarmed if they do spot a yellow tint to their newborn's skin, as most will develop at least a mild case of jaundice during the first days of life.
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