Neonatal autonomic nervous system dysfunction as a predictor of autism spectrum disorder in preterm infants

Project Summary/Abstract Autonomic nervous system (ANS) development begins in the prenatal period and is critical for a successful transition to extrauterine life. ANS supports vital functions, like cardiac activity and thermal regulation, as well as higher-level cortical processes from birth through adulthood. Adverse neonatal conditions can impair or alter ANS function and ANS dysfunction has been associated with several neurodevelopmental impairments (NDIs), including autism spectrum disorder (ASD). The rate of ASD in infants born preterm is more than triple that of the general population, with reports of a 10-fold increase for very preterm (VPT) infants. Yet, the etiological link between preterm birth and the development of ASD remains unknown. The goals of this prospective, longitudinal study are 1) to evaluate preterm ANS dysfunction as an ASD-specific etiological mechanism in VPT infants, using complementary measures of heart rate and thermal gradients 2) to examine whether and how neonatal morbidities (severe brain injury, infection, bronchopulmonary dysplasia, retinopathy of prematurity) moderate the association between ANS dysfunction and ASD/NDI outcomes and 3) to comprehensively document emerging ASD and NDI features across the first three years of life for VPT infants, who are at increased likelihood for both ASD and NDI. This study will quantify ANS dysfunction for VPT infants across the NICU hospitalization to compare with the emergence of ASD-specific and NDI features across the first three years (months 12, 24, 36). Identification of infants who are at heightened developmental risk prior to NICU discharge is essential to guide very early intervention efforts and improve childhood outcomes.