Increased risk of autism in extremely preterm children with a history of retinopathy of prematurity

Aim: To investigate the association between retinopathy of prematurity and autism spectrum disorder in extremely preterm children. Methods: Data in children born extremely preterm at <28 weeks' gestational age in the Region Vastra Gotaland, 2013-2017, were analysed for association between retinopathy of prematurity and neurodevelopmental disorders. We focussed on autism spectrum disorder and excluded children with perinatal brain injuries or genetic disorders. Results: Of 266 children with neurodevelopmental evaluation, 143 had no documented brain injury or genetic disorders. Of these 143, autism spectrum disorder was diagnosed in 18%, attention deficit hyperactivity disorder in 15% and intellectual disability in 7%. Of the 72/143 children with a history of no or mild retinopathy of prematurity (stage <1), 10% were diagnosed with autism spectrum disorder compared to 27% of 71/143 with prior moderate-to-severe retinopathy of prematurity (stages >= 2), (p = 0.008). A history of retinopathy of prematurity stages >= 2 was associated with a threefold increased likelihood of later autism spectrum disorder even when adjusting for gestational age and sex (p = 0.011). Conclusion: Moderate-to-severe retinopathy of prematurity associated with a higher likelihood of later autism spectrum disorder diagnosis in extremely preterm children without documented brain injuries or genetic disorders.