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Pediatrics. 2018 Jan;141(1). pii: e20171645. doi: 10.1542/peds.2017-1645. Epub 2017 Dec 18.

Attention-Deficit/Hyperactivity Disorder and Very Preterm/Very Low Birth Weight: A Meta-analysis.

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Postgraduate Program in Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
Departments of Child and Adolescent Psychiatry and.
Medical Genetics, Faculty of Medicine, Ege University, Izmir, Turkey.
Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil.
Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.
Neonatology Section, Department of Pediatrics and.
Department of Child and Adolescent Psychiatry, Hospital de Clínicas de Porto Alegre and Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; and.
National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil.
Postgraduate Program in Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil;



Although very preterm (VP), extremely preterm (EP), very low birth weight (VLBW), and extremely low birth weight (ELBW) newborns seem to have a higher risk of later attention-deficit/hyperactivity disorder (ADHD), the magnitude of the risk is not well-defined.


To systematically review and meta-analyze the risk of VP/VLBW and EP/ELBW individuals to develop a ADHD categorical diagnosis or dimensional symptomatology compared with controls with normal weight and/or birth age.


We used PsycINFO, Medline, Embase, and Cochrane databases.


We selected cross-sectional, prospective, or retrospective studies with no time or language restriction.


Independent reviewers screened and extracted data using predefined standard procedures.


In 12 studies (N = 1787), researchers relying on a categorical diagnosis showed that both VP/VLBW and EP/ELBW subjects have a higher ADHD risk (odds ratio [OR] = 3.04 higher than controls; 95% confidence interval [CI] 2.19 to 4.21). In subgroup analyses, we demonstrated that the more extreme the cases, the higher the ORs (VP/VLBW: OR = 2.25 [95% CI 1.56 to 3.26]; EP/ELBW: OR = 4.05 [95% CI 2.38 to 6.87]). We drew data from 29 studies (N = 3504) on ADHD symptomatology and found significant associations with inattention (standardized mean difference [SMD] = 1.31, 95% CI 0.66 to 1.96), hyperactivity and impulsivity (SMD = 0.74, 95% CI 0.35 to 1.13), and combined symptoms (SMD = 0.55, 95% CI 0.42 to 0.68) when compared with controls.


Heterogeneity was significantly high for all analyses involving the 3 ADHD dimensions.


With our results, we provide evidence that VP/VLBW subjects have an increased risk of ADHD diagnosis and symptomatology compared with controls, and these findings are even stronger in the EP/ELBW group. Future researchers should address which risk factors related to prematurity or low birth weight lead to ADHD.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Moreira-Maia received fees for the development of educational materials for Novartis, Libbs, and Pfizer and served as a consultant to or on the speakers’ bureau of Novartis and Shire. Dr Moreira-Maia also received travel awards from the Health Technology Assessment Institute and the Federal University of Rio Grande do Sul and travel, accommodation, and registration support to the fourth and fifth World Congress on attention-deficit/hyperactivity disorder (ADHD) from the World Federation of ADHD. Dr Rohde has received grant or research support from, served as a consultant to, and served on the speakers’ bureau of Eli Lilly and Co, Janssen, Medice, Novartis, and Shire. The ADHD and Juvenile Bipolar Disorder Outpatient Programs chaired by Dr Rohde have received unrestricted educational and research support from the following pharmaceutical companies: Eli Lilly and Co, Janssen, Novartis, and Shire. Dr Rohde has received travel grants from Shire to take part in the 2015 World Congress on ADHD; the other authors have indicated they have no potential conflicts of interest to disclose.

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