Endotracheal Intubation in Early Life and Its Association with Mental Health Disorders from Childhood to Adolescence: A National Longitudinal Cohort Study up to Age 18.
A breathing tube before age five sharply raises the chance of later autism or ADHD—so flag these kids early.
01Research in Context
What this study did
Doctors tracked every child in one country who had a breathing tube before age five. They compared them to kids who never needed the tube. The team then counted who later got an autism or ADHD diagnosis up to age 18.
The study used national health records, so no one was missed. It is one of the largest looks at early medical care and later brain development.
What they found
Kids who were intubated before their fifth birthday had almost three times the chance of later autism. Their odds of ADHD nearly doubled. The link stayed strong even after the researchers adjusted for birth weight, mom’s age, and other illnesses.
How this fits with other research
Pham et al. (2022) saw the same pattern with a different risk: poor housing, smoke, and stress also raised autism symptoms at age two. Together the papers say the first years are fragile; many early hits can shape later diagnosis.
Bellon-Harn et al. (2020) looked at newborn thyroid hormone levels and found no link to autism. That seems opposite, but they tested a routine blood drop, not a major medical event. A quiet lab value is different from the stress of intensive care.
Ptomey et al. (2021) add a possible reason. They found chemical tags on the oxytocin gene in kids with both autism and ADHD. Early trauma like intubation might leave similar molecular marks; more work is needed to connect the dots.
Why it matters
If a toddler on your caseload was intubated, share the record with the developmental pediatrician. Watch language, play, and self-regulation extra closely. Start autism screens on time, not late. You can also use the history when you teach families why their child may need more support now—and why early skill building is urgent.
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02At a glance
03Original abstract
Background/Objectives: The long-term impact of intubation during infancy or early childhood on later childhood or adolescence remains unclear. This study investigates the association between early-life intubation and subsequent mental health outcomes. Methods: We conducted a retrospective cohort study using nationwide data on children born in Korea between 2002 and 2005. Those who underwent intubation (exposed cohort) were compared with 1:10 matched unexposed controls who did not undergo intubation. Results: The exposed cohort (n = 18,799) had a significantly higher incidence rate of mental health disorders than controls (28.2 vs. 13.9 per 1000 person-years; HR 1.82, 95% CI 1.74–1.93). Autism spectrum disorder (HR 3.09) and attention-deficit/hyperactivity disorder (HR 1.61) increased in early childhood, while bipolar disorders (HR 2.36), schizophrenia spectrum disorders (HR 2.27), depressive disorders (HR 1.94) and anxiety disorders (HR 1.84) increased in adolescence. Higher incidence was noted in females, children not admitted to intensive care units, and those without congenital heart disease or bronchopulmonary dysplasia (p < 0.05). Hospitalization length correlated with mental health outcomes (p < 0.001), but ventilator duration did not (p = 0.694). Conclusions: Early-life intubation is associated with an increased risk of mental health disorders, highlighting the need for long-term follow-up and support for these children. In particular, increased clinical awareness is needed during follow-up care for patients at higher risk, such as females, children without congenital heart disease or bronchopulmonary dysplasia, those intubated at an older age, and those with longer hospitalizations.
Journal of Clinical Medicine, 2026 · doi:10.3390/jcm15020824