Newborn Risk Factors for Subsequent Physical Abuse Hospitalizations

Abstract

OBJECTIVES:To describe the prevalence of risk factors for abuse and newborns' risks for physical abuse hospitalizations during early infancy. METHODS:We created a nationally representative US birth cohort using the 2013 and 2014 Nationwide Readmissions Databases. Newborns were characterized by demographics, prematurity or low birth weight (LBW), intrauterine drug exposure, and medical complexity (including birth defects). Newborns were tracked for 6 months from their birth hospitalization, and subsequent abuse hospitalizations were identified by using International Classification of Diseases, Ninth Revision codes. We calculated adjusted relative risks (aRRs) with multiple logistic regression, and we used classification and regression trees to identify newborns with the greatest risk for abuse on the basis of combinations of multiple risk factors.RESULTS: There were 3 740 582 newborns in the cohort. Among them, 1247 (0.03%) were subsequently hospitalized for abuse within 6 months. Among infants who were abused, 20.4% were premature or LBW, and 4.1% were drug exposed. Premature or LBW newborns (aRR 2.16 [95% confidence interval (CI): 1.87-2.49]) and newborns who were drug exposed (aRR 2.86 [95% CI: 2.15-3.80]) were independently at an increased risk for an abuse hospitalization, but newborns with medical complexity or noncardiac birth defects were not. Publicly insured preterm or LBW newborns from rural counties had the greatest risk for abuse hospitalizations (aRR 9.54 [95% CI: 6.88-13.23]). Publicly insured newborns who were also preterm, LBW, or drug exposed constituted 5.2% of all newborns, yet they constituted 18.5% of all infants who were abused.CONCLUSIONS: Preterm or LBW newborns and newborns who were drug exposed, particularly those with public insurance and residing in rural counties, were at the highest risk for abuse hospitalizations. Effective prevention directed at these highest-risk newborns may prevent a disproportionate amount of abuse.WHAT'S KNOWN ON THIS SUBJECT: Current physical abuse prevention strategies have had inconsistent and marginal effectiveness. A better stratification of newborn infants' risk for physical abuse may prove valuable in informing the allocation of preventive services and improving their effectiveness.WHAT THIS STUDY ADDS: Using a nationally representative birth cohort, we report on risk factors for physical abuse that can be readily ascertained at birth. Five percent of newborns were identified as accounting for 1 in 5 infants who are abused and should be targets for secondary prevention.

Prenatal Substance Exposure and Child Maltreatment: A Systematic Review

“…Common maternal characteristics were socioeconomic status (N = 11) (Bauer et al, 2005; Lewis et al, 1997; Prindle et al, 2018; Puls et al, 2019; Putnam-Hornstein et al, 2016; Rebbe et al, 2019b; Shah et al, 2012; Smith & Testa, 2002; Williams-Petersen et al, 1994; Witt et al, 2017), race/ethnicity (N = 10) (Bauer et al, 2005; Lewis et al, 1997; Prindle et al, 2018; Putnam-Hornstein et al, 2016; Rebbe et al, 2019a, 2019b; Smith & Testa, 2002; Sun et al, 2007; Wasserman & Leventhal, 1993; Witt et al, 2017), age (N = 9) (Bauer et al, 2005; Frame, 2002; Lewis et al, 1997; Prindle et al, 2018; Putnam-Hornstein et al, 2016; Rebbe et al, 2019a; Shah et al, 2012; Sun et al, 2007; Williams-Petersen et al, 1994), timing of prenatal care (N = 7) (Doris et al, 2006; Friedman et al, 2009; Leventhal et al, 1997; Prindle et al, 2018; Putnam-Hornstein et al, 2016; Rebbe et al, 2019a, 2019b), history of prior maltreatment (N = 7) (Doris et al, 2006; Frame, 2002; Friedman et al, 2009; Leventhal et al, 1997; Smith & Testa, 2002; Sun et al, 2007; Williams-Petersen et al, 1994), and partner status (N = 6) (Lewis et al, 1997; Prindle et al, 2018; Putnam-Hornstein et al, 2016; Shah et al, 2012; Smith & Testa, 2002). Common infant characteristics were infant size (N = 5) (Bauer et al, 2005; P...…”

Evaluation of a midwifery network to guarantee outpatient postpartum care: a mixed methods study

“…Women organising care themselves searched the Internet for personal details of midwives and contacted them themselves. Risk factors for a vulnerable transition into parenthood with associated risks for impaired child development and for child abuse such as teenage mother, single mother, no vocational education, jobless, poverty, migration, drug abuse, domestic violence, multiples, preterm birth or child with congenital malformation were investigated as single and cumulative factors [27,28]. Descriptive statistics were computed according to the type of variables and study groups were compared using chi squared tests for categorical variables and Mann-Whitney-U-test for metric variables.…”

Incidence of Injury, Maltreatment, and Developmental Disorders Among Substance Exposed Infants

“…Recent studies have examined clinical outcomes among substance exposed infants (Agrawal et al, 2019; Hwang et al, 2017; Puls et al, 2019; Uebel et al, 2015; Witt et al, 2017) with prior studies demonstrating an increased risk of hospitalization for a variety of conditions during infancy and early childhood among substance exposed infants compared to their unexposed counterparts (Hwang et al, 2017; Puls et al, 2019; Uebel et al, 2015; Witt et al, 2017). For example, a cohort study in Washington State found an increased risk of re-hospitalization prior to age five years for infants with neonatal abstinence syndrome (NAS; i.e.…”

“…Among 2003–2009 births in Massachusetts, infants born to mothers with substance use disorders in pregnancy had higher use of hospital-based care, including hospital admissions, observational stays, and emergency department visits, in the first year of life compared to infants of mothers without a documented substance use disorder in pregnancy (Hwang et al, 2017). In a nationally-representative sample of 2013–2014 births, prenatal substance exposure was associated with an increased risk of physical abuse hospitalizations prior to age 6 months (Puls et al, 2019).…”

“…While results from these studies contribute substantially to our understanding of the needs of substance exposed infants, there are gaps. First, prior studies have largely been limited to examining outcomes identified in the inpatient setting, excluding those diagnosed in an outpatient setting (Hwang et al, 2017; Patrick et al, 2015; Puls et al, 2019; Uebel et al, 2015; Witt et al, 2017). Some outcomes, such as injuries and developmental disorders, may be more likely to be diagnosed in an outpatient setting.…”