Patrick Kelly1, John M D Thompson2, Jean Koh3, Shanthi Ameratunga4, Timothy Jelleyman5, Teuila M Percival6, Hinemoa Elder7, Edwin A Mitchell8. 1. Departments of Pediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand; Te Puaruruhau (Child Protection Team), Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand. 2. Departments of Pediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand; Obstetrics and Gynecology, University of Auckland, Auckland, New Zealand. 3. Te Puaruruhau (Child Protection Team), Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand. 4. Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand. 5. Pediatrics and Newborn Services, Waitemata District Health Board, Auckland, New Zealand. 6. Departments of Pediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand; Kidz First Children's Hospital, Counties Manukau District Health Board, Auckland, New Zealand. 7. Te Whare Wānanga o Awanuiārangi, Auckland, New Zealand. 8. Departments of Pediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
Abstract
OBJECTIVE: To estimate associations between factors recorded in pregnancy and the first week of life and subsequent abusive head trauma. STUDY DESIGN: Multicenter, retrospective case-control study of perinatal records from 142 cases of abusive head trauma and 550 controls, matched by date and hospital of birth from 1991 to 2010. Multiple logistic regression assessed the relationship between perinatal exposures and abusive head trauma. RESULTS: The risk of abusive head trauma decreased with increasing maternal age (OR, 0.91 per year; 95% CI 0.85-0.97) and increasing gestational age at birth (OR 0.79 per week; 95% CI 0.69-0.91). Mothers of cases were more likely to be Māori (OR 4.61; 95% CI 1.98-10.78), to be single (OR 5.10; 95% CI 1.83-14.23), have recorded social concerns (OR 4.29; 95% CI 1.32-13.91), and have missing data for antenatal care, partner status, social concerns, and substance abuse (OR 13.53; 95% CI 2.39-76.47). Case mothers were more likely not to take supplements in pregnancy (OR 3.53; 95% CI 1.30-9.54), to have membrane rupture longer than 48 hours before delivery (OR 13.01; 95% CI 2.84-59.68), and to formula feed (OR for mixed breast and formula feeding 6.06; 95% CI 2.39-15.36) before postnatal discharge (median 3 days). CONCLUSIONS: Factors associated with subsequent abusive head trauma can be identified from routine perinatal records. Targeted interventions initiated perinatally could possibly prevent some cases of abusive head trauma. However, any plans for targeted prevention strategies should consider not only those with identified risk factors but also those for which data are missing.
OBJECTIVE: To estimate associations between factors recorded in pregnancy and the first week of life and subsequent abusive head trauma. STUDY DESIGN: Multicenter, retrospective case-control study of perinatal records from 142 cases of abusive head trauma and 550 controls, matched by date and hospital of birth from 1991 to 2010. Multiple logistic regression assessed the relationship between perinatal exposures and abusive head trauma. RESULTS: The risk of abusive head trauma decreased with increasing maternal age (OR, 0.91 per year; 95% CI 0.85-0.97) and increasing gestational age at birth (OR 0.79 per week; 95% CI 0.69-0.91). Mothers of cases were more likely to be Māori (OR 4.61; 95% CI 1.98-10.78), to be single (OR 5.10; 95% CI 1.83-14.23), have recorded social concerns (OR 4.29; 95% CI 1.32-13.91), and have missing data for antenatal care, partner status, social concerns, and substance abuse (OR 13.53; 95% CI 2.39-76.47). Case mothers were more likely not to take supplements in pregnancy (OR 3.53; 95% CI 1.30-9.54), to have membrane rupture longer than 48 hours before delivery (OR 13.01; 95% CI 2.84-59.68), and to formula feed (OR for mixed breast and formula feeding 6.06; 95% CI 2.39-15.36) before postnatal discharge (median 3 days). CONCLUSIONS: Factors associated with subsequent abusive head trauma can be identified from routine perinatal records. Targeted interventions initiated perinatally could possibly prevent some cases of abusive head trauma. However, any plans for targeted prevention strategies should consider not only those with identified risk factors but also those for which data are missing.
Authors: Patrick Kelly; John M D Thompson; Santuri Rungan; Shanthi Ameratunga; Timothy Jelleyman; Teuila Percival; Hinemoa Elder; Edwin A Mitchell Journal: BMJ Open Date: 2019-03-01 Impact factor: 2.692