Article in Pediatrics Shows Newborns in Rural Counties at Highest Risk for Abuse Hospitalizations

REFERENCE: Henry T. Puls, James D. Anderst, Jessica L. Bettenhausen, Nicholas Clark, Molly Krager, Jessica L. Markham, Matthew Hall. Newborn Risk Factors for Subsequent Physical Abuse HospitalizationsPediatrics, Feb 2019, 143 (2) e20182108; DOI: 10.1542/peds.2018-2108

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.