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Perinatal risk and protective factors for pediatric abusive head trauma: a multicenter case-control study

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This case-control study examined the relationship between perinatal data and the first week of life and subsequent abusive head trauma. Perinatal records were examined from 142 cases of abusive head trauma and 550 controls, matched by date and hospital of birth from 1991 to 2010. Cases were admitted to Starship Hospital in Auckland and identified from the hospital child protection team database. In multiple logistic regression analysis, the risk of abusive head trauma decreased with increasing maternal age (OR, 0.91 per year; 95% CI, 0.85 to 0.97) and increasing gestational age at birth (OR 0.79 per week; 95% CI, 0.69 to 0.91). Mothers of cases were more likely to be indigenous Māori (OR 4.61; 95% CI, 1.98 to 10.78), to be single (OR 5.10; 95% CI, 1.83 to 14.23), to have “other social history” (OR 4.29; 95% CI, 1.32 to 13.91) and have missing data for antenatal care, partner status, social concerns, and substance abuse (OR 13.53; 95% CI, 2.39 to 76.47). Case mothers were more likely not to take supplements (nonprescribed medications) in pregnancy (OR 3.53; 95% CI, 1.30 to 9.54), to have rupture of membranes for longer than 48 hours before delivery (OR 13.01; 95% CI, 2.84 to 59.68), and to formula feed (OR for mixed breast and formula feeding 6.06; 95% CI, 2.39 to 15.36) at the time of postnatal discharge (median 3 days).

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Reference: J Pediatr. 2017;187:240-6
Independent commentary by Dr. Matire Hardwood

Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.

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