More Effective Prevention Needed Against Non-Accidental Trauma in Infants

Baby boys up to nine months of age are at greatest risk of non-accidental trauma (NAT) despite educational interventions targeted at preventing the abuse, show results presented at this year’s American Academy of Pediatrics National Conference & Exhibition in Chicago, IL.

Presenting the results in the session on Child Abuse and Neglect was LaVerne Thompson, Student Researcher, University at Buffalo, Neurosurgery, NY. Ms Thompson’s study investigated the rate of NAT following the implementation of The Shaken Baby Project, an educational initiative.

Parent education programs are being implemented by many hospitals in the US to help prevent child abuse. These projects strive to inform parents of the dangers of shaking their baby while providing coping mechanisms for the stress of an infant crying. The ‘Shaken Baby Project’, is one such project, which was initiated in 1998 by Mark Dias, and has now been expanded to become the ‘Safe Babies’ program.

The researchers concluded that their data show children in the New York region continue to face the threat of NAT with baby boys at greatest risk. “This provides a template for injury prevention programming, which is clearly still in great need,” they noted.

The higher incidence of NAT in boy babies could be from a number of factors, explained Ms Thompson to Doximity. “We don’t have specific data to explain but it is consistently in our data and others. One hypothesis is that it is our cultural gender bias which demands boys be ‘tougher’.

Asked for possible reasons why educational programs for new parents did not appear to be delivering the desired results, Ms Thompson said that, “The education is typically presented to the parents shortly after delivery and prior to discharge home from the hospital. Given the excitement and stress that follows delivery it is unclear how much retention the family has of the information presented. Additionally, without continued follow up education the initial education may be forgotten as the child ages and new challenges of parenting arise.”

Ms LaVerne explained that a major sequela of NAT is traumatic brain injury, which disproportionately affects children under five and can have lasting complications, and potentially devastating effects for patients and families. ‘The program has been implemented in all hospitals in our region that provide maternity care, and is required for parents to complete after delivery. In spite of the early success of these programs, NAT is still common in our region,’ said the researchers.

The retrospective study reviewed charts of children admitted to the Women and Children’s Hospital of Buffalo, Buffalo, NY with ICD-9 and ICD-10 codes for child abuse, shaken infant syndrome, intracerebral hemorrhage, and subdural hemorrhage. Data were also provided by the Safe Babies program, which tracks NAT in the New York region. Children with a diagnosis of abuse aged between 0 to 24 months were included, while children who suffered a genuine accidental trauma, or those with insufficient corroborating evidence to support the NAT diagnosis were excluded. A total of 107 cases were included in the analysis.

Annual incidence data based on yearly birth records in the New York region were analyzed using a linear regression model and comparisons between gender and incidence of NAT were generated. Incidence of NAT was also stratified by age.

The analysis found that the linear regression model demonstrated a positive slope, representing a statistically significant rise in the incidence of NAT between 1999 and 2016 (p=0.0086). Consistent with earlier reports, children between two and nine months old had the highest incidence of NAT, and when stratified by gender, the data show a trend toward higher incidence of injury in boys, although this was not statistically significant (p=0.175). But, added the researchers, the results were found to be consistent with earlier reports that found children between two and nine months old had the highest incidence of NAT.

Presented at American Academy of Pediatrics National Conference & Exhibition in Chicago, IL on September 17, 2017.

Abstract:

(5) Rising Incidence of Non-Accidental Trauma in Infants: A Call to Revisit Prevention Strategies

LaVerne W. Thompson1; Kathryn Bass, MD2; Justice Agyei, MD1; Naseem Hibbit-Ur-Rauf, MD2; Jiefei Wang1; Renee Reynolds, MD MS1, (1) University at Buffalo Neurosurgery, Buffalo, NY, (2) Women and Children’s Hospital of Buffalo, Buffalo, NY

Purpose: Traumatic brain injury is a major sequelae of non-accidental trauma (NAT) that disproportionately affects children under five and can have lasting complications. Considering the potentially devastating effects for patients and families, many hospitals are creating parent education programs to help prevent child abuse. These projects strive to inform parents of the dangers of shaking their baby while providing coping mechanisms for the stress of an infant crying. One such program is The Shaken Baby Project, initiated in 1998 by Mark Dias, now expanded as the Safe Babies program. The program has been implemented in all hospitals in our region that provide maternity care and is required for parents to complete after delivery. In spite of the early success of these programs, NAT is still common in our region. We studied the rate of NAT following the implementation of The Shaken Baby Project.

Methods: After IRB approval, we performed a retrospective chart review of children admitted to our hospital with ICD-9 and ICD-10 codes for child abuse, shaken infant syndrome, intracerebral hemorrhage, and subdural hemorrhage (431, 852.30, 995.54, 995.50, 995.55, T76.12xA, T74.12xA, Z62.21, T74.4xxA, and T74.4xxD). Data were also provided by the Safe Babies program, which tracks NAT in our region. Inclusion criteria were children with diagnosis of abuse ages 0 to 24 months old. Exclusion criteria were children who suffered a genuine accidental trauma, or those with insufficient corroborating evidence to support the NAT diagnosis. Annual incidence data based on yearly birth records in our region was analyzed using a linear regression model in SAS Software University Edition. Comparison between gender and incidence of NAT was performed via paired T-Test. A Kolmogrov-Dmirnov two-sample test was used to compare age and gender in relation to NAT incidence. A p-value less than 0.05 was considered significant.

Results: For the 139 cases of NAT included in the analysis, the linear regression fit demonstrated a positive slope, showing a statistically significant rise in the incidence of NAT (p=0.0086) (Fig. 1). When stratified by gender, the data show a trend toward higher incidence of injury in boys, though statistically insignificant (p=0.175). Consistent with earlier reports, children between 2 and 9 months old had the highest incidence of NAT (Fig. 2).

Conclusion: Data collected during this study show that despite educational interventions targeted at preventing NAT, there is a significant rise in the trend of newly reported cases of NAT. Our data shows that children in our region still face the threat of NAT with male infants up to 9 months of age at greatest risk. This provides a template for injury prevention programming, which is clearly still in great need.

By Becky McCall, contributing writer for Doximity

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