Prematurity and neonatal comorbidities as risk factors for nonaccidental trauma

Parental, familial, and demographic risk factors for nonaccidental trauma (NAT) have been well-studied, but neonatal factors, such as comorbidities and prematurity have not. We assess the correlation of these factors with NAT.

A total of 234 cases of NAT and 287 cases of accidental trauma (AT) among children <1 year were identified in a trauma registry. Known risk factors for NAT, gestational age, and neonatal comorbidities were abstracted from medical records. Chi-square analysis and logistic regression evaluated the association of prematurity and comorbidities with NAT compared to AT with and without controlling for confounders.

Children treated for NAT were younger than those treated for AT and were more likely to have younger parents with substance abuse issues. Prematurity, major comorbidities, and minor comorbidities were more common in those treated after NAT than after AT (24.8% vs 12.7%, p=0.0004; 25.6% vs 7.2%, p<0.0001, and 42.6% vs 29.3%, p=0.0014, respectively). After model adjustments for other risk factors, major comorbidity remained a significant risk factor for NAT compared to AT, with an adjusted odds ratio of 4.37 (p<0.0001).

Among other risk factors, neonatal factors predict a child's risk for abuse. We have an opportunity for targeted preventive interventions among this at-risk population.