Intrauterine Substance Exposure and the Risk for Subsequent Physical Abuse Hospitalizations

Area of Science:

• Pediatrics
• Neonatology
• Public Health
• Child Abuse Prevention

Background:

• Infants exposed to substances in utero (SEI) represent a vulnerable population.
• Neonatal Abstinence Syndrome (NAS) is a specific outcome of substance exposure in newborns.
• Understanding the risk of physical abuse in these infants is crucial for early intervention.

Purpose of the Study:

• To determine the relative risk of physical abuse hospitalization in substance-exposed infants (SEI).
• To compare the risk between SEI with NAS and SEI without NAS.
• To inform targeted safety planning for high-risk infants.

Main Methods:

• Utilized a nationally representative US birth cohort from the 2013-2014 Nationwide Readmissions Databases.
• Employed International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify infants and outcomes.
• Used multiple logistic regression to calculate adjusted relative risks for physical abuse hospitalization within six months of birth.

Main Results:

• Infants with NAS exhibited a significantly increased risk (aRR: 3.84) of subsequent physical abuse hospitalization compared to non-SEI.
• Substance-exposed infants without NAS did not show an increased risk.
• A similar pattern was observed in infants with narcotic exposure, with NAS indicating higher risk.

Conclusions:

• Newborns diagnosed with NAS are at a substantially higher risk of physical abuse in early infancy.
• These findings are critical for identifying infants who require enhanced safety planning and follow-up care.
• The study underscores the importance of distinguishing NAS from general substance exposure when assessing abuse risk.