The 130th Annual Meeting of APHA

Abstract #37079

Joan Rosen Bloch, PhD, Center for Health Outcomes and Policy Research, University of Pennsylvania, 420 Guardian Drive, Philadelphia, PA 19104, 856-751-9211, jbloch@nursing.upenn.edu

Purpose: Mounting evidence identifyies the time of insult causing neonatal brain injury (NBI) occurs in-utero, before labor ever begins, for some infants. It is therefore important to explore the relationship between utilization of prenatal care and NBI to identify if prenatal care is a modifiable risk for NBI in LBW infants.

Design: The study design was a nested case-control study from the Central New Jersey Neonatal Brain Hemorrhage Study. The original population-based cohort included 1105 newborns weighing 500 to 2000 grams at birth was enrolled from several central New Jersey hospitals from September 1984 to June 1987.

Methods: Cases (n=72) were selected based upon evidence of brain injury by four hours after birth based upon cranial ultrasound. Controls (n=412) were selected if there was no evidence of brain injury based upon all cranial ultrasounds. Prenatal care data were abstracted from the mother's prenatal and L&D records. Prenatal care utilization was categorized three separate ways (Kessner Index, Kotelchuck Index, and yes/no to receipt of prenatal care).

Results: Birth weight was the most significant predictor of NBI. No receipt of prenatal care was significant for black infants (OR: 2.11; 95% CI 1.20-3.72). The Adequacy Indices (Kotelchuck and Kessner) did not predict brain injury. However, applying both indices to the same population of women yielded different prenatal care adequacy: 14% scored inadequate on the Kessner verses 22% on the Kotelchuck (c2=25.5, p=0.00).

Conclusions: At-risk are black infants of mothers who received no prenatal care. The study confirmed methodological variations and challenges when evaluating prenatal care use. A broader framework for research is needed.

Learning Objectives:

• List antenatal antecedents of neonatal brain injury.
• Describe research methodological challenges of evaluating infant outcomes of prenatal care.
• Discuss the differences of how the adequacy indices (Kessner & Kotelchuck) report different findings when applied to the same population of mothers of pre-term infants.

Keywords: Prenatal Care, Low Birthweight

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.