Medical surveillance and child maltreatment incidence reporting among NICU graduates

Objective: Identify background infant and maternal characteristics that predict child maltreatment incidence reporting among Neonatal Intensive Care Unit (NICU) graduates by healthcare providers versus community sentinels with the goal of identifying ways to improve child maltreatment (CM) risk surveillance .

Methods: Demographic, medical data including diagnoses and caregiving needs at discharge for infants treated in a NICU during 2005-2008 were obtained from the Neonatology databases. CM outcome data was obtained from child welfare databases. Latent class analysis procedures were used to identify observable infant and maternal characteristics that define unobserved groups (latent classes) that predict NICU graduates CM incidence reporting among healthcare providers versus community sentinels.

Results: Medical surveillance (reports made by health care providers) accounted for only 37% of the child maltreatment reports made to child welfare. Infant health was more predictive of medical surveillance than maternal characteristics suggesting that health providers may assess risk differently than community sentinels. Based on a simple two latent class model, the latent class with high infant health indicator membership probabilities was a better predictor of  healthcare provider related reports than the class with lower membership probabilities  (Odds ratio: 2.72(95% CI: 1.76-4.20).

Conclusions: Health care providers may be keyed more to an infant’s medical frailty than to caregiver (maternal) contextual characteristics and thus may miss an opportunity to identify and intervene to prevent child maltreatment among children with medical problems. Findings raise the question of whether increased attention to contextual factors can aid or increase early identification of infants at risk of child maltreatment in NICU settings.