title: Prematurity and neonatal comorbidities as risk factors for nonaccidental trauma.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Wake Forest School of Medicine, Department of General Surgery, Winston-Salem, NC, United States; Childress Institute for Pediatric Trauma, Winston-Salem, NC, United States.
authors.forename: Andrea N
authors.initials: AN
authors.lastname: Doud
authors.affiliation: Weill Cornell, Department of General Surgery, New York, NY, United States.
authors.forename: Kendall
authors.initials: K
authors.lastname: Lawrence
authors.affiliation: Wake Forest School of Medicine, Department of Pediatrics, Winston-Salem, NC, United States.
authors.forename: Meggan
authors.initials: M
authors.lastname: Goodpasture
authors.affiliation: Wake Forest School of Medicine, Section of Pediatric Surgery, Winston-Salem, NC, United States; Childress Institute for Pediatric Trauma, Winston-Salem, NC, United States. Electronic address: kzeller@wakehealth.edu.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Zeller
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data*; D002649:Child Abuse / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology*
keywords: Nonaccidental Trauma; Pediatric trauma; Prematurity