A maltreatment risk score was able to identify which children were more likely to be in danger of post-neonatal death and hospitalization, researchers found.
Children who were flagged at the 10% and 20% risk thresholds had more than four times higher risk of post-neonatal mortality and and a higher risk of hospitalization, reported Rhema Vaithianathan, PhD, of Auckland University of Technology in New Zealand, and colleagues.
Prior research found “linked administrative data and predictive risk models” can be used to identify which children have a greater risk of abuse and neglect, they wrote in writing in Pediatrics.
“If children identified by a [predictive risk model] for maltreatment are at risk for negative health outcomes beyond simply child protection involvement, these families should be prioritized for a broader swath of higher intensity preventive services,” the authors wrote.
Researchers used the Integrated Child Dataset, a census for all live births in New Zealand from 2004 to 2011, which is also linked to health, welfare benefits, child protective services and criminal justice registers to determine a risk score for children born in 2011.
They estimated a child’s probability of being “a victim of maltreatment” by the age of 2 years, using the “predictors” of child characteristics and family background. Certain factors shown to be predictive of maltreatment risk included:
- Preterm birth (prior to 37 weeks gestation)
- Infant’s sex (girl)
- High parenting demand (more than three children in the family, multiple birth children or multiple children ages <2 years)
- Maternal characteristics, such as age <25 or age >35
- Marital status (single)
- Receipt of public income support
- History of mental health or substance abuse
- Criminal records in last 5 years
After ranking children according to their probability of maltreatment, they estimated mortality and injury rates by age 3 for the children with the highest probability of maltreatment. Researchers then examined the top 10% of the risk score distribution as “very high risk” and the top 20% as “high risk.”
The “very high risk” group of children were more likely to have a single mother, a mother age <20, and to live in a family with high parenting demand. Not surprisingly, past or current child protective services involvement was "more prevalent" among "very high risk" children. Similar patterns were seen among the top 20%, or the "high risk" group of children.
Overall, children in the “very high risk” group were 4.8 times more likely to die in infancy (95% CI 3.2-7.2) versus other children. Their relative risk ratio was 9.0 for injury deaths overall (95% CI 3.9-20.7), the authors said, albeit with an extremely wide confidence interval.
The “very high risk” group was also two times as likely (95% CI 1.8-2.2) to be hospitalized versus other children, and hospitalizations for long bone fractures by age 2 was 2.6 times more likely to occur among this group (95% CI 1.7-4.0).
In an accompanying editorial, Brett Drake, PhD, and Melissa Jonson-Reid, PhD, both of Washington University in St. Louis, characterized this as a “breakthrough” in using predictive risk modeling to predict negative child outcomes.
“Until now, preventive services have been parent-initiated or from a hotline referral. This system breaks down relative to child fatalities because most fatalities happen early,” the editorialists wrote. “Creating such a program in the United States … would represent a paradigmatic change in how we see the role of the state in protecting children and supporting families, supplementing the current hotline-gated system with an empirically sound and timely, preventive system.”
Study limitations included some potential problems with data linkage and that the analysis was limited only to children in New Zealand, and not the immigrant children born into the country. Also, the researchers only looked at outcomes into early childhood, so the results would not be generalizable to outcomes at older ages.
Vaithianathan and co-authors, as well as Drake and Jonson-Reid, disclosed no relevant relationships with industry.
Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner