Follow-up of newborns and their mothers after early hospital discharge.

As postpartum hospital stays have become increasingly shorter, more attention has been focused on the importance of routine postdischarge follow-up for newborns and mothers. Recent guidelines and legislation, however, include few specifics on how follow-up services should be provided. Based on the authors' review of the recent literature, it was concluded that the research to date provides little useful information to guide follow-up practices under current conditions. Additional studies that focus on postdischarge follow-up, rather than on length of hospital stay, are needed to provide the basis for more specific practice guidelines.

Is intrauterine growth retardation a risk factor for child abuse?

A case-control study was conducted to determine whether infants with intrauterine growth retardation are at an increased risk of child abuse. Case children were those who had been born at Yale-New Haven Hospital and were reported to the hospital's child abuse committee because they had been physically abused. For each case, one control child was chosen from the hospital's log of births and matched to the case child by age, gender, race of the mother, method of payment for the hospitalization, and the provider of the child's health care at the time of birth. Infants were defined as having intrauterine growth retardation if they had either a ponderal index or a birth weight that was less than the tenth percentile for gestational age using the Kansas City or Denver growth standards. We identified 117 case-control pairs that met those criteria. The matched odds ratios for each of the four definitions of intrauterine growth retardation were less than one, indicating that infants with intrauterine growth retardation are at a decreased risk of abuse. The matched odds ratio for a low ponderal index according to the Kansas City standard was 0.4 (95% confidence interval 0.19, 0.83). This result was not affected by such possible confounding factors as the mother's age. We conclude that infants with intrauterine growth retardation are not at an increased risk and may be at a decreased risk of physical abuse.

Does breast-feeding protect against infections in infants less than 3 months of age?

To determine whether breast-feeding protects infants from infections, a case-control study was conducted. The cases were previously healthy children who were admitted to Yale-New Haven Hospital for an infectious illness at or before 90 days of age. The controls were chosen from the log of births and matched to the cases for five important demographic variables. In addition, logistic regression models were used to adjust the results for other potential confounders. To minimize the potential surveillance bias that might occur if formula-fed and breast-fed infants with the same degree of illness have a different probability of being hospitalized, the case-control pairs were stratified by the severity of the medical condition of the case at the time of hospitalization. For the 281 case-control pairs, the matched odds ratio was .50 (95% confidence interval .32, .77; P less than .005), which indicates that breast-feeding is protective against infections. However, this apparent protective effect was diminished substantially when the data were stratified according to the severity of illness: the matched odds ratio for the 164 infants with serious illnesses was .79 (.47, 1.32; P less than .50), and for the 117 infants with mild illnesses it was .17 (.03, .44; P less than .001). These stratified results suggest that breast-feeding protects infants from hospitalization rather than from infections. Failure to consider the problem of surveillance bias may lead to erroneous conclusions about the protective effect of breast-feeding.

Reassessment of the relationship of perinatal risk factors and child abuse.

We performed a case-control study to examine the relationship of child abuse to several perinatal risk factors. Cases were children who had been born at Yale-New Haven (Conn) Hospital and were reported for physical abuse to the Hospital's Child Abuse Committee. For each case, a control was chosen from the hospital's log of births and matched according to five demographic variables. We identified 117 case-control pairs. No relationship was found between either prematurity or low birth weight and child abuse. In contrast, there was an association between child abuse and young maternal age (both at the birth of the index child and at the birth of the first child). We conclude that prematurity and low birth weight are not risk factors for physical abuse but that young maternal age is related to abuse.