Violent death in children in a metropolitan county: changing patterns of homicide, 1958 to 1982

Death rates from homicide in children younger than 15 years of age in the United States have increased during the last 30 years. Previous studies have suggested a typology consisting of fatal child abuse in young children and community violence in older children. We reviewed the data from the Cuyahoga County, Ohio, coroner's office pertaining to homicides in children less than 15 years of age between 1958 and 1982 and obtained similar findings. The homicide rates for city children increased from 1.1 to 6.7/100,000 in the first 20 years and then stabilized. Nonwhite boys had the highest death rates except in one period. Assailants were usually adolescent and young adult men of the same race; however, 43% of children less than 5 years of age were killed by women. The older the child, the more likely the homicide was to have been committed by a nonrelative, outside of the home, and with a firearm. Overall, firearms are the leading cause of homicide (36.2%). The temporal characteristics of child homicides are also described.     

Age-related patterns of violent death, Cook County, Illinois, 1977 through 1982

To clarify age-related patterns of violent death in childhood, a study was undertaken of medical examiner records concerning 437 deaths of Cook County, Illinois residents, aged younger than 15 years, who died from 1977 through 1982, and whose deaths were ruled as homicides or of an undetermined manner. Males outnumbered females after the age of 1 year. Black children were overrepresented. Perpetrators were usually parents for victims aged younger than 5 years and others for victims aged 5 years or older. Different circumstances of death characterized victims who were younger (mainly beatings) and older (mainly gunshots). Incidence was associated with urban residence and poverty, and it was highest among the youngest and oldest children. Striking differences were found in death rates for age subgroups within standard age groupings (eg, 19.77/100,000 for 1 and 2 years and 6.35/100,000 for 3 and 4 years). Different geographic areas had the highest rates for younger and older victims. We conclude: (1) Separate strategies are needed to protect the two groups at highest risk for homicide: black children aged younger than 3 years and older than 11 years in poor urban areas. (2) Standard homicide reporting practices should include narrow age groupings. (3) Age-related patterns of child homicide must be considered in the planning of prevention trials. (4) Research is needed to clarify why children of different ages are at differing risks in different communities.     

The impact of perinatal depression on exclusive breastfeeding: a cohort study

Perinatal depression is associated with infant undernutrition. We hypothesised that perinatal depression was associated with early cessation of exclusive breastfeeding and reduced quantity of breast milk in rural Pakistan. We used a prospective cohort design to study a population‐based sample of 132 depressed and 147 non‐depressed women from the third trimester of pregnancy to 6 months post‐natal. Current major depressive episode was measured in the third trimester and 6 months post‐natal using the Structured Clinical Interview for DSM‐IV Diagnosis. In a convenience sample of 24 depressed and 31 non‐depressed exclusively breastfeeding mothers, breast milk quantity was assessed (mL kg^?1 infant weight per 24 h) at 4 months using the dose‐to‐mother deuterium dilution method. We administered also the Perception of Insufficient Milk questionnaire at 6 months post‐natal. Depression was associated with fewer days of exclusive breastfeeding (91.8 (SD = 47.1) vs. 108.7 days (SD = 54.3) (95% CI: 3.4 to 30.3 P = 0.014). Women with persistent depression ceased exclusive breastfeed earliest. There was no difference in the quantity of breast milk produced by depressed and non‐depressed mothers: 89.3 (SD = 38.1) vs. 83.9 (29.0) ml/kg infant wt/24 hours, P = 0.57. Depressed mothers were significantly more likely to report insufficient milk: PIM scores were 34.4 (SD = 14.3) for depressed and 39.7 (SD = 10.4) for non‐depressed women (P = 0.004). In Cox regression PIM score mediated the association between depression and early cessation of breastfeeding. In this area of rural Pakistan, perinatal depression is associated with early cessation of exclusive breastfeeding and this is associated with mothers' perceptions of insufficiency of breast milk but not reduced milk production.     

Cerebral palsy and socioeconomic status: a retrospective cohort study

Aims: To study the relation between risk of cerebral palsy and socioeconomic status. Methods: A total of 293 children with a diagnosis of cerebral palsy out of 105 760 live births between 1 January 1982 and 31 December 1997 were identified from the special conditions sub-file of the West Sussex Computerised Child Health System. Results: There was a linear association between risk of cerebral palsy and socioeconomic status (SES) measured by the Registrar General''s social class (RGSC) and enumeration district (ED) ranked into quintiles by the Townsend Deprivation Index derived from 1991 census data. Fifty one per cent and 30% of cases of cerebral palsy were statistically "attributable" to inequality in SES using the RGSC and ED quintile respectively. A linear association was also noted for singleton live births. The association between risk of cerebral palsy and ED quintile persisted in a logistic regression model that included birth weight and gestational age, although that between RGSC and cerebral palsy no longer reached conventional levels of statistical significance after adjustment. Conclusions: A strong association was observed between socioeconomic status and the risk of cerebral palsy, which was only partly accounted for by the known social gradients in birth weight and gestational age.     

Survival and major neurodevelopmental impairment in extremely low gestational age newborns born 1990–2000: a retrospective cohort study

Background  

It is important to determine if rates of survival and major neurodevelopmental impairment in extremely low gestational age newborns (ELGANs; infants born at 23–27 weeks gestation) are changing over time.     

Cerebral palsy and socioeconomic status: a retrospective cohort study.

AIMS: To study the relation between risk of cerebral palsy and socioeconomic status. METHODS: A total of 293 children with a diagnosis of cerebral palsy out of 105,760 live births between 1 January 1982 and 31 December 1997 were identified from the special conditions sub-file of the West Sussex Computerised Child Health System. RESULTS: There was a linear association between risk of cerebral palsy and socioeconomic status (SES) measured by the Registrar General's social class (RGSC) and enumeration district (ED) ranked into quintiles by the Townsend Deprivation Index derived from 1991 census data. Fifty one per cent and 30% of cases of cerebral palsy were statistically "attributable" to inequality in SES using the RGSC and ED quintile respectively. A linear association was also noted for singleton live births. The association between risk of cerebral palsy and ED quintile persisted in a logistic regression model that included birth weight and gestational age, although that between RGSC and cerebral palsy no longer reached conventional levels of statistical significance after adjustment. CONCLUSIONS: A strong association was observed between socioeconomic status and the risk of cerebral palsy, which was only partly accounted for by the known social gradients in birth weight and gestational age.     

Diagnostic value of radiography in cases of perinatal death: a population based study

Objective: To examine the yield of radiographic abnormalities in a population based set of perinatal deaths, the diagnostic value of whole body postmortem radiographs in the same set, and previous factors that may increase the proportion of useful examinations. Design: Retrospective population based study. Setting: A region of Norway. Patients: All infants from a well defined geographical area who were stillborn or had died soon after birth over an 11 year period (n=542), who had routinely undergone whole body radiography and autopsy. Main outcome measures: (a) Proportion of cases with abnormal radiographic findings. (b) Proportion of abnormal radiographs providing new information that was useful for postmortem diagnosis. Results: Radiographs were abnormal in 162/542 cases (30%). These provided new information about, but did not help to confirm, the pathological process leading to death in 14/162 (8.6%), may have helped to confirm, but not establish, the cause(s) of death in 1/162 (0.6%), and were of vital importance for establishing the cause(s) of death in 5/162 (3.1%). Among infants with external malformations, the proportion of useful radiographs was 12/100 (12%), and among the remainder it was 8/436 (1.8%), a difference of 10.2% (95% confidence interval 3.7% to 16.7%; data missing for six cases). Conclusions: The diagnostic value of postmortem radiography in this population based set was low. However, radiographic findings were of vital importance for establishing the cause(s) of death in 5/542 cases (0.9%).     

Neonatal jaundice is a risk factor for childhood asthma: a retrospective cohort study

Background: The association between neonatal jaundice and childhood asthma is a new finding of two reports. The purpose of the study was to verify their results. Methods: Data from 11,321 children were collected from the National Health Insurance Research Database. Their claims data were evaluated from birth to 10 yr old. Children were analyzed as case (those with neonatal jaundice) and controls (those without neonatal jaundice). The diagnostic criteria for asthma were as follows: at least four asthma diagnoses at outpatient services and emergency department (ED), or one asthma diagnosis during an admission. In children fitting the asthma criteria, those with no asthma diagnosis after 1 yr of age were excluded. Mantel–Haenszel’s odds ratios were calculated after adjustment for the following confounders: preterm/low birth weight, neonatal infection, other respiratory conditions, other birth conditions, and gender. Asthma rate, onset time, the use of drugs, upper respiratory infection and lower respiratory infection (LRI) rates, hospital admission/ED visit rates, and the effect of phototherapy were evaluated. Results: After adjustment for the confounding factors, the rate of asthma was higher in icteric children (OR: 1.64, 95% CI 1.36–1.98, p < 0.001), and the influence in females was stronger. There still was an association between neonatal jaundice and late onset asthma (asthma onset after 3 yr of age). In asthmatic children, those with neonatal jaundice have increased asthma onset rate before age 6, increased use of inhalant steroids, LRI rates, and ED visits for respiratory disease. Conclusions: Neonatal jaundice increased the rate and severity of childhood asthma in subjects aged up to 10 yr and may be a risk factor for childhood asthma.     

Amniotic fluid infections with intact membranes leading to perinatal death: a prospective study

We determined the grief response to neonatal death of 50 mother-father pairs by administering a questionnaire and conducting a semistructured interview during the infant postmortem review. As measured by a parent grief score, maternal grief significantly exceeded paternal grief (t = 5.89, P less than .0001). Parent grief was not significantly related to birth weight, duration of life, extent of parent-infant contact, previous perinatal loss, parent age, or distance from the hospital of birth to the regional center (Pearson product-moment correlation coefficients). However, the attitudes and behavior of family, friends, and health care personnel in the hospital of birth often adversely influenced parent grieving. Of 39 mother-father pairs whose infants required respirator support, 18 participated in a group decision with their physician to withdraw respirator support when the prospects of infant survival seemed hopeless (limited respirator care group). No significant differences in parent grief scores were found (t tests) when the limited respirator care group was compared to those parents of infants who died despite uninterrupted respirator care. Our data suggest that informed parents can participate as partners with their physician in difficult infant care decision, even when death results, and adjust to their loss with healthy grieving.     

Leprosy in children: a retrospective study in China, 1986-1997

Leprosy in children forms an important link in the natural evolution and the epidemic profile of the disease. The study was undertaken on 1208 child cases detected during the years 1986-1997 in China. The number of child cases constituted 3-4 per cent of the total during this period although the incidence rates decreased dramatically. The detection rate significantly increased with age, and the average rate of 0.027 per 100,000 population was much lower than that in adults. In the pediatric cases, children in the younger age group had a higher prevalence of solitary lesions and lower prevalence of reactions and disabilities than the older group. A total of 70.01 per cent of the affected cases were infected by intra-familial contact, 35.60 per cent were detected by contact examination, and another 22.86 per cent by active surveys. The results of the study suggest that leprosy in children is not a public health problem at the present in China, but the regular screening of children in the family of patients is still one of the important ways to detect child cases and should be recommended.     

Thrombocytopenia in neonates and the risk of intraventricular hemorrhage: a retrospective cohort study

Background  

The overall prevalence of thrombocytopenia in neonates admitted to neonatal intensive care units ranges from 22 to 35%. There are only a few small studies that outline the relationship between the severity of thrombocytopenia and the risk of bleeding. This makes it difficult to form an evidence-based threshold for platelet transfusions in neonatal patients. The aim of this study was to determine the prevalence of thrombocytopenia in a tertiary neonatal intensive care unit and to study the relation between thrombocytopenia and the risk of intraventricular hemorrhage (IVH).