Risk for Child Maltreatment Among Infants Discharged From a Neonatal Intensive Care Unit: A Sibling Comparison

Elizabeth C. Risch, Arthur Owora, Raja Nandyal, Mark Chaffin, Barbara L. Bonner

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Studies suggest that neonatal illness may cause increased risk for child maltreatment (CM), but these findings may be biased by observed and unobserved confounding factors (social, family, and maternal characteristics) including increased surveillance by health care providers. This study expands on previous research by examining and controlling for these potential study biases and confounders using a sibling discordance retrospective cohort study design. Infants born in a Level IV neonatal intensive care unit (NICU) were matched with non-NICU born sibling controls. Cox proportional hazard models with shared frailty terms were used to account for clustering and heterogeneity in CM survival time (time to CM event). Potentially key covariates were selected using the directed acyclic graph approach, and surveillance reports were identified and systematically included or excluded from analyses. Managing these sources of bias reduced but did not eliminate the association between neonatal illness and CM report risk. Risk was especially high during the first year of the NICU infant’s life and among families with multiple well-known CM risk factors.

Original languageEnglish (US)
Pages (from-to)92-100
Number of pages9
JournalChild Maltreatment
Issue number2
StatePublished - May 13 2014
Externally publishedYes


  • NICU
  • child abuse
  • child maltreatment
  • infants
  • survival analysis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology


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