Publications

Abstract

Background: Timely and accurate diagnosis of early child physical abuse (CPA) is crucial to avoid recurrence and protect victims. Ruling out differential diagnoses is also important to avoid misdiagnosis of CPA. We evaluated the risk of hospitalization for early CPA before hospitalization for its 2 main differential diagnoses: osteogenesis imperfecta (OI) and severe hemophilia (SH).

Methods: This population-based cohort study used the national administrative database covering all hospitals in France. We followed infants born from 2010 to 2019 until age 2. We identified infants with a first discharge code for early CPA, OI, and SH and calculated crude absolute and relative risks.

Results: Among the 6,315,216 infants included, 2088 (33/100,000 infants per year) were hospitalized for early CPA, 160 (3/100,000) for OI, and 402 (6/100,000) for SH before age 2. Among infants hospitalized for early CPA, 2085 (99.86 %) had no further hospitalization for OI or SH, 3 (0.14 %) were further hospitalized for OI with a 9-month median interval between hospitalizations, and 0 were further hospitalized for SH. The absolute risk of hospitalization for early CPA before hospitalization for OI was 1.9 % (3/160, 95 % confidence interval [CI] 0.39–5.38), and the relative risk as compared with infants without hospitalization for OI was 56.8 (95 % CI 18.5–174.3).

Conclusions: The very low to null absolute risks of hospitalization for early CPA before OI or SH probably reflect excellent current clinical practices in ruling out differential diagnoses. A better implementation of existing guidelines could further shorten the time to diagnosis of OI before age 2.

Abstract

Background: Intimate partner violence (IPV) is associated with children's emotional and behavioral difficulties. Psychological-IPV (P-IPV) is most common, and occurs alone or along other forms of IPV. Little is known about the longitudinal course of P-IPV exposure and its consequences on children taking into account whether or not they are present during parental arguments.

Objective: To identify longitudinal trajectories of P-IPV from preconception through the child's second year of life and examine associations with children's emotional-behavioral outcomes at age five years, depending on the child's presence during parental arguments in the second year of life.

Participants and setting: Data from the nationally representative French birth cohort ELFE including children born in 2011 were used.

Methods: P-IPV exposure was assessed before conception, during pregnancy, at two months and at two years postpartum. Parents completed the Strengths and Difficulties Questionnaire (SDQ) at five years. Group-based trajectory modelling was used to identify P-IPV trajectories. Multivariate logistic regression models were used to study the relationship between P-IPV trajectories and SDQ.

Results: 9639 children were included. Five trajectories of exposure to P-IPV were identified: minimal (70.6 %), prenatal (10.0 %), increasing (6.4 %), decreasing (7.5 %), persistent (5.5 %). Persistent and decreasing P-IPV trajectories and frequent child presence during parental arguments were associated with children's increased odds of having abnormal total SDQ scores (OR 2.31 95 % CI 1.54–3.47; OR 1.64 95%CI: 1.11–2.43; OR 1.88 95%CI:1.17–3.02, respectively).

Conclusions: Early identification and consideration of children living in a home where IPV occurs could allow provision of timely and appropriate support.

Abstract

Background: Adverse childhood experiences (ACEs) may negatively affect prenatal mental health. However, the use of a cumulative ACEs score may obscure the identification of which specific types of adversity are most strongly associated with unfavorable mental health outcomes.

Aim: This study aims to evaluate the association between ACEs and prenatal symptoms of depression and anxiety using a cumulative score, a person-centered approach, and the dimensional model of adversity and psychopathology (DMAP).

Methods: Data were collected from 1887 pregnant women in the French Etude des Déterminants du développement et de la santé de l’ENfant (EDEN) cohort. To operationalize our exposure, we calculated a cumulative ACE score, threat and deprivation scores, and conducted latent class analysis (LCA). Depressive and anxious symptoms were assessed with the Center for Epidemiologic Studies-Depression Scale (CES-D) and the State-Trait Anxiety Inventory state subscale (STAI-S) questionnaires, using cutoffs of 16 and 38 indicating high symptoms. Participants were categorized into four outcome groups: (1) no symptoms, (2) high depressive symptoms only, (3) high anxious symptoms only, and (4) comorbid high symptoms. Multinomial regressions were performed.

Results: LCA identified three ACE classes: low-risk, family discordance, and multidimensional adversity. Women reporting two or more ACEs had higher odds of depressive and comorbid symptoms, compared to those with zero ACEs. Compared to the low-risk class, women in the family discordance class had increased odds of high depressive symptoms (adjusted odds ratios [aOR] 95% confidence interval [CI] = 1.80 [1.33, 2.56]) and comorbid high symptoms (aOR [95% CI] = 2.04 [1.43, 2.89]). Threat experiences were significantly linked to high depressive symptoms (aOR [95% CI] = 1.48 [1.22, 1.79]) and comorbid high symptoms (aOR [95% CI] = 1.53 [1.25, 1.87]).

Conclusion: Using the DMAP and LCA approaches, we found that ACEs related to the familial environment and relationships during childhood were most strongly associated with prenatal high depressive and comorbid symptoms. This highlights the importance of operationalizing ACEs beyond a cumulative score to better capture their role in the development of prenatal mental health difficulties.

Abstract

Background: Abusive Head Trauma (AHT) is a leading cause of morbidity and mortality in infants requiring rapid neuroimaging performance and prognostic rapid diagnosis. The Pittsburgh Infant Brain Injury Score (PIBIS) clinical prediction rule (CPR) was derived to identify infants most likely to present brain injury, whose diagnosis would benefit from head CT. Our study aimed to externally validate the PIBIS CPR in a pediatric French population.

Methods: A retrospective study was conducted in a French pediatric emergency department between 2015 and 2017. We included all consecutive infants who underwent a neurological imaging. Medical data were collected, and PIBIS score was determined, both retrospectively.

Results: We included 129 infants among which 33 cases (including 20 with a diagnosis of AHT). The sensitivity and specificity of the PIBIS CPR were 75.8 % (95 % CI 57.7-88.9) and 61.4 % (51.0-71.2) and negative and positive predictive values 88.1 % (77.8-94.7) and 40.3 % (33.0-48.2). Among the 20 infants with a diagnosis of AHT, 19 (95.0 %) were correctly identified by the PIBIS CPR.

Conclusion: Our external validation study found a lower diagnostic value of the PIBIS CPR than in the original study. This argues for adding biomarkers to improve its performance, notably in the context of suspected AHT.

Abstract

 Objective: To examine the association between intimate partner psychological violence (P-IPV) from before pregnancy to 2 years after the child’s birth and child’s sleep patterns, i.e. sleep onset difficulty (SOD), nighttime awakenings (NA), and nighttime sleep duration (NSD) between 2 and 5 years of child’s age. 

Méthods: Data come from the population-based French birth ELFE cohort launched in 2011. P-IPV was assessed before and during pregnancy, at 2 months and 2 years post-partum. Children’s sleep patterns were measured at 2, 3, and 5 years of age. Group-based trajectory modelling was used to identify trajectories of P-IPV and each child’s sleep patterns. Associations between P-IPV and children’s sleep trajectories were assessed by weighted multivariate logistic regressions. 

Results: Five P-IPV trajectories were identified: minimal (64%), prenatal (14%), decreasing (9%), increasing (8%), and persistent (5%). Two trajectories of SOD (few 65% and many 35%), three trajectories of NA (few 49%, decreasing 24%, and many 23%), and three trajectories of NSD (short 21%, medium 56%, and long 23%) were identified. About 9513, 9512, and 9499 children were included in comparative analyses, respectively, focused on SOD, NA, and NSD. Increasing and persistent P-IPV trajectories were both associated with the trajectory of many SODs [odds ratio (OR) = 1.53, 95% confident interval (CI) = 1.24–1.91; and OR = 1.71, 95% CI = 1.31–2.22, respectively] and the trajectory of many NA (OR = 1.66, 95% CI = 1.29–2.13); and (OR = 1.95, 95% CI = 1.42–2.69, respectively). Associations between persistent P-IPV and decreasing and many NA were significant among girls (OR = 1.76, 95% CI = 1.12–2.75 and OR = 2.27, 95% CI = 1.39–3.71, respectively), but not among boys.

Conclusion: Family interventions in response to IPV should pay particular attention to sleep patterns of children exposed to IPV.

Abstract

Background: Numerous strategies for preventing abusive head trauma (AHT) have been proposed, but controlled studies failed to demonstrate their effectiveness. Digital tools may improve the effectiveness of AHT prevention strategies by reaching a large proportion of the adult population.

Objective: This study aimed to describe the characteristics of videos of AHT prevention published on the internet, including their quality content, and to study their association with popularity.

Methods: From a systematic appraisal performed in June 2023, we identified videos addressing the primary prevention of AHT in children younger than 2 years that were published in English or French on the internet by public organizations or mainstream associations. We analyzed the characteristics of the videos; their quality with the Global Quality Scale (GQS); and their association with an index of popularity, the Video Power Index, using multivariable quasi-Poisson modeling.

Results: We included 53 (6.6%) of the 804 videos identified. Videos were mainly published by public organizations (43/53, 81%). The median time spent on the web was 6 (IQR 3-9) years, the median length was 202 (IQR 94-333) seconds, and the median GQS score was 4 (IQR 3-4). Infants were often depicted (42/53, 79%), including while crying (35/53, 66%) and being shaken (21/53, 40%). The characterization of shaking as an abuse and its legal consequences were cited in 47% (25/53) and 4% (2/53) of videos, respectively. The main prevention strategies in the videos were to raise awareness of the noxious outcome of shaking (49/53, 93%) and convince viewers of the effectiveness of coping strategies for infants’ cries (45/53, 85%). The Video Power Index was positively correlated with the GQS (r=0.38; P=.007) and was independently associated with depicting an infant being shaken (P=.03; β=1.74, 95% CI 1.06-2.85) and the use of text or headers (P=.04; β=2.15, 95% CI 1.08-4.26).

Conclusions: AHT prevention videos had high quality but did not frequently deal with parental risk factors. The characteristics identified as being associated with the popularity of AHT prevention videos could help improve the impact of future prevention programs by enhancing their popularity.