Fatal Child Research Articles

Older Adult Fatality Reviews: A Powerful Tool to Improve Policies, Protections, and Services

Older adult maltreatment is a serious problem that can hasten mortality and cause fatality. Child and Domestic Violence Fatality Review teams have made a major impact to improve protections, services, and system responses for victims. There are over 1300 child fatality review teams in 50 US states and 200 domestic violence fatality teams in 45 states. Older adult fatality reviews, in contrast, have not proliferated across the country, missing opportunities to bring interdisciplinary expertise together to resolve policy, protection, and services needed to prevent older adult premature deaths due to violence and abuse. Method: A mini mock review of a fatality of an older adult woman will demonstrate the possibilities of beginning Older Adult Fatality Review Board as recommended by the American Bar Association. Conclusion: Interdisciplinary older adult fatality review teams have been an underutilized tool to make changes in older adult mistreatment protection services and systems.

A primer on Bayesian estimation of prevalence of COVID-19 patient outcomes.

A common research task in COVID-19 studies often involves the prevalence estimation of certain medical outcomes. Although point estimates with confidence intervals are typically obtained, a better approach is to estimate the entire posterior probability distribution of the prevalence, which can be easily accomplished with a standard Bayesian approach using binomial likelihood and its conjugate beta prior distribution. Using two recently published COVID-19 data sets, we performed Bayesian analysis to estimate the prevalence of infection fatality in Iceland and asymptomatic children in the United States.

Can child drowning be eradicated? A compelling case for continued investment in prevention.

To explore temporal trends in fatal child drowning and benchmark progress across three high-income countries to provide prevention and future investment recommendations. A total population analysis of unintentional fatal drownings among 0- to 19-year-olds in Australia, Canada and New Zealand from 2005 to 2014 was undertaken. Univariate and chi-square analyses were conducted, age- and sex-specific crude rates calculated and linear trends explored. A total of 1454 children drowned. Rates ranged from 0.92 (Canada) to 1.35 (New Zealand) per 100000. Linear trends of crude drowning rates show both Australia (y=-0.041) and Canada (y=-0.048) reduced, with New Zealand (y=0.005) reporting a slight rise, driven by increased drowning among females aged 15-19years (+200.4%). Reductions of 48.8% in Australia, 51.1% in Canada and 30.4% in New Zealand were seen in drowning rates of 0- to 4-year-olds. First Nations children drowned in significantly higher proportions in New Zealand (X2 =31.7; P<.001). Continual investment in drowning prevention, particularly among 0- to 4-year-olds, is contributing to a reduction in drowning deaths; however, greater attention is needed on adolescents (particularly females) and First Nation's children. Lessons can be learned from each country's approach; however, further investment and evolution of prevention strategies will be needed to fully eradicate child drowning deaths.

Challenges in Determining Child Maltreatment Fatalities: What Do We Really Know?

The challenges associated with determining causes of fatal child maltreatment have been documented by multiple professional fields and by the US government. This study explored these challenges, as well as the relative lethality of determinations of general neglect, medical neglect and physical abuse. Existing sources of information were used for this study: (1) data from the US National Child Abuse and Neglect Data System (NCANDS) data set extracted from annual Child Maltreatment reports published by the US Department of Health and Human Services; and (2) information published in recent state‐level child death review team (CDRT) reports. Results from the NCANDS data set indicated that more children died from general neglect (x̅ = 70.9%) than abuse (x̅ = 44.8%) or medical neglect (x̅ = 8.2%). Children who experienced medical neglect died at the highest rate (6.82 per 1000 medical neglect victims), making it the most lethal, followed by physical abuse and general neglect. The findings from CDRT reports were inconsistent, with some states indicating that more children died from abuse than neglect, which is in direct contrast to national statistics. The inconsistent and confusing use of language and constructs from CDRTs has important implications for multiple child‐serving fields.Key Practitioner Messages Professional child‐serving fields struggle with making accurate determinations of abuse or neglect‐related fatalities. Most child maltreatment fatalities are related to neglect. In terms of lethality, medical neglect appears to be most lethal, followed by physical abuse, and then general neglect. US‐state CDRT reports are not consistent in their use of terms and confuse constructs such as ‘neglect’ and ‘accident’. This makes it challenging to use their reviews as reliable sources of information. We recommend the adoption of consistency in the use and understanding of terms related to child maltreatment deaths, at a minimum across all jurisdictions in the USA, if not across all nations.

State-by-State Analysis of Child Fatality Reporting: a 21-Year Review

Online reports published by Child Fatality Review Boards (CFRBs) for all 50 of the USA across 21 years, from 1998 to 2018, were downloaded and analyzed to determine the nature of the information available to the public about the causes of child fatalities. A modified coding system based on the Life Events Checklist (LEC) system of the National Center for PTSD was used to identify contexts of children’s fatal injuries. Child death due to inflicted injury by other persons is the most frequently reported context category in the 21 years surveyed. The LEC-based system captured 80% of the published fatality context data. A lack of consensus was found among the states in regard to the kinds of information reported online, how the information is organized and presented, and the frequency of reporting. These inconsistencies encumber the development of national data trends and analyses. Individual case reports with specific details about child injury context and causation, child protection history, and child protection interventions were infrequent, and when present often highly redacted.

The epidemiology of fatal drowning in children: a 13-year retrospective study in Turkey

This retrospective study aimed to investigate the prevalence of unintentional fatal drowning in children aged 0–17 years in Turkey between 2005 and 2017 and to determine the risk factors in drowning. This study is based on media reports, and all data were obtained from the media. All data were presented in frequency and percentage. Relative risk and 95% confidence intervals were calculated using the relevant population data. A total of 3,419 children died by drowning in these 13 years. The unintentional fatal child drowning rates in Turkey were 1.16; 1.80 for males and 0.48 for females per 100,000 children, which means males drowned nearly four times more than females. In terms of season, the highest rate of unintentional fatal drowning was in summer (0.69 per 100,000 children), and the lowest rate in winter (0.05 per 100,000 children). The unintentional fatal drowning rate decreased after reaching a peak in 2010 (1.52 per 100,000 children). As of 2015, the rate of unintentional fatal drowning decreased every year and reached a minimum in 2017 (0.66 per 100,000 children). Even if the mortality rate in children has decreased in recent years, more measures are still needed to prevent drowning in children.

More data, more questions: No simple answer about which children should undergo screening neuroimaging for clinically occult abusive head trauma

Abusive head trauma (AHT) is the leading cause of fatal child physical abuse. Victims may initially present with clinically occult AHT without overt signs of head trauma or with only subtle, nonspecific symptoms, which can make timely recognition of AHT challenging. Research has shown missed opportunities for early detection of AHT in the medical setting are common and can lead to repeated injury. Neuroimaging is needed to diagnose clinically occult AHT but is not without risk. Researchers have worked to understand the yield of neuroimaging in detection of clinically occult AHT and to identify risk factors, yet findings have varied widely across studies. Identifying which children undergoing physical abuse evaluations are at highest risk of clinically occult AHT is key to development of evidence-based imaging decision support tools for clinicians. Here we discuss the recent literature, identify potential reasons for variation across studies, and offer opportunities for future research.

After the First Wave of COVID-19: Reflections From Italy.

After the First Wave of COVID-19: Reflections From Italy.

Impact of statewide safe sleep legislation on hospital practices and rates of sudden unexpected infant deaths

BackgroundSudden Unexpected Infant Death (SUID) is the leading cause of death in the post-neonatal period in the United States. In 2015, Connecticut (CT) passed legislation to reduce the number of SUIDs from hazardous sleep environments requiring birthing hospitals/centers provide anticipatory guidance on safe sleep to newborn caregivers before discharge. The objective of our study was to understand the barriers and facilitators for compliance with the safe sleep legislation by birthing hospitals and to determine the effect of this legislation on SUIDs associated with unsafe sleep environments.MethodsWe surveyed the directors and/or educators of the 27 birthing hospitals & one birthing center in CT, about the following: 1) methods of anticipatory guidance given to parents at newborn hospital discharge; 2) knowledge about the legislation; and 3) barriers and facilitators to complying with the law. We used a voluntary online, anonymous survey. In addition, we evaluated the proportion of SUID cases presented at the CT Child Fatality Review Panel as a result of unsafe sleep environments before (2011–2015) and after implementation of the legislation (2016–2018). Chi-Square and Fisher’s exact tests were used to evaluate the proportion of deaths due to Positional Asphyxia/Accident occurring before and after legislation implementation.ResultsAll 27 birthing hospitals and the one birthing center in CT responded to the request for the method of anticipatory guidance provided to caregivers. All hospitals reported providing anticipatory guidance; the birthing center did not provide any anticipatory guidance. The materials provided by 26/27 (96%) of hospitals was consistent with the American Academy of Pediatrics (AAP) Guidelines. There was no significant change in rates of SUID in CT before (58.86/100,000) and after (55.92/100,000) the passage of the legislation (p = 0.78). However, more infants died from positional asphyxia after (20, 27.0%) than before the enactment of the law (p < 0.01).ConclusionsDespite most CT hospitals providing caregivers with anticipatory guidance on safe sleep at newborn hospital discharge, SUIDs rates associated with positional asphyxia increased in CT after the passage of the legislation. The role of legislation for reducing the number of SUIDs from hazardous sleep environments should be reconsidered.

Lessons From COVID-19 in Children: Key Hypotheses to Guide Preventative and Therapeutic Strategies.

The current pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), reveals a peculiar trend of milder disease and lower case fatality in children compared to adults. Consistent epidemiologic evidence of reduced severity of infection in children across different populations and countries suggests there are underlying biologic differences between children and adults that mediate differential disease pathogenesis. This presents a unique opportunity to learn about disease modifying host factors from pediatric populations. Our review summarizes the current knowledge of pediatric clinical disease, role in transmission, risks for severe disease, protective immunity, as well as novel therapies and vaccine trials for children. We then define key hypotheses and areas for future research that can use the pediatric model of disease, transmission, and immunity to develop preventive and therapeutic strategies for people of all age groups.

Child Access Prevention Firearm Laws and Firearm Fatalities Among Children Aged 0 to 14 Years, 1991-2016

Firearms caused more than 500 pediatric fatalities in 2017-a 50% increase from 2009. Laws regulating firearms are one approach to reducing pediatric firearm fatalities. To evaluate the association between state child access prevention (CAP) firearm laws and pediatric firearm fatalities. A state-level, cross-sectional study of CAP firearm laws throughout the United States, 1991-2016, was conducted using negative binomial regression to analyze differences in state fatality rates in children aged 0 to 14 years. Data analysis was performed from November 21, 2018, to October 18, 2019. Implementation of 2 categories of state CAP firearm laws: recklessness laws, which pertain to providing a firearm to a child, and negligence laws, which pertain to accessibility of a firearm within the home. Rates of firearm fatalities across all intents and by specific intent (homicide, suicide, and unintentional) per 100 000 children aged 0 to 14 years. Twenty-five states passed CAP laws between 1989 and 2000. Between 1991 and 2016, 13 697 firearm fatalities occurred in children aged 0 to 14 years. Recklessness laws were not associated with changes in pediatric firearm fatality rates. Negligence laws overall were associated with significant reductions in firearm fatalities in children aged 0 to 14 years, with a 13% relative reduction in all firearm fatalities (95% CI, -18% to -7%), a 15% relative reduction in firearm homicides (95% CI, -22% to -7%), a 12% relative reduction in firearm suicides (95% CI, -20% to -2%), and a 13% relative reduction in unintentional firearm fatalities (95% CI, -24% to -1%). The most stringent negligence laws were associated with unintentional firearm fatality reductions of 59% (95% CI, -68% to -49%). A total of 3929 deaths (29% of all firearm deaths) were associated with states not having passed the most stringent form of negligence CAP laws. In this study, negligence laws were associated with relative reductions in firearm fatality rates in children aged 0 to 14 years. The most stringent negligence laws were associated with the largest reductions in unintentional firearm fatalities. Recklessness laws were not associated with reduced firearm fatality rates. The passage of negligence CAP laws may have the potential to reduce firearm fatalities in children.

Risk Factors for Child Maltreatment Fatalities in a National Pediatric Inpatient Database.

Child maltreatment (CM) is recognized as a major public health concern, and an important number of children suffer injuries related to abuse and neglect that result in death. We sought to identify risk factors for CM fatalities among hospitalized children that can provide clinicians with information to recognize at-risk children and reduce further death. In this study, we included cases from the 2012 Kids' Inpatient Database with diagnosis codes related to CM who were <5 years of age and were not transferred to another facility. Potential demographic and clinical risk factors were identified and compared to child fatality in the hospital by using bivariate and multivariate analyses. To assess how cases coded specifically for maltreatment differed from similar cases that only suggested maltreatment, a reduced-model multivariable logistic regression for fatality was created. We found 10 825 children <5 years who had inpatient diagnoses coded in their medical record for CM. Most demographic variables (age, race, and sex) were not significantly associated with fatality, whereas clinical variables (transferring in, drowning, ingestions, and burns) were significantly associated with fatality. There were regional differences on the basis of hospital location as well as significantly more chronic conditions, procedure charges, and longer lengths of stay among children who died. Controlling for significant risk factors, those with diagnoses specific for physical abuse had ∼3 times the odds of dying (odds ratio = 2.797; 95% confidence interval: 1.941-4.031). In this study, although infancy and decreased income were associated with increased risk for fatality, more important factors were the types of injuries the child endured and whether the inpatient clinician had identified specific injuries indicating physical abuse.

Survival and sex composition of offspring: Individual-level responses in the quantum and tempo of childbearing during the demographic transition

Previous studies have documented varying fertility responses to childhood mortality and to the sex composition of the surviving offspring during the demographic transition. We contribute to this literature by applying a mixture cure model to reproductive histories of Estonian women born 1850–99. This model, unlike standard event history models, is capable of separating the effect of the covariates on the propensity of having another birth from their effect on its timing. Child fatalities, not having sons, and to a smaller extent, not having daughters, increased the propensity to have another child and decreased the interval to it. The response was stronger among later cohorts, but only with respect to parity progression. By contrast, the accelerated childbearing response diminished over time. Our findings suggest that behavioural responses in the quantum and tempo of childbearing can occur relatively independently.

Bile Salts Alter the Mouse Norovirus Capsid Conformation - Possible Implications for Cell Attachment and Immune Evasion

Noroviruses are the major cause for endemic gastroenteritis worldwide, resulting in 650 million cases and 50,000 child fatalities annually. To date, no antivirals or vaccine treatments are available. Outbreak prevention has proven difficult due to the high infectivity rate of the virus. The norovirus capsid is composed of 180 copies of the VP1 protein and consists of a shell and a protruding (P) domain. Utilizing murine norovirus (MNV) as a model, the MNV cellular receptor (CD300lf) was identified by the Virgin lab. It was found bile salts enhance binding interactions between soluble forms of CD300lf and the P domains and improve viral attachment to target cells. Using cryo-EM, we found the virus in PBS buffer exists in an ‘expanded’ state with the P domain ‘floating’ above the shell domain. Upon bile addition, the P domain rotates 90° and contracts down >10Å. From modeling and the cryo-EM structure of the receptor/virus complex, it appears there is more room for receptor binding in the bile-induced contracted state. Bile also causes conformational changes within the P domain. When bile binds, a surface loop (C’D’) rotates upwards, resulting in a large movement in the major antigenic loops. From our cryo-EM structures of two different Fab/MNV complexes, this bile-induced conformation may not be amenable to antibody binding. Therefore, it appears there are two ‘faces’ of MNV. In serum, a highly flexible P domain and one structure of the antigenic loops is presented to the immune system. When entering the site of initial infection, the gut, bile binds and compresses the capsid into a conformation that is optimized for receptor binding while shifting the P domain away from an antibody binding conformation to one that favors receptor binding.

Rosmarinic acid exhibits broad anti-enterovirus A71 activity by inhibiting the interaction between the five-fold axis of capsid VP1 and cognate sulfated receptors

ABSTRACT Enterovirus A71 (EV-A71), a positive-stranded RNA virus of the Picornaviridae family, may cause neurological complications or fatality in children. We examined specific factors responsible for this virulence using a chemical genetics approach. Known compounds from an anti-EV-A71 herbal medicine, Salvia miltiorrhiza (Danshen), were screened for anti-EV-A71. We identified a natural product, rosmarinic acid (RA), as a potential inhibitor of EV-A71 by cell-based antiviral assay and in vivo mouse model. Results also show that RA may affect the early stage of viral infection and may target viral particles directly, thereby interfering with virus-P-selectin glycoprotein ligand-1 (PSGL1) and virus-heparan sulfate interactions without abolishing the interaction between the virus and scavenger receptor B2 (SCARB2). Sequencing of the plaque-purified RA-resistant viruses revealed a N104K mutation in the five-fold axis of the structural protein VP1, which contains positively charged amino acids reportedly associated with virus-PSGL1 and virus-heparan sulfate interactions via electrostatic attraction. The plasmid-derived recombinant virus harbouring this mutation was confirmed to be refractory to RA inhibition. Receptor pull-down showed that this non-positively charged VP1-N104 is critical for virus binding to heparan sulfate. As the VP1-N104 residue is conserved among different EV-A71 strains, RA may be useful for inhibiting EV-A71 infection, even for emergent virus variants. Our study provides insight into the molecular mechanism of virus-host interactions and identifies a promising new class of inhibitors based on its antiviral activity and broad spectrum effects against a range of EV-A71.

Clinico-epidemiological characteristics of hospitalized acute encephalitis syndrome children and their correlation with case fatality rate

Background:Acute Encephalitis Syndrome (AES) in children contributes considerable morbidity and mortality in endemic region. A study was conducted to see the clinico-epidemiological characteristics of hospitalized AES children and to find out if there is any correlation of clinico-epidemiological factors with case fatality rate (CFR).Methods:This hospital-based observational prospective study was conducted in a tertiary care teaching hospital of Assam, India from 16th May, 2019 to 15th May, 2020. We enrolled clinically diagnosed 140 hospitalized AES children consecutively as per WHO case definition. Cerebrospinal fluid and serum samples were tested for JEV-specific IgM antibodies.Results:Out of 140 AES children 84 (60%) were male and 5–12 years age group had the highest 79 (56.4%) number of cases. Primarily cases were from rural areas 132 (94.3%). In addition to fever, major clinical manifestations were seizures 114 (81.4%), altered sensorium 128 (91.4%), meningeal signs 62 (44.3%), and <8 GCS 42 (30%). CFR was 27.7%. Significantly high CFR was seen among AES children with GCS <8 (P-value 0.0001) and presence of meningeal signs (P-value 0.0007). A higher proportion of non-survivors 55.6% were non JE AES. Monthly incidence of AES/Death showed a peak in the month of July.Conclusion:AES in children is a significant public health problem in the study area with high CFR. Presence of GCS <8 and meningeal irritation are the important predictors of mortality in AES children. Preponderance of non-JE AES case fatality in children warrant further exploration and appropriate public health interventions.

Professional negligence during nitrous oxide sedation and child fatality in dental office and suggested precautions: A short communication on childcare and nitrous oxide sedation

Paediatric death inside dental office by the effect of anaesthesia in dentistry is a very difficult case but not rare. In this article, we reviewed more than thirty studies with data focussing on death associated with dental anaesthesia using nitrous oxide (N2O). In children, most cases died at the age of 2–5 years. Hypoxia was the most common cause of death and cardiovascular, respiratory. Although rare death following general anaesthesia in dentistry, it is a critical side effect mostly seen in adult patients with compromised health conditions. Therefore, appropriate case selection in regard to patient's general health status as well as standard technical and equipment conditions is mandatory to reduce the risk of death during N2O dental anaesthesia in children. We have also given the list of guidelines and dietary care for children during N2O anaesthetic procedures inside the dental office.

Driving Improvements in Child Protection and Safeguarding Practice

Driving Improvements in Child Protection and Safeguarding Practice

Estimating the Burden of Prematurity on Infant Mortality: A Comparison of Death Certificates and Child Fatality Review in Ohio, 2009-2013.

Introduction Infant mortality is a key population health indicator, and accurate cause of death reporting is necessary to design infant mortality prevention strategies. Death certificates and child fatality review (CFR) both track leading infant causes of death in Ohio but produce different results. Our aim was to determine the frequency and characteristics of differences between the two systems to understand both cause of death ranking systems for Ohio. Methods We linked and analyzed data from death certificates and CFR records for all infant deaths (aged < 1year) in Ohio during 2009-2013. Death certificate and CFR cause of death assignments were compared. Kappa statistic was used to measure concordance. Death certificate-CFR cause of death pairs were plotted to identify common concordant and discordant pairs. Results A total of 5030 infant deaths with death certificate and CFR records were analyzed. The most common discordant cause of death pair was other perinatal condition on the death certificate and prematurity by CFR (1119). Specific injury categories had higher concordance (kappa 0.71-1.00) than medical categories (kappa 0.00-0.78). Among 456 deaths categorized as sudden infant death syndrome on death certificates, approximately 50% (230) were categorized as missing, unknown, or undetermined by CFR. Discussion Linking death certificate and CFR causes of death provided a more robust understanding of infant causes of death in Ohio. Separately, each system serves distinct and valuable purposes that should be reviewed before selecting one system for ranking leading causes of infant mortality.

Changes in monocyte subsets are associated with clinical outcomes in severe malarial anaemia and cerebral malaria

Monocytes are plastic heterogeneous immune cells involved in host-parasite interactions critical for malaria pathogenesis. Human monocytes have been subdivided into three populations based on surface expression of CD14 and CD16. We hypothesised that proportions and phenotypes of circulating monocyte subsets can be markers of severity or fatality in children with malaria. To address this question, we compared monocytes sampled in children with uncomplicated malaria, severe malarial anaemia, or cerebral malaria. Flow cytometry was used to distinguish and phenotype monocyte subsets through CD14, CD16, CD36 and TLR2 expression. Data were first analysed by univariate analysis to evaluate their link to severity and death. Second, multinomial logistic regression was used to measure the specific effect of monocyte proportions and phenotypes on severity and death, after adjustments for other variables unrelated to monocytes. Multivariate analysis demonstrated that decreased percentages of non-classical monocytes were associated with death, suggesting that this monocyte subset has a role in resolving malaria. Using univariate analysis, we also showed that the role of non-classical monocytes involves a mostly anti-inflammatory profile and the expression of CD16. Further studies are needed to decipher the functions of this sub-population during severe malaria episodes, and understand the underlying mechanisms.