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BACKGROUND: Analysis of pediatric traumatic brain injury (TBI) from maltreatment (Abusive Health Trauma, or AHT), particularly in infants, has given rise to interventions designed to ensure that no infant suffers serious TBI due to maltreatment. Pediatric neurosurgeon Mark Dias demonstrated that the rate of infant AHT was reduced by half when using an intervention that included showing an educational video to, and obtaining a signed commitment statement from parents of newborns, and coupled with a nurse follow-up to parents who did not complete the signed statement. Based upon this research Minnesota Statute (M.S.) 144.574 was enacted (effective: 1-1-2006), assuring that a video on the dangers of shaking infants is available for viewing by parents of newborns. This analysis looks at the effect of the statute on preventing AHT in infants.
METHODS: AHT Cases were identified from the TBI Registry; this statewide registry mandates reporting of all hospitalized TBI, including AHT. This data was supplemented with cases from hospital administrative claims data as well as death certificates. Cases identified from these 3 sources were used to create a data file from 1999-2012, providing 7 years of observation both prior to, and following, the effective date of M.S. 144.574.
RESULTS: We found 383 cases of infant AHT, including 25 fatalities. Minnesota’s 14-year annualized rate of infant AHT, 39.9/100,000 infants, is similar to that reported by Dr. Dias in New York prior to his intervention. In Minnesota, over our 14 year study period there was an increasing trend for infant AHT. The annualized rate of AHT in infants before the effective date of M.S. 144.574 (1999-2005) was 34.4 per 100,000 infants; in the time period after (2006-2012) it was 45.0/100,000.
CONCLUSIONS: Our analysis is unable to demonstrate an intervention effect of M.S. 144.574. Clearly there is year-to-year volatility in the counts, including a possible effect in 2005 due to the increased awareness of infant AHT from the enactment of the statute. The increase in the time period following the effective date of the statute stands in contrast to Dr. Dias’ research showing a significant reduction in AHT following his intervention. However, his research had indicated showing the video to parents was the weakest part of his intervention; M.S. 144.574 mandates only the provision of the video, not the signed statement or the nurse follow-up. Consideration should be given to going beyond the minimal statutory mandate, and more faithfully implementing Dr. Dias’ intervention.