The relationship between utilization of prenatal care and neonatal brain injury in low birth weight infants

Low birth weight (LBW) is a leading cause of neonatal and infant death and morbidity. Significant morbidity in LBW infants occurs due to neonatal brain injury. Increased survival of LBW infants has been accompanied by an increase in neonatal brain injury with devastating long term sequelae that include cerebral palsy, vision loss, epilepsy, mental retardation, and school-age psychiatric disorders. There is mounting evidence identifying the time of insult causing neonatal brain injury occurring in-utero for some infants. It is therefore important to explore the relationship between utilization of prenatal care (PNC) and neonatal brain injury to identify if PNC is a modifiable risk for neonatal brain injury in LBW infants. The purpose of this nested case-control study was to examine the relationship between the utilization of PNC and the outcome of brain injury in LBW infants. Serially-timed cranial ultrasounds first obtained four hours after birth were used to select cases (n = 72) and controls (n = 412) from the Central New Jersey Neonatal Brain Hemorrhage Study. PNC utilization was categorized three separate ways (Kessner Index, Kotelchuck Index, and yes/no to receipt of care). Univariable and multiple logistic regression analyses were performed. Results identified birth weight as the most significant predictor of brain injury. Adequacy scores, reflecting entry into care and number of attended visits, using both the Kessner and Kotelchuck Indices were noncontributory to the predictive models. Applying both indices to the same population of women also yielded very different stories about their adequacy of PNC use. Most important, no receipt of care was significant. Black infants whose mothers did not receive PNC were 2.11 times more likely to have brain injury than non-black infants whose mothers received PNC (95% CI: 1.20, 3.72). Also, infants of the lowest birth weights were at higher risk if their mothers received no PNC. Continued research with a broader framework is needed to better understand what about PNC makes the difference.