Am J Perinatol 2024; 41(06): 764-770
DOI: 10.1055/s-0042-1744509
Original Article

Risk Factors for Foster Care Placement in Patients with Bronchopulmonary Dysplasia

Tyler L King
1   Division of Newborn Medicine, Washington University School of Medicine in St. Louis, St Louis, Missouri
,
A. Ioana Cristea
2   Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Indiana University School of Medicine, Indianapolis, Indiana
,
James E. Slaven
3   Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
,
Jason Z. Niehaus
4   Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, Indiana
› Author Affiliations

Abstract

Objective Bronchopulmonary dysplasia (BPD) is a major cause of morbidity in neonates and can be associated with long hospitalization and high health care utilization. This extremely stressful situation can be difficult for many families and caregivers. The high-risk situation combined with increased medical complexity can result in involvement of Department of Child Services (DCS) and even foster care placement. This study seeks to define risk factors for DCS involvement and foster care placement in children with BPD.

Study Design A retrospective study of children born at less than 32 weeks of gestation born between 2010 and 2016, on oxygen at 28 days of life and discharged home from a tertiary care center.

Results A total of 246 patients were identified. DCS was involved in 49 patients with 13 requiring foster care placement. The most common correlated risk factors that were identified for DCS involvement were maternal THC (tetrahydrocannabinol) positivity, hospital policy violations, maternal mental health diagnosis, and home insecurity. Home insecurity (p < 0.005) and amphetamine use (p < 0.005) were associated with foster care placement.

Conclusion There are numerous risk factors for both DCS and foster care placement. The identification of these risk factors is important to help establish services to help families and identify potential biases to avoid.

Key Points

  • There were both substance-related and non-substance-related risk factors for DCS involvement.

  • Home insecurity and maternal amphetamine use were risk factors associated with foster care placement.

  • This study fills the knowledge gap of risk factors for DCS and foster care placement in BPD.



Publication History

Received: 28 July 2021

Accepted: 17 February 2022

Article published online:
18 April 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Williams EP, Seltzer RR, Boss RD. Language matters: identifying medically complex children in foster care. Pediatrics 2017; 140 (04) e20163692
  • 2 Wildeman C, Emanuel N. Cumulative risks of foster care placement by age 18 for U.S. children, 2000-2011. PLoS One 2014; 9 (03) e92785
  • 3 Tung I, Christian-Brandt AS, Langley AK, Waterman JM. Developmental outcomes of infants adopted from foster care: predictive associations from perinatal and preplacement risk factors. Infancy 2020; 25 (01) 84-109
  • 4 Vig S, Chinitz S, Shulman L. Young children in foster care. Infants Young Child 2005; 18 (02) 147-160
  • 5 Parker MG, Garg A, McConnell MA. Addressing childhood poverty in pediatric clinical settings: the neonatal intensive care unit is a missed opportunity. JAMA Pediatr 2020; 174 (12) 1135-1136
  • 6 Voynow JA. “New” bronchopulmonary dysplasia and chronic lung disease. Paediatr Respir Rev 2017; 24: 17-18
  • 7 Hintz SR, Kendrick DE, Vohr BR, Poole WK, Higgins RD. National Institute of Child Health and Human Development (NICHD) Neonatal Research Network. Community supports after surviving extremely low-birth-weight, extremely preterm birth: special outpatient services in early childhood. Arch Pediatr Adolesc Med 2008; 162 (08) 748-755
  • 8 Mowitz ME, Ayyagari R, Gao W, Zhao J, Mangili A, Sarda SP. Health care burden of bronchopulmonary dysplasia among extremely preterm infants. Front Pediatr 2019; 7: 510
  • 9 Álvarez-Fuente M, Arruza L, Muro M. et al. The economic impact of prematurity and bronchopulmonary dysplasia. Eur J Pediatr 2017; 176 (12) 1587-1593
  • 10 Michael Z, Spyropoulos F, Ghanta S, Christou H. Bronchopulmonary dysplasia: an update of current pharmacologic therapies and new approaches. Clin Med Insights Pediatr 2018; 12: 1179556518817322
  • 11 Mowitz ME, Mangili A, Han L. et al. Prevalence of chronic respiratory morbidity, length of stay, inpatient readmissions, and costs among extremely preterm infants with bronchopulmonary dysplasia. Expert Rev Pharmacoecon Outcomes Res 2021; 21 (05) 1117-1125
  • 12 Kalikkot Thekkeveedu R, Guaman MC, Shivanna B. Bronchopulmonary dysplasia: a review of pathogenesis and pathophysiology. Respir Med 2017; 132: 170-177
  • 13 Vogel JP, Chawanpaiboon S, Moller AB, Watananirun K, Bonet M, Lumbiganon P. The global epidemiology of preterm birth. Best Pract Res Clin Obstet Gynaecol 2018; 52: 3-12
  • 14 Vos AA, Posthumus AG, Bonsel GJ, Steegers EA, Denktaş S. Deprived neighborhoods and adverse perinatal outcome: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2014; 93 (08) 727-740
  • 15 Tooley WH. Epidemiology of bronchopulmonary dysplasia. J Pediatr 1979; 95 (5, Pt 2): 851-858
  • 16 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
  • 17 Harris PA, Taylor R, Minor BL. et al; REDCap Consortium. The REDCap consortium: building an international community of software platform partners. J Biomed Inform 2019; 95: 103208
  • 18 Alenius S, Kajantie E, Sund R. et al. Out-of-home care placements of children and adolescents born preterm: a register-based cohort study. Paediatr Perinat Epidemiol 2020; 34 (01) 38-47 6
  • 19 Wildeman C, Edwards FR, Wakefield S. The cumulative prevalence of termination of parental rights for U.S. children, 2000-2016. Child Maltreat 2020; 25 (01) 32-42
  • 20 Wolf ER, Donahue E, Sabo RT, Nelson BB, Krist AH. Barriers to attendance of prenatal and well-child visits. Acad Pediatr 2021; 21 (06) 955-960
  • 21 Sanmartin MX, Ali MM, Lynch S, Aktas A. Association between state-level criminal justice-focused prenatal substance use policies in the US and substance use-related foster care admissions and family reunification. JAMA Pediatr 2020; 174 (08) 782-788
  • 22 Wendell AD. Overview and epidemiology of substance abuse in pregnancy. Clin Obstet Gynecol 2013; 56 (01) 91-96
  • 23 McHugh RK, Wigderson S, Greenfield SF. Epidemiology of substance use in reproductive-age women. Obstet Gynecol Clin North Am 2014; 41 (02) 177-189
  • 24 Gorman MC, Orme KS, Nguyen NT, Kent III EJ, Caughey AB. Outcomes in pregnancies complicated by methamphetamine use. Am J Obstet Gynecol 2014; 211 (04) 429.e1-429.e7
  • 25 Nguyen D, Smith LM, Lagasse LL. et al. Intrauterine growth of infants exposed to prenatal methamphetamine: results from the infant development, environment, and lifestyle study. J Pediatr 2010; 157 (02) 337-339
  • 26 Smid MC, Metz TD, Gordon AJ. Stimulant use in pregnancy: an under-recognized epidemic among pregnant women. Clin Obstet Gynecol 2019; 62 (01) 168-184
  • 27 Cutts DB, Meyers AF, Black MM. et al. US Housing insecurity and the health of very young children. Am J Public Health 2011; 101 (08) 1508-1514
  • 28 Drennen CR, Coleman SM, Ettinger de Cuba S. et al. Food insecurity, health, and development in children under age four years. Pediatrics 2019; 144 (04) e20190824
  • 29 Gadson A, Akpovi E, Mehta PK. Exploring the social determinants of racial/ethnic disparities in prenatal care utilization and maternal outcome. Semin Perinatol 2017; 41 (05) 308-317
  • 30 Beck AF, Edwards EM, Horbar JD, Howell EA, McCormick MC, Pursley DM. The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families. Pediatr Res 2020; 87 (02) 227-234
  • 31 Lorch SA, Enlow E. The role of social determinants in explaining racial/ethnic disparities in perinatal outcomes. Pediatr Res 2016; 79 (1–2): 141-147
  • 32 Rijbroek B, Strating MMH, Konijn HW, Huijsman R. Child protection cases, one size fits all? Cluster analyses of risk and protective factors. Child Abuse Negl 2019; 95: 104068