Background: Shaken baby syndrome (SBS) is a violent act of abuse that can cause neurological, cognitive, and other functional deficits. In most serious cases, death can result. Main clinical features that suggest inflicted head trauma include retinal hemorrhage, subdural, and/or subarachnoid hemorrhage in an infant with little signs of external trauma. The diagnosis is often very difficult and sometimes avoided by health care practitioners, child care providers, due to the scarce experience on acute and subacute signs of SBS and on early clinical course (first 24-48 h). Aim: To provide the clinical experience on the diagnosed cases of SBS managed by the staff of the Crisis Unit for CAN of the Pediatrics Department of Padua University, and to provide a summary of research to date on SBS. Methods: The present study reviews and analyses the case clinical records of 8 cases of SBS diagnosed in the last 2 years. Particular attention was paid to clinical aspects related to the early signs and symptoms of presentation at the ER, and the clinical course within the first 48 hours. Neuroimaging and ophtalmological data have been analysed for the first 4-6 months period to evaluate the chronic consequences of injury (according to the lenght of stay in the hospital and the duration of follow-up. A comparison with data of the literature was carried out. Results: In this case series, 8 cases have been reviewed (mean age 12 months; range 1-19 months). The cases were abstracted from hospital charts. In all 8 cases the history provided by the primary caregiver did not match the severity of the injuries. 3 case subjects presented with patterned bruises. Multilayered retinal hemorrhages and acute subdural hematoma were observed in all 8 cases. The most common symptoms of onset were respiratory difficuties, dispnoea, convulsive hepisodes, enlargement of cranial circumference. At RMN, the pattern of observed injuries included subdual hemorrage and brain atrophia. 4 of the victims had occult skeletal fractures. Retinal hemorrages were observed in all cases. The fisrt 24-48 h usually have a common clinical course with a typichal pattern. Most of the cases have been brought to the attention of the physician of the ER more than once. Conclusions: Cases should be thoroughly reviewed and strategies developed to ameliorate the diagnostic specificity and to prevent future incidents. The clinical course is usually misinterpreted and tends to be confusing in the diagnostic pathway. A crucial point, even if still very poorly explored, is the assessment for the prognosis on long-term outcome in infants with SBS.

Shaken Baby Syndrome from suspect to discharge: main clinical characteristics, injury timing and neuro-developmental outcome of cases.

ROSA RIZZOTTO, MELISSA;FACCHIN, PAOLA
2007

Abstract

Background: Shaken baby syndrome (SBS) is a violent act of abuse that can cause neurological, cognitive, and other functional deficits. In most serious cases, death can result. Main clinical features that suggest inflicted head trauma include retinal hemorrhage, subdural, and/or subarachnoid hemorrhage in an infant with little signs of external trauma. The diagnosis is often very difficult and sometimes avoided by health care practitioners, child care providers, due to the scarce experience on acute and subacute signs of SBS and on early clinical course (first 24-48 h). Aim: To provide the clinical experience on the diagnosed cases of SBS managed by the staff of the Crisis Unit for CAN of the Pediatrics Department of Padua University, and to provide a summary of research to date on SBS. Methods: The present study reviews and analyses the case clinical records of 8 cases of SBS diagnosed in the last 2 years. Particular attention was paid to clinical aspects related to the early signs and symptoms of presentation at the ER, and the clinical course within the first 48 hours. Neuroimaging and ophtalmological data have been analysed for the first 4-6 months period to evaluate the chronic consequences of injury (according to the lenght of stay in the hospital and the duration of follow-up. A comparison with data of the literature was carried out. Results: In this case series, 8 cases have been reviewed (mean age 12 months; range 1-19 months). The cases were abstracted from hospital charts. In all 8 cases the history provided by the primary caregiver did not match the severity of the injuries. 3 case subjects presented with patterned bruises. Multilayered retinal hemorrhages and acute subdural hematoma were observed in all 8 cases. The most common symptoms of onset were respiratory difficuties, dispnoea, convulsive hepisodes, enlargement of cranial circumference. At RMN, the pattern of observed injuries included subdual hemorrage and brain atrophia. 4 of the victims had occult skeletal fractures. Retinal hemorrages were observed in all cases. The fisrt 24-48 h usually have a common clinical course with a typichal pattern. Most of the cases have been brought to the attention of the physician of the ER more than once. Conclusions: Cases should be thoroughly reviewed and strategies developed to ameliorate the diagnostic specificity and to prevent future incidents. The clinical course is usually misinterpreted and tends to be confusing in the diagnostic pathway. A crucial point, even if still very poorly explored, is the assessment for the prognosis on long-term outcome in infants with SBS.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11577/2437679
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