Early developmental, behavioral, and quality of life outcomes following abusive head trauma in infants

Abstract

BackgroundDevelopmental delays following pediatric abusive head trauma are common. ObjectiveTo assess early developmental, behavioral, and quality of life outcomes following infant abusive head trauma and evaluate injury severity and early therapeutic intervention as potential predictors. Participants and settingInfants under 12 months old who were admitted to a large pediatric hospital with abusive head trauma between October 2010 and October 2017 and followed at a multidisciplinary post-injury clinic were included. MethodsInjury severity groups were classified based on days in the Pediatric Intensive Care Unit. Participation in early intervention services and/or physical or occupational therapy by the first clinic visit was documented. Development was assessed using the Mullen Scales of Early Learning, which 47 patients completed at approximately 6 month intervals up to 3 years of age (an average of 19 months post-injury). Behavior and quality of life were assessed around age 2 using the Child Behavior Checklist (n = 24) and PedsQL™ (n = 27), respectively. ResultsOverall cognitive development, fine motor function, and expressive language significantly declined with age up to 3 years (p < 0.05). The changes in these developmental scales with age differed significantly between injury severity groups (p < 0.05). Internalizing behaviors were also greater in patients with moderate than mild injuries (t = 2.37, p = 0.037). Quality of life was comparable to healthy populations. Early therapeutic intervention was not significantly associated with developmental, behavioral, or quality of life outcomes (p > 0.05). ConclusionsLong-term comprehensive follow-up is recommended for children following abusive head trauma, as developmental delays and behavioral problems may present at later ages.