Diagnosis Of Shaken Baby Syndrome Research Articles

Knowing, recognizing, and preventing shaken baby syndrome: The role of primary care pediatrician

The Shaken Baby Syndrome (SBS) is the result of a severe form of physical abuse inflicted on children under the age of 2, mostly by parents or other caregivers, to quiet their inconsolable crying. The violent shaking of the child results in devastating consequences up to death or can lead to serious neurological sequelae and/or compromise of their neurodevelopment. The clinical diagnosis of SBS is not always easy and immediate, especially in cases where the picture presents with subtle signs and symptoms not directly attributable to abuse: it is therefore fundamental that the family pediatrician is aware of this nosological entity, suspects it in the presence of certain risk factors, always considers it in the differential diagnosis like any other pathology, and above all prevents it through sensitization and education of parents and other caregivers to adequately manage their child's crying. This article aims to emphasize the role of primary care pediatricians in knowing, recognizing, and preventing the shaken baby syndrome.

Una RM encefalo che parla da sola

A two-month-old infant was admitted with clonic movements of the limbs. At the brain MRI multiple supra and infratentorial haemorrhagic lesions were present leading to the diagnosis of shaken baby syndrome.

Una meningite da scossa

The case of a 30-day-old newborn presenting with clonic movements and loss of consciousness, initially misdiagnosed as bacterial meningitis, is described. The diagnosis of shaken baby syndrome was finally made.

COULD BIRTHMARKS BE A RISK FACTOR FOR CHILD ABUSE?

Ponte Academic JournalFeb 2022, Volume 78, Issue 2 COULD BIRTHMARKS BE A RISK FACTOR FOR CHILD ABUSE?Author(s): Ahmet Sedat Dündar ,Bora Özdemir, Mucahit Oruç, Selami Çağatay Önal, Atilla ÇifciiJ. Ponte - Feb 2022 - Volume 78 - Issue 2 doi: 10.21506/j.ponte.2022.2.7 Abstract:BACKGROUND Mongolian spots, especially when seen in atypical areas, are of great importance in forensic medicine as they can be confused with the bruising and marks that are one of the most important skin findings of abuse. This confusion could cause a misdiagnosis of abuse. Several skin findings are known to resemble the marks of physical and sexual abuse. However, in child abuse, there is the question to be considered of risk factors of the child, parents, and family. CASE SUMMARY The case is here presented of an infant with retarded development and a Mongolian spot among findings mimicking physical abuse. As there were severe clinical findings on presentation which conflicted with the anamnesis taken from the mother, a diagnosis of shaken baby syndrome was made first. As the medical records were incomplete, it was difficult to decide on the point of child abuse for this infant who was brought to the clinic with head trauma. CONCLUSİONS Together with retarded development, Mongolian spots, which are not given much importance by physicians, could be a risk factor leading to child abuse. Download full text:Check if you have access through your login credentials or your institution Username Password

Shaken Baby Syndrome: Simple Review Article

Shaken Baby Syndrome (SBS) occurs in infants when the head is subjected to excessive acceleration and deceleration. Guthkelch first identified SBS when he noticed that infants with subdural hematoma did not always have gross markings, indicating the possibility of a baby shaking. The rotational force pushes the brain against the skull, causing various types of head and neck injuries. Ophthalmologic testing for retinal haemorrhages and ocular fundus, which can rule out SBS, is one of the tests for SBS. Immunohistochemical staining for -amyloid precursor protein (-APP) and magnetic resonance imaging (MRI) accurately identify brain injuries and bleeding, resulting in a more accurate diagnosis of SBS. SBS symptoms are shared by other etiologies, making it difficult to determine the true cause of infantile injury. Experiments using biomechanical models to recreate the whiplash movement have not revealed subdural haemorrhaging, but limitations in the models have doubt to these results.

Fractures and skin lesions in pediatric abusive head trauma: a forensic multi-center study

Abusive head trauma (AHT) and its most common variant, the shaken baby syndrome (SBS), are predominantly characterized by central nervous system-associated lesions. Relatively little data are available on the value of skeletal and skin injuries for the diagnosis of SBS or AHT. Thus, the present study retrospectively investigated 72 cases of living children diagnosed with the explicit diagnosis of SBS during medico-legal examinations at three German university institutes of legal medicine. The risk of circular reasoning was reduced by the presence of 15 cases with confession by perpetrators. Accordingly, the comparison with the 57 non-confession cases yielded no significant differences. Skeletal survey by conventional projection radiography, often incomplete, was found to be performed in 78% of the cases only. Fractures were found in 32% of the cases. The skull (43%) and ribs (48%) were affected most frequently; only 8% of the cases showed classic metaphyseal lesions. In 48% of the cases, healing fractures were present. Skin lesions (hematomas and abrasions) were found in 53% of the cases with the face (76%), scalp (26%), and trunk (50%) being the major sites. In 48% of the cases, healing skin lesions were observed. Nearly 80% of the cases with fractures also showed skin lesions. The data prove that SBS is frequently accompanied by other forms of physical abuse. Therefore, skeletal survey is indispensable and should always be done completely and according to existing imaging guidelines if child abuse is suspected.

The legal challenges to the diagnosis of shaken baby syndrome or how to counter 12 common fake news.

The shaken baby syndrome (SBS) is a common cause of severe traumatic lesions in infants. Although well established for almost five decades, SBS and its diagnosis are becoming more and more aggressively challenged in courts. These challenges feed on the scientific debate and controversies regarding the pathophysiology and the differential diagnoses, scientific uncertainty being readily exploited by specialized barristers. In the present review, we analyze the most common challenges to the concept of SBS and its diagnosis, as well as the scientific evidence available to counter these challenges, the differential diagnoses, and how SBS can be diagnosed with confidence. We found that the pathophysiology of SBS is well documented, with stereotyped descriptions by perpetrators, in good correlation with experimental studies and computer models. SBS is a well-defined clinico-pathological entity with a characteristic constellation of lesions; with a rigorous evaluation protocol, its diagnosis can be made rapidly and with excellent accuracy beyond a reasonable doubt. It is important that medical experts master an extensive knowledge regarding the pathophysiology of the lesions of SBS, in particular infantile subdural hematomas, as well as other CSF-related conditions. This emphasizes the role that pediatric neurosurgeons should play in the clinical and medicolegal management of these patients.

The medical and social outcome in 2016 of infants who were victims of shaken baby syndrome between 2005 and 2013

IntroductionThere are few studies that have investigated the long-term outcome of children who have been victims of shaken baby syndrome (SBS). However, the consequences appear to be significant and the data available from a social point of view are scarce. The main objective of this study was to define the medical and social outcome in 2016 of the infants who were victims of SBS and admitted to one of the Marseille university hospitals. The number of patients followed by a specialized team was evaluated along with their clinical state, living conditions, and whether a social support system such as the Child welfare system had been put into place. MethodThe study was retrospective and descriptive. Patients under 1 year of age who were hospitalized between January 2005 and December 2013 and manifested clinical and paraclinical characteristics enabling the diagnosis of SBS were included in the study. The diagnosis was certain, probable, or possible according to the definitions given by the consensus of the 2011 shaken baby health authority conference (HAS). ResultsEighty babies qualified for the study, three of whom died in intensive care. Only ten of these patients (12.9%) had regular (annual) neuropediatric check-up during the whole study period. Thirty-seven patients (48%) had an annual neuropediatric check-up during the first 2 years only following the diagnosis. Only 12 of the children (15.6%) were still being followed after the age of 6. The children were followed up on average for 2.5 years (29.6 months). In 24 cases (31%), the last medical visit revealed an abnormal neurological examination including multiple disabilities due to spastic quadriplegia and severe intellectual deficit, which led to total dependency in half of these cases. Forty-four patients (57%) had a normal neurological examination. Concerning the babies’ social outcome, 50 patients (64.9%) had returned home, 12 (15.6%) benefited, from educational assistance at the patient's home (AEMO) following the ruling of a children's judge, and 19 (24.7%) were still placed in foster care (ASE). The average foster care placement lasted 34.7 months. Discussion and conclusionLong-term medical follow-up for children having sustained serious head injury as a result of abuse is inadequate. Sequelae such as multiple disabilities are less frequent than described in the literature. According to this study, a longer-term follow-up is necessary for children suffering from sequelae such as learning disabilities than what is actually possible in our center.

Diagnostic criteria of shaking 2017: A crucial advance into knowledge on the Shaken baby syndrome (SBS)

Shaken baby syndrome constitutes a major public health risk. In 2011, guidelines have been established by the High Authority of Health and the SOFMER to help health professionals cope with the diagnosis of SBS. The method used was to compare the most frequent lesions observed in SBS, which are multifocal subdural hematoma and retinal haemorrhages with the lesions induced by mechanism often pointed out by the adults when the child is brought to hospital or during the judicial process. If the lesions induced were the same as those of SBS or therefore the mechanism was acceptable. If not the mechanismwas rejected. From these results, diagnostic criteria of shaking were established based exclusively on the lesions observed and on the history related by the caretaker to explain the child's state and not on the risk factors. Moreover, from 2011 it has been possible to go further(study of the literature and experts’ opinion). Other mechanisms have been brought forward: vaccines, apparent life-threatening events (ALTEs)… And the knowledge on the type of lesions in case of SBS has also improved: type and location of the SDH/lesions newly described as the rupture thrombosis of the bridging veins, intra thecal SDH … The diagnostic criteria were updated from these results. For an infant, at the end of the clinical and radiological assessments, whatever the initial symptoms, after having ruled out differential diagnosis (infection/metabolic disease) and if the clinical history is absent, incoherent, changes over time or is incompatible with the observed lesions or the child's age, these new criteria let us make the diagnosis or consider it as probable. These guidelines to professionals make it easier to diagnose shaken baby syndrome. But these diagnostic criteria have to be known by professionals. Consequently better training is the key: the initial and continuing training must be reinforced. http://www.has-sante.fr/portail/jcms/c_1095929/recommandation-syndrome-du-bebe-secoue .

What are acceptable conclusions? Response to Dr. Ludvigsson.

We would like to thank to Dr Ludvigsson (1), who was the only critical commentary author to acknowledge the methodological problems inherent in the diagnosis of shaken baby syndrome, following the publication of our systematic review (2) in Acta Paediatrica. Dr Ludvigsson posed two questions regarding the two main conclusions, which deserve responses. This article is protected by copyright. All rights reserved.

FRAGILE BRAIN, HANDLE WITH CARE: A CASE OF ABUSIVE HEAD TRAUMA AND A REVIEW OF LITERATURE

We report an 11-month-old boy who brought with status epilepticus. The presence of bilateral retinal hemorrhages and generalized cerebral atrophy indicating ischemia revealed on imaging tests lead us to keep a differential diagnosis of shaken baby syndrome (SBS). On repeated questioning, mother gave the history of shaking by a relative which further supported our diagnosis. Thus in a child with a nonspecific febrile convulsive state, the treating physician should keep SBS also as a differential diagnosis. Key words: Abusive head trauma, Brain injuries, Craniocerebral trauma, Nervous system trauma, Shaken baby syndrome

Shaken baby syndrome manifesting as infantile spasms seizure type

The diagnosis of child maltreatment leading to head injury is challenging. Here, we present the case of a 3-month-old female infant who presented with focal seizures that lasted for several minutes. After admission, she began to show intermittent clusters of head nods, irritable crying, arching, writhing, stiffening, and jerking of both arms. These results and electroencephalography findings were attributed as the diagnosis of infantile spasms (IS). Brain computed tomography and magnetic resonance imaging (MRI) revealed the presence of chronic subdural hematoma mixed with acute ischemic injuries. Examination of the eye fundus confirmed the presence of retinal hemorrhage. Therefore, all evidence pointed to a diagnosis of shaken baby syndrome (SBS). Based on this case, we suggest that physicians should consider a diagnosis of SBS for children with new-onset IS and that should be evaluated, diagnosed, and treated as promptly as possible.

Association hémorragies cérébrales et rétiniennes chez 2 enfants : ne pas conclure trop vite au diagnostic d’enfant secoué

We report on 2 cases associating retinal (RH) and cerebral hemorrhages (CH), which first suggested the diagnosis of shaken baby syndrome (SBS). After an etiologic search, the diagnosis was corrected: the first case was a late hemorrhagic disease of the newborn and the second case hemophilia A. RH is a major feature of SBS, although not pathognomonic. There is no specific RH of SBS but they usually affect the posterior retinal pole. Typically, RHs of SBS are present in both eyes, although unilateral RHs do not exclude the diagnosis of SBS. The relationship between RH and CH has been reported in SBS but also in other diseases. Thus, one must search for hemostasis abnormalities, even though the clinical presentation suggests SBS. Ignoring SBS as well as coming to the conclusion of SBS too quickly should be avoided. Diagnostic difficulties may be related to the number of physicians involved and their interpretation of the facts. These 2 cases underline the need for working as a team that includes hematologists able to interpret coagulation parameters.

Letter regarding Guddat et al. “Fatal spontaneous subdural bleeding due to neonatal giant cell hepatitis: a rare differential diagnosis of shaken baby syndrome”

Letter regarding Guddat et al. “Fatal spontaneous subdural bleeding due to neonatal giant cell hepatitis: a rare differential diagnosis of shaken baby syndrome”

The “Shaken Baby” syndrome: pathology and mechanisms

The "Shaken Baby" syndrome (SBS) is the subject of intense controversy; the diagnosis has in the past depended on the triad of subdural haemorrhage (SDH), retinal haemorrhage and encephalopathy. While there is no doubt that infants do suffer abusive injury at the hands of their carers and that impact can cause catastrophic intracranial damage, research has repeatedly undermined the hypothesis that shaking per se can cause this triad. The term non-accidental head injury has therefore been widely adopted. This review will focus on the pathology and mechanisms of the three physiologically associated findings which constitute the "triad" and are seen in infants suffering from a wide range of non-traumatic as well as traumatic conditions. "Sub" dural bleeding in fact originates within the deep layers of the dura. The potential sources of SDH include: the bridging veins, small vessels within the dura itself, a granulating haemorrhagic membrane and ruptured intracranial aneurysm. Most neuropathologists do not routinely examine eyes, but the significance of this second arm of the triad in the diagnosis of Shaken Baby syndrome is such that it merits consideration in the context of this review. While retinal haemorrhage can be seen clinically, dural and subarachnoid optic nerve sheath haemorrhage is usually seen exclusively by the pathologist and only rarely described by the neuroradiologist. The term encephalopathy is used loosely in the context of SBS. It may encompass anything from vomiting, irritability, feeding difficulties or floppiness to seizures, apnoea and fulminant brain swelling. The spectrum of brain pathology associated with retinal and subdural bleeding from a variety of causes is described. The most important cerebral pathology is swelling and hypoxic-ischaemic injury. Mechanical shearing injury is rare and contusions, the hallmark of adult traumatic brain damage, are vanishingly rare in infants under 1 year of age. Clefts and haemorrhages in the immediate subcortical white matter have been assumed to be due to trauma but factors specific to this age group offer other explanations. Finally, examples of the most common causes of the triad encountered in clinical diagnostic and forensic practice are briefly annotated.

Fatal spontaneous subdural bleeding due to neonatal giant cell hepatitis: a rare differential diagnosis of shaken baby syndrome

A 7-week-old girl showed vomiting after feeding, facial pallor, loss of muscle tone and respiratory depression. An emergency doctor performed successful resuscitation and after arrival in hospital, cranial ultrasound showed left-sided subdural hemorrhage, cerebral edema with a shift of the midline, and a decrease in cerebral perfusion. Ophthalmologic examination showed retinal hemorrhage. In view of this, the doctors suspected shaken baby syndrome and approached the parents with their suspicions, but they denied any shaking or trauma. Despite surgery for the subdural hemorrhage the girl died a few hours later with a severe coagulopathy. Autopsy verified subdural hemorrhage, cerebral edema and retinal hemorrhage, but also revealed intact bridging veins and a lack of optic nerve sheath hemorrhage, therefore shaken baby syndrome could not be proven by autopsy. Histological examination showed severe neonatal giant cell hepatitis as the cause of the severe coagulopathy and the associated spontaneous subdural bleeding. Neonatal giant cell hepatitis may be responsible for unexpected deaths in infancy and, although rarely associated with subdural bleeding, must be considered as a potential differential diagnosis of shaken baby syndrome.

Shaken baby syndrome: a common variant of non-accidental head injury in infants.

Recent cases of child abuse reported in the media have underlined the importance of unambiguous diagnosis and appropriate action. Failure to recognize abuse may have severe consequences. Abuse of infants often leaves few external signs of injury and therefore merits special diligence, especially in the case of non-accidental head injury, which has high morbidity and mortality. Selective literature review including an overview over national and international recommendations. Shaken baby syndrome is a common manifestation of non-accidental head injury in infancy. In Germany, there are an estimated 100 to 200 cases annually. The characteristic findings are diffuse encephalopathy and subdural and retinal hemorrhage in the absence of an adequate explanation. The mortality can be as high as 30%, and up to 70% of survivors suffer long-term impairment. Assessment of suspected child abuse requires meticulous documentation in order to preserve evidence as well as radiological, ophthalmological, laboratory, and forensic investigations. The correct diagnosis of shaken baby syndrome requires understanding of the underlying pathophysiology. Assessment of suspected child abuse necessitates painstaking clinical examination with careful documentation of the findings. A multidisciplinary approach is indicated. Continuation, expansion, and evaluation of existing preventive measures in Germany is required.

Update on shaken baby syndrome: ophthalmology

Shaken baby syndrome is a common problem with a high morbidity and mortality. Ophthalmologists help manage this condition and therefore must keep abreast of current advances. Clinical updates include the discovery that retinal folds and traumatic retinoschisis can very rarely occur after crush head injury, but remain specific for shaken baby syndrome in other scenarios. Pathology updates include new studies on orbital histology and woodpecker anatomy that suggest the retinal and optic nerve hemorrhages in shaken baby syndrome are caused by shaking itself rather than secondary to intracranial pathology. Regarding this shaking injury, some primary prevention strategies have proven surprisingly effective. In the near future, serum biomarkers may be used as a screening tool for inflicted neurotrauma. Animal models such as the neonatal pig and computer models using finite element analysis are promising experimental techniques for studying shaken baby syndrome. Finally, child abuse recently became an accredited subspecialty of pediatrics, which will lead to further advances in patient care, education, research and prevention. Ophthalmologists play a key role in the diagnosis of shaken baby syndrome. In addition, they are in a unique position to study ophthalmic aspects of the syndrome, which in turn furthers the overall understanding of this devastating condition.

Unilateral retinal hemorrhages in shaken baby syndrome

To present a detailed series of patients with unilateral retinal hemorrhages in shaken baby syndrome. Patients with a diagnosis of Shaken Baby Syndrome evaluated by the Ophthalmology Department at Penn State University between January 1999 and January 2004 were reviewed. Patients were identified and their medical records, photographs, and computed tomographic scans were reviewed. Additional records were obtained from the Children's Hospital of Philadelphia. Of the 12 patients evaluated at Penn State University, the age at presentation ranged from 6 weeks to 15 months, with an average age of 4.3 months. Six (50%) had bilateral intracranial hemorrhage, while 6 (50%) had unilateral intracranial hemorrhage. The six patients with unilateral intracranial hemorrhage all had ipsilateral retinal hemorrhages. The perpetrators were male (100%) and 11 (92%) were the babies' fathers. For the five patients evaluated at Children's Hospital of Philadelphia, the age at presentation ranged from 4 weeks to 1 year, with an average of 4.35 months. Three (60%) had bilateral intracranial hemorrhage and two (40%) had unilateral intracranial hemorrhage. The perpetrators were male in four (80%) cases and three (60%) were the babies' fathers. These patients demonstrate the varied presentations of shaken baby syndrome. Unilateral retinal hemorrhages do not rule out the diagnosis of shaken baby syndrome.

Incidence, distribution, and duration of birth-related hemorrhages: a prospective study

A prospective study of 53 neonates was performed in order to document the morphology, distribution, and the natural history of birth-related retinal hemorrhages. The number of infants with retinal hemorrhages was 18 (34%). The incidence in relation to the type of delivery was as follows: vacuum delivery (77.8%), normal vaginal delivery (30.4%), forceps delivery (30.3%), and Cesarean section (8.3%). All hemorrhages were intraretinal and resolved in all but two infants by 16 days. In two subjects, hemorrhages were still present at 31 and 58 days and were related to vacuum delivery. The authors conclude that birth-related hemorrhages are common, and that those related to vacuum delivery may persist for up to two months after delivery. This may have important implications for consideration in the differential diagnosis of Shaken Baby Syndrome. —Michael D. Wagoner