Head Injury In Infants Research Articles

Traumatismes crâniens accidentels ou non du nourrisson: Étude prospective de 88 cas

To study the epidemiology of head injury (HI) in infants, the factors favouring the occurrence of a subdural haematoma (SDH), the prevalence of retinal haemorrhages (RH) and the prognostic factors, by comparing the non-accidental (NAHI) and accidental (AHI) head injuries. RH, in particular, are of fundamental value in the diagnosis of NAHI but, in the absence of systematic studies, their sensitivity and specificity for the diagnosis of the NAHI have rarely been assessed.We prospectively collected the clinical, ophthalmologic and radiological data of HI occurring in children under 24 months old, notably by distinguishing essential macrocrania and symptomatic macrocrania of an SDH, by classifying the HI according to its severity.We observed 88 cases over a period of 22 months. It 28 cases it was NAHI and in the 60 others, AHI. The SDH was often correlated with the presence of retinal haemorrhages and the absence of signs of cranial impact, but not with child abuse or with essential macrocrania. The RH were of great importance in the diagnosis of NAHI; however, non-severe RH was noted in 4 cases of AHI. The neurological prognosis was essentially correlated with the initial clinical severity.Although only representing 33% of cases, child abuse was responsible for 2/3 of the deaths and for the totality of the severe morbidity in our series. The infants exhibiting perinatal problems represented an important group at risk of abuse, which justified their regular medical-social follow-up.

Head injuries.

Last summer, the National Institute for Clinical Excellence (NICE) published Head Injury: Triage, assessment, investigation and early management of head injury in infants, children and adults. The recommendations on computed tomography (CT) in this guidance for minor head injuries are similar to the Canadian CT head rule published in 2001.

A biomechanical analysis of the causes of traumatic brain injury in infants and children.

There is significant disagreement among medical professionals regarding the mechanisms for infant brain injury. This disagreement is due in part to the failure by some to acknowledge and incorporate known biomechanical data and models into hypotheses regarding causes. A proper biomechanical understanding of the mechanisms of traumatic brain injury (TBI) challenges many published and testified assumptions regarding TBI in infants and children. This paper analyzes the biomechanical relationship between the causes of TBI in infants and children, and their physiological consequences. Loading characteristics, injury parameters and criteria, scaling, failure characteristics, differences between infants and adults, and impact due to falls are described and discussed in the context of the laws of mechanics. Recent studies are critiqued with reference to their contribution to an understanding of brain injury mechanisms. Finally, methods for improving our currently incomplete knowledge of infant head injuries, and their mechanisms, consequences and tolerances are proposed. There is an urgent need for close collaboration between physicians and biomechanicians to objectively and scientifically evaluate infant head injuries to further define their mechanical bases, and to assist in their diagnosis and treatment.

Craniocerebral trauma in childhood

This article describes typical head injuries in infants and children. In comparison with adults there are distinct differences in the etiology of trauma and in the kind of reaction of the skull and brain. In infants and children there are three different types of trauma: birth trauma, accidental and non-accidental injury. The typical injuries in these three groups are described.

Neuropathology of Fatal Infant Head Injury

Journal of NeurotraumaVol. 20, No. 9 Letter to the EditorNeuropathology of Fatal Infant Head InjuryJennian F. Geddes and Helen L. WhitwellJennian F. GeddesSearch for more papers by this author and Helen L. WhitwellSearch for more papers by this authorPublished Online:8 Jul 2004https://doi.org/10.1089/089771503322385836AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "Neuropathology of Fatal Infant Head Injury." , 20(9), p. 905FiguresReferencesRelatedDetailsCited byAkute und chronische organische Psychosyndrome im Kindes- und Jugendalter15 February 2023References5 January 2012Contusional brain injury and intracerebral haemorrhage3 January 2013 Volume 20Issue 9Sep 2003 To cite this article:Jennian F. Geddes and Helen L. Whitwell.Neuropathology of Fatal Infant Head Injury.Journal of Neurotrauma.Sep 2003.905-905.http://doi.org/10.1089/089771503322385836Published in Volume: 20 Issue 9: July 8, 2004PDF download

Inflicted head injury in infants

There is scant neuropathological information in the child abuse literature; even the best reviews include assumptions based on the findings of a few inadequate early studies. Our recent series of 53 fatal cases (Brain 124 (2001) 1290, 1299 [1,2]) demonstrated age-related patterns of brain injury and showed the substrate of severe encephalopathy in the infants to be hypoxic brain damage, not diffuse traumatic axonal injury (‘DAI’), as had previously been thought. About one-third had craniocervical injuries, particularly in the brain stem, suggestive of stretch injury to the neuraxis. Our interpretation was that this finding implied a mechanism of injury—brain stem damage from stretch injury to the neck with resultant apnoea—that could account for the clinical scenario in many cases, and for which violence would not necessarily be required. Since publishing this study we have turned our attention to the subgroup of infants who die without objective signs of injury, such as skull fracture or impact, whose carers are accused of abuse, usually, “violent shaking”, on the pathologic findings alone. Given the striking discrepancy that there often is in such cases between the relatively trivial findings in the brain and the accusations of violence, we have been looking at the pathogenesis of the typical intracranial bleeding. A histologic study of dura from 50 paediatric autopsies, none of whom had suffered a head injury, has led us to propose that the subdural and retinal bleeding in such cases may well have a physiological aetiology, rather than being caused directly by trauma.

Stroller/Pram-Related Head and Face Injuries In Infants and one Year-Olds: Data From the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP)

Stroller/Pram-Related Head and Face Injuries In Infants and one Year-Olds: Data From the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP)

Head injuries in infants: the risks of bouncy chairs and car seats

Aims: To establish whether the incorrect use of bouncy chairs (BC) and car seats (CS) is a significant cause of injuries in babies. Methods: Prospective study over a 12 month...

Retinal haemorrhages in infant head injury

We would like to congratulate Dr Geddes et al . and Brain for publishing their recent valuable contributions to the field of infant head injury/shaken baby syndrome (Geddes et al ., 2001 a, b ). It is unacceptable for malicious child abuse to go undetected and there is an obligation on those looking after children to protect them. However, a refusal to study alternative explanations should not be allowed to unjustly destroy the lives of the accused and their families (Wilkins, 1997). We believe that these papers have important implications for the understanding of retinal haemorrhages in shaken infants. …

The potential and limitations of utilising head impact injury models to assess the likelihood of significant head injury in infants after a fall

The use of engineering principles in assessing head injury scenarios is of increasing significance in investigations into suspected child abuse. A fall scenario is often given as the history for a head injury to an infant. This paper addresses the basic engineering principles and factors to be considered when calculating the severity of a head impact after free-fall. The application of head injury models (HIMs) to ascertain the forces involved in childhood head injuries from impact is also discussed. Previous studies including Duhaime et al. [J. Neurosurg. 66 (1987) 409] and Nokes et al. [Forensic Sci. Int. 79 (1995) 85] have utilised HIMs for this purpose: this paper reviews those models most widely documented. The HIM currently considered the ‘state-of-the-art’ is the head injury criterion (HIC) and it is suggested that this model should be utilised for assessing head impact injury in child abuse cases where appropriate.

Neuropathology of inflicted head injury in children: II. Microscopic brain injury in infants

There are very few reports in the literature dealing with the neuropathology of infant head injury, and the question of whether diffuse traumatic brain damage [diffuse axonal injury (DAI)] occurs in such children has not yet been reliably established by detailed neuropathological studies. We report the findings in the brains of a series of 37 infants aged 9 months or less, all of whom died from inflicted head injuries, and 14 control infants who died of other causes. Axonal damage was identified using immunohistochemistry for beta-amyloid precursor protein. Full clinical details were available for each case, the most constant of which in the study cohort was an episode of significant apnoea at presentation, found to have been recorded in 75% of cases. Global hypoxic damage was the most common histological finding. Widespread axonal damage, interpreted as vascular, was present in 13 cases, but widespread traumatic axonal injury was found in only two children, both of whom had severe head injuries with multiple skull fractures. Epidural cervical haemorrhage and focal axonal damage to the brainstem and the spinal nerve roots, found in 11 cases but not in controls, indicate that the craniocervical junction is vulnerable in infant head injury, the neuropathology being that of stretch injury from cervical hyperextension/flexion. Damage to this region could account for the observed apnoea, which could in turn lead to hypoxic damage and brain swelling. The observation that the predominant histological abnormality in cases of inflicted head injury in the very young is diffuse hypoxic brain damage, not DAI, can be explained in one of two ways: either the unmyelinated axon of the immature cerebral hemispheres is relatively resistant to traumatic damage, or in shaking-type injuries the brain is not exposed to the forces necessary to produce DAI.

Head injury in routine and forensic pathological practice.

In recent years, head injury has lost its Cinderella status in the neuroscience world, as advances in the understanding of the cellular pathology have opened up the very real possibility of therapeutic intervention. For pathologists, a direct consequence of this has been that not only can much more of the tissue damage resulting from trauma now be appreciated on light microscopy, thanks to the development of immunocytochemical markers, but also there are often greater expectations of the autopsy and brain examination in a head injury case. This chapter describes a modern approach to head injury for non-neuropathologists, then addresses the specific problem of axonal injury, and finally tackles a rather specialist subject about which there is very little published information — namely, non-accidental head injury in infants.

Infantile head injury, with special reference to the development of chronic subdural hematoma

An infantile head injury has unique features in that infants are totally helpless and dependent on their parents, and biomechanical characteristics of the skull and brain are very different from those of other age groups. The authors reviewed a total of 16 infant head injury patients under 12 months of age who were treated in our hospital from 1989 to 1997. Birth head injury was excluded. The most common age group was 3-5 months. Early seizures were noted in 7 cases, and motor weakness in 6. Three patients with acute intracranial hematoma and another 3 with depressed skull fracture were operated on soon after admission. Chronic subdural hematomas (SDHs) developed in 3 infants. Initial CT scans showed a small amount of SDH that needed no emergency operation. Resolution of the acute SDH and development of subdural hygroma appeared on follow-up CT scans within 2 weeks of injury. Two of these infants developed early seizures. Chronic SDH was diagnosed on the 68th and 111th days after the injuries were sustained, respectively. The third patient was the subject of close follow-up with special attention to the evolution of chronic SDH in view of our experience in the previous 2 cases, and was found to have developed chronic SDH on the 90th day after injury. All chronic SDH patients were successively treated by subduro-peritoneal shunting. In conclusion, the evolution of chronic SDH from acute SDH is relatively common following infantile head injury. Infants with head injuries, especially if they are associated with acute SDH and early development of subdural hygroma, should be carefully followed up with special attention to the possible development of chronic SDH

Child Abuse: Report of Three Cases from Khamis Mushayt

The problem of child abuse was first described by Kempe et al. in their landmark article entitled "the battered child syndrome" which was published in 1962. Since then the problem has had increased recognition worldwide and legal solutions and state-enforced statutes have been put in place to combat this menace in many Western countries. In the US child abuse is the second most important cause of serious head injuries and deaths after motor vehicle accidents. There are only a few published reports of child abuse in Saudi Arabia the majority of them from tertiary care hospitals in Riyadh and a recent one from Jubail. In this communication we report three cases of child abuse seen in Civil Hospital Khamis Mushayt in the year 1999. This is the first report of child abuse to be presented from this region of Saudi Arabia. (excerpt)

Shaken baby (shaken impact) syndrome: non-accidental head injury in infancy.

Shaken baby (shaken impact) syndrome: non-accidental head injury in infancy.

Biomechanical Modeling in Infant Head Injury: From Tissue to Patient History

Biomechanical Modeling in Infant Head Injury: From Tissue to Patient History

Crush head injuries in infants and young children neurologic and neuropsychologic sequelae.

Neurologic and neuropsychologic sequelae of crush head injury, which is produced by static forces occurring when the head is stationary and pinned against a rigid structure, were studied prospectively in a series of eight children ranging in age from 13 to 32 months. Hospital course, computed tomographic findings, and neurologic and developmental outcomes were examined. All children sustained pronounced cerebral trauma characterized by multiple fractures throughout the calvaria, extra-axial hemorrhages, and parenchymal contusions. Cranial nerve injuries were noted in three and hemiparesis in two of the cases. Two months after the injury, 63% of the children displayed deficits in either IQ or motor functioning. One year after the injury, five of the six children reevaluated had a good recovery. Motor scores were significantly lower than cognitive scores at baseline and showed the greatest degree of improvement over time. Neuropsychologic outcome after brain injury produced by static loading of the head is more favorable than from traumatic brain injury associated with dynamic loading.

Fatal Physical Child Abuse in Two Children of a Family

Fatal Physical Child Abuse in Two Children of a Family

Head injuries in infants: A closer look at baby-walkers, stairs and nursery furniture

This article describes the methods and findings of an analytical study of potential risk and protective factors for infants presenting with head injuries to emergency departments of seven hospitals in NSW. The Injury Prevention Policy Unit, NSW Department of Health, conducted a case-control study that examined baby-walkers, stairs and nursery furniture.

Nonaccidental head injury in infants--the "shaken-baby syndrome".

Trauma is the most common cause of death in childhood, and inflicted head injury is the most common cause of traumatic death in infancy.1–3 Beginning with the classic descriptions of Kempe et al.4 and Caffey5 and with subsequent clinical, biomechanical, and radiologic studies, the diagnostic features of nonaccidental head injury in infants and toddlers have become widely recognized. This review outlines the mechanisms, typical features, differential diagnosis, and acute management of the most frequently encountered form of infantile inflicted head injury, the so-called shaken-baby syndrome. Biomechanics and Terminology The names applied to the syndromes of inflicted head injury in . . .