Shaken baby syndrome (síndrome do bebê chacoalhado): relato de caso

Abstract

RESUMO -Os autores relatam o caso de uma lactente de 50 dias de vida que foi trazida ao Pronto Socorro Pediátrico do Hospital de Clínicas da UNICAMP com crises convulsivas. Ao exame apresentava-se sem sinais externos de trauma, hipoativa e com crises convulsivas generalizadas. A fundoscopia evidenciou hemorragia retiniana difusa bilateral. Foi submetida a tomografia de crânio que mostrou hemorragia inter-hemisférica e "swelling" cerebral. A criança foi internada na UTI pediátrica, mantida sob ventilação assistida e recebendo hidantal porém, apesar do tratamento, evoluiu para óbito três dias depois. Desde o início havia suspeita de maus-tratos, o que foi confirmado um dia após a internação quando o pai relatou que "chacoalhou" a criança porque ela chorava bastante. O presente estudo tem como objetivo ressaltar aspectos sociais, epidemiológicos e a dificuldade diagnostica desta síndrome que algumas vezes pode ser fatal, como neste caso. PALAVRAS-CHAVE: traumatismo crânio-encefálico, síndrome do bebê chacoalhado, maus-tratos. Skaken baby syndrome: case reportSUMMARY -The authors report the case of a 50-day-old baby who was brought to the Pediatric Emergency Room of the "Hospital de Clinicas da UNICAMP" with seizures. At the examination she presented without external signs of trauma, hypoactive and with generalized seizures. Numerous hemorrhages were found in the ocular fundi. CT scan showed interhemisferic hemorrhage and brain swelling. The child was admitted to the Pediatric Intensive Care Unit, kept under controlled ventilation and hydantal. Although these measures, she died three days later. Since the beginning there was suspicion of child abuse. One day after the admission the father told that he had shaken the baby because she was crying too much. The present paper discuss social and epidemiological aspects, and about the difficulties in the diagnosis of this syndrome that sometimes may be fatal, as in this case.KEY WORDS: head injury, shaken baby syndrome, child abuse.O estudo da violência contra a criança mostra-se relevante devido às conseqüências deletérias ao desenvolvimento infantil, como a ocorrência de lesões ósseas, traumatismo craniano e desajustamentos emocionais. Além disso, soma-se a reprodução de padrões disciplinares que envolvem o uso de força física abusiva, isto é, crianças agredidas, quando adultas, tendem a reproduzir o modelo de violência na educação infantil 4 . O diagnóstico de abuso físico possibilita a conduta do Estudo realizado na Faculdade de Ciências Médicas

Subdural Hematomas and Emergency Management in Infancy and Childhood

“…1 Therefore, it is clinically difficult to answer the question, ''Which childhood SH occurs due to trauma or nontraumatic reasons?'' 5,6 As mentioned in the literature, underlying etiologic factor is fall down from height in most of the cases. 4 Male preponderance and age range are also similar to previous puplication.…”

“…In asymptomatic cases, SH can cause mental and physical retardation. 4,5,15,16 Child abuse may therefore be missed in the initial assessment. We recommend that physicians should evaluate these cases with great care and suspicion.…”

Subdural Hematoma In Childhood: Considerations About Twenty Cases And Review Of The Literature

“…58 , 61 Some children with acute SDH for physical abuse not submitted to adjusted evaluations, probably due to lack of technological resources and of the ignorance of this clinical entity for the doctor. 34 , 68 How much to the distribution of the SDH in this study, the parieto-temporal region was more frequently reached, followed of the fronto-parietal, parietal region and finally fossa posterior. 68…”

“…The subdural hematoma (SDH) is an entity defined as a clot between the dura-mater and arachnoid space due to trauma, infectious diseases (empyema, meningitis) or coagulopathy. 17 , 34 In infancy, represents a clinical syndrome relatively constant with little identification.…”

Evidence-Based Medicine and Shaken Baby Syndrome

“…Two studies had appropriate control groups, 3 had inappropriate control groups, and 21 were case series without control groups. Twelve studies were case reports: [3][4][5]8,10,17,22,24,31,32,51,55 Retinal pathology in suspected SBS, 5 cases Blunt head injury at autopsy, 1 Subdural hemorrhage (SDH) and retinal hemorrhage (RH) as a result of fall and chest compression, 1 case Shaking causing traumatic aneurism, 1 case Arteriovenous malformation, not SBS, as cause, 1 case Intentional asphyxia and shaking of 15-week-old baby, 1 case Magnetic resonance imaging value in diagnosis, 1 case Raised intracranial pressure as cause of RH, 1 case Fifteen were "other" articles 6,12,16,20,21,23,25,27,37,38,40,41,43,44,54 Historical reviews of SBS,10 articles Opinion papers without original material, 3 articles Social issues and SBS, 1 article Review of imaging in SBS (computed tomography versus magnetic resonance imaging), 1 article…”