Infants dying suddenly and unexpectedly share demographic features with infants who die with retinal and dural bleeding: a review of neural mechanisms

Squier, Waney; Mack, Julie; Jansen, Anna

doi:10.1111/dmcn.13202

Cited by 10 publications

(6 citation statements)

References 146 publications

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“…In this context, it is of interest that, in 1953, Guthkelch had already discussed the possibility that the male SDH preponderance could be explained by a birth trauma, stating: “the preponderance of males might be explained on the basis that male infants have bigger heads than females, and therefore more likely to sustain intracranial injury at birth.” [ 5 ] This hypothesis is further supported by recent interpretations by Squier, Vinchon, and Miller [ 15 , 21 , 26 ].…”

Section: Discussion Principal Findingssupporting

confidence: 74%

Epidemiology of subdural haemorrhage during infancy: A population-based register study

et al. 2018

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ObjectivesTo analyse subdural haemorrhage (SDH) during infancy in Sweden by incidence, SDH category, diagnostic distribution, age, co-morbidity, mortality, and maternal and perinatal risk factors; and its association with accidents and diagnosis of abuse.MethodsA Swedish population-based register study comprising infants born between 1997 and 2014, 0–1 years of age, diagnosed with SDH-diagnoses according to the (International Classification of Diseases, 10th version (ICD10), retrieved from the National Patient Register and linked to the Medical Birth Register and the Death Cause Register. Outcome measures were: 1) Incidence and distribution, 2) co-morbidity, 3) fall accidents by SDH category, 4) risk factors for all SDHs in the two age groups, 0–6 and 7–365 days, and for ICD10 SDH subgroups: S06.5 (traumatic SDH), I62.0 (acute nontraumatic), SDH and abuse diagnosis.ResultsIncidence of SDH was 16·5 per 100 000 infants (n = 306). Median age was 2·5 months. For infants older than one week, the median age was 3·5 months. Case fatality was 6·5%. Male sex was overrepresented for all SDH subgroups. Accidental falls were reported in 1/3 of the cases. One-fourth occurred within 0–6 days, having a perinatal risk profile. For infants aged 7–365 days, acute nontraumatic SDH was associated with multiple birth, preterm birth, and small-for-gestational age. Fourteen percent also had an abuse diagnosis, having increased odds of being born preterm, and being small-for-gestational age.ConclusionsThe incidence was in the range previously reported. SDH among newborns was associated with difficult birth and neonatal morbidity. Acute nontraumatic SDH and SDH with abuse diagnosis had similar perinatal risk profiles. The increased odds for acute nontraumatic SDH in twins, preterm births, neonatal convulsions or small-for-gestational age indicate a perinatal vulnerability for SDH beyond 1st week of life. The association between prematurity/small-for-gestational age and abuse diagnosis is intriguing and not easily understood.

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Section: Discussion Principal Findingssupporting

confidence: 74%

Epidemiology of subdural haemorrhage during infancy: A population-based register study

et al. 2018

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“…It is of interest that cardiopulmonary resuscitation had been attempted in 14 of the 37 cases described in this study. This observation raises the possibility that, in at least some of the cases described, the subdural hemorrhage may have been in part or wholly related to an elevation of intracranial intravascular pressure stemming from chest compressions-a mechanism that data from other published studies would perhaps support (33), and which has previously been proposed by others (34). However, the data set out herein are not thought to provide meaningful further assistance in assessment of this theory.…”

Section: Original Articlementioning

confidence: 68%

Non-Traumatic Acute Subdural Hemorrhage Due To Cranial Venous Hypertension

Orde¹

2019

Academic Forensic Pathology

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Acute subdural hemorrhage is typically associated with a history of head trauma, and as such it is a finding with significant potential medicolegal consequences. In this article, 37 adult and post-infantile pediatric sudden death autopsy cases with small volume (“thin film” or “smear”) acute subdural hemorrhage are presented—in which there is either no further evidence of head trauma or only features of minor head injury. The possible underlying pathophysiological mechanisms are explored, and it is concluded that a common thread in many of these cases is likely to have been cranial venous hypertension at around the time of death. These findings may have implications in instances where small volume subdural hemorrhage is identified in the absence of other evidence of significant head injury.

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“…Although not evaluated in this model, the unilateral pattern of HH is unlikely to result from neck injury and/or nerve reflexes from the dura, which cause global apnea, a mechanism purported by Geddes and colleagues and others. 10,11,[41][42][43] An alternate possible mechanism is a regional metabolic mismatch between supply and demand. The exact pathophysiological mechanisms by which widespread unilateral hemispheric hypoxic-ischemic injury is initiated and propagated in children are not fully understood, but similar findings were produced in this model in the absence of angular acceleration/deceleration.…”

Section: Discussionmentioning

confidence: 99%

Development of a Model of Hemispheric Hypodensity (“Big Black Brain”)

Costine-Bartell

McGuone

Price

et al. 2019

Journal of Neurotrauma

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Subdural hematoma (SDH) is the most common finding after abusive head trauma (AHT). Hemispheric hypodensity (HH) is a radiological indicator of severe brain damage that encompasses multiple vascular territories, and may develop in the hemisphere(s) underlying the SDH. In some instances where the SDH is predominantly unilateral, the widespread damage is unilateral underlying the SDH. To date, no animal model has successfully replicated this pattern of injury. We combined escalating severities of the injuries and insults commonly associated with HH including SDH, impact, mass effect, seizures, apnea, and hypoventilation to create an experimental model of HH in piglets aged 1 week (comparable to human infants) to 1 month (comparable to human toddlers). Unilateral HH evolved over 24 h when kainic acid was applied ipsilateral to the SDH to induce seizures. Pathological examination revealed a hypoxic-ischemic injury-type pattern with vasogenic edema through much of the cortical ribbon with relative sparing of deep gray matter. The percentage of the hemisphere that was damaged was greater on the ipsilateral versus contralateral side and was positively correlated with SDH area and estimated seizure duration. Further studies are needed to parse out the pathophysiology of this injury and to determine if multiple injuries and insults act synergistically to induce a metabolic mismatch or if the mechanism of trauma induces severe seizures that drive this distinctive pattern of injury.

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Infants dying suddenly and unexpectedly share demographic features with infants who die with retinal and dural bleeding: a review of neural mechanisms

Cited by 10 publications

References 146 publications

Epidemiology of subdural haemorrhage during infancy: A population-based register study

Epidemiology of subdural haemorrhage during infancy: A population-based register study

Non-Traumatic Acute Subdural Hemorrhage Due To Cranial Venous Hypertension

Development of a Model of Hemispheric Hypodensity (“Big Black Brain”)

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