Long‐term outcome and morphology/function correlates in cases of shaken baby syndrome

Abstract

Purpose Shaken Baby Syndrome(SBS) presents with acute encephalopathy,subdural and retinal haemorrhages,with inconsistent history,in < 2 years old.Long‐term sequelae are still under study.Aim is to present the long‐term outcome in a case series of SBS followed‐up by a multidisciplinary team. Methods Case series of 14 children(9 M,5 F)with confirmed SBS has been examined and followed‐up.Patients underwent fundus evaluation (indirect ophtalmoscopy) and wide‐field digital ophthalmic camera (RetCam II) until bleeding reabsorption.Assessment was repeated at follow‐up combined with ocular motility evaluation, visual field(BEFIE test),visual acuity(Teller acuity cards),refractometry, cognitive‐behavioral evaluations (Griffiths scales,Child Behaviour Check List), and family stress measurement(Parenting Stress Index),segmentation analysis of MRI. Results Mean age at acute episode of SBS: 6.5 months (range 2‐20), 9/14 in the first 6 months of life. Mean age at last follow‐up evaluation: 32 months (range 8‐65). 4 cases were lost to follow‐up. At last follow‐up evaluation: 4 out of 10 had a decreased visual acuity (cortical visual impairment), 4 out of 10 had visual field deficits, 3 out of 10 had strabismus. None of the cases showed significant refractive errors. Cognitive/behavioural assessment demostrated global delay and impairments in neuromotor ability, speech/language development and attention problems. MRI analysis showed atrophic alterations in several brain areas. Conclusion Multidisciplinary assessment including ophthalmologic examination and neuro behavioural evaluation provides crucial prognostic information in cases of suspected SBS.Functional outcome is largely dependent on brain injury and atrophy.