Long-Term Outcome in Infants with the Shaking-Impact Syndrome

Abstract

Nonaccidental injury accounts for nearly one quarter of all hospital admissions for head injury in infancy, and is associated with significant morbidity and mortality. Long-term outcome in survivors, however, has been incompletely studied. In this series, 84 infants 2 years of age and younger with the shaking-impact syndrome consecutively admitted to a single hospital between 1978 and 1988 were identified. A questionnaire detailing current medical, developmental, and behavioral status was developed, and attempts were made to locate the 62 children surviving the acute injury. Family instability and strict confidentiality restrictions precluded locating the majority of children, but 14 children with demographic and injury characteristics similar to those of the overall group were contacted at an average of 9 years after injury. Seven children were severely disabled or vegetative, 2 were moderately disabled, and 5 had a good outcome. Of the latter group, 3 had repeated grades and/or required tutoring. Acute factors associated with poor outcome included unre-sponsiveness on admission, need for intubation, age less than 6 months, and bilateral or unilateral diffuse hypodensity on CT scan. All children with bilateral diffuse hypodensity and loss of gray-white differentiation on CT scan remained blind, retarded, nonverbal, and nonambulatory in spite of aggressive medical and surgical management. This study suggests that the majority of children surviving the shaking-impact syndrome suffer major permanent morbidity, and that acute factors predicting long-term outcome may help guide aggressiveness of care.

Diagnostic Performance of Ultrafast Brain MRI for Evaluation of Abusive Head Trauma

“…1 The outcomes of AHT victims are worse than those of children with accidental traumatic brain injury including higher rates of mortality and permanent disability from neurological impairment. [2][3][4][5] The diagnosis of AHT is frequently not recognized when affected patients initially present to a physician, and up to 28% of children with missed AHT diagnoses may be reinjured leading to permanent neurological damage or even death. 6 Because neuroimaging plays a central role in AHT, continued improvements in neuroimaging are necessary.…”

Maturation-dependent response of the piglet brain to scaled cortical impact

“…Interestingly, in some instances such as in nonaccidental injuries in infancy, damage may be profound, beyond that seen with similar-appearing injuries in adults, although after some types of injuries recovery is superior to that seen in adults, possibly due to increased brain plasticity early in life. 2,18,29,31 The heterogeneity of clinical pediatric head injury makes an analysis of the effect of maturation on injury response difficult; 30 thus, whether specific therapies would be particularly effective or even counterproductive after brain injury in infants and children remains unclear.…”

Child Abuse: A Complex Case Report: Association of Amitriptyline Intoxication and Shaken Baby Syndrome

“…According to scientific reviews, the cerebral lesion met in SBS/ AHT can cause many after-effects such as severe to moderate handicap in more than 50% of the cases, post-trauma epilepsy, cerebral atrophy, and intellectual deficit [14][15][16][17][18]. The after-effects of amitriptyline intoxication are not defined, but the scientific literature suggests a favorable clinical evolution [10,11,19].…”