medigraphic.com
Órgano Oficial del Instituto Nacional de Pediatría

2015, Number 2

<< Back Next >>

Acta Pediatr Mex 2015; 36 (2)

Shaken Baby Syndrome: Clinical features and outcome of 17 cases at the Instituto Nacional de Pediatría

Loredo-Abdalá A, Casas-Muñoz A, Trejo-Hernández J, Melquiades-Parra I, Martín-Martín V

Language: Spanish
References: 36
Page: 72-80
PDF size: 611.30 Kb.


ABSTRACT

Introduction: Shaken baby syndrome (SBS) is an extreme form of child abuse (CA); it affects the brain and the retina. Their frequency and characteristics have not been clarified in México.
Objective: To describe and clarify the possible triggers, factors the caregivers clinical manifestations and evolution.
Method: Seventeen patients were diagnosed with SBS at the Instituto Nacional de Pediatría from 2002 to 2010.
Results: 70% were male; the mean age was 5.7 months. The background in the child that could trigger shaking were: irritability (71%), inconsolable crying (47%) and acute illness (35%); in parents, impulsivity (29%), stress (29%) and anger (18%). The usual caregivers were the mother of the child (65%), uncles (29%), both parents (24%) and grandparents (18%); but the witness of the onset of severer symptoms was the father (35%), uncles (24%), mother (18%) or both parents (12%). The clinical manifestations were seizures (76%), irritability (41%), respiratory distress (41%), cyanosis (35%) and refusal to eat (29%). At the hospital the following were observed: seizures (82%), altered consciousness (65%), need for ventilatory support (41%) and irritability (18%). The fundus examination revealed: unilateral or bilateral retinal hemorrhage (88%), bilateral vitreous hemorrhage (53%) and retinal detachment (18%). Computed tomography scan of the skull (CTSs) showed: cerebral edema (59%), subarachnoid hemorrhage (50%), subdural hematoma (29%) and skull fracture (29%) all of these conditions substantiated the diagnosis of SBS (71%) and SBS and impacted (35%): six children died (35%), every survivor had sequelae: visual impairment (59%), motor damage (53%), seizures (50%), language problems (41%) and hearing problems (18%).
Conclusion: The SBS is a form of physical abuse and should be suspected in a child less than a year old that suddenly develops seizures, cardiorespiratory distress and or arrives dead at hospital.


REFERENCES

  1. McMenemy MC. Who recognizes child abuse a major problem. Lancet 1999;353:1340.

  2. Dubowitz H. Bennet S. Physical abuse and neglect of children. Lancet 2007;369:1891-9.

  3. Loredo Abdalá A. Maltrato al menor: Consideraciones clínicas sobre maltrato físico, agresión sexual y deprivación emocional. Gac Med Méx 1999;135:611-620.

  4. Loredo Abdalá A. Maltrato en niños y adolescentes. Editores de Textos Mexicanos. México DF. 2004. pp. 143-49.

  5. Caffey J. The whiplash –shaken infant syndrome. Pediatrics 1974;54:396-403.

  6. Harding B, Risdon PA, Krous HF. Shaken baby syndrome. BMJ 2004;328:720-21.

  7. American Academy of Pediatrics. Committee on Child Abuse and Neglect. Shaken baby syndrome, rotational cranial injuries (technical report) Pediatrics 2001;108:206-10.

  8. Perea Martínez A, Loredo Abdalá A, Guicho Alba E. El niño sacudido-impactado una modalidad del maltrato físico severo. En: Loredo Abdalá A. Maltrato en Niños y Adolescentes. México. Editores de Textos Mexicanos; 2004 p. 143-9.

  9. Delgado FA, Lavalle VA, Torres GS y cols. Síndrome del niño sacudido. Bol Med Hosp Infant Mex 1995;52:481-484.

  10. Block Ch and Committee Child Abuse and Neglect. Abusive head trauma in infant and children. Pediatrics 2009;123:1409-1411.

  11. Chiesa A. Dunhaime A Ch. Traumatismo craneoencefálico por maltrato. Pediatr Clin N Amer 2009;56:317-331.

  12. Guthkelch AK. Infantile subdural hematoma and its relationship to whisplash injuries. Br Med J 1971:2:430-1.

  13. Caffey J. Multiple fractures in the long bones of infants suffering from chronic subdural hematoma. AJR AM J Roentgenol 1946;56:163-73.

  14. Silverman FN. Roentgen manifestations of unrecognized skeletal trauma in infants. Am J Roentgenol Radium Ther Nucl Med 1953:69:413-427.

  15. Ommaya AK, Faas F, Yamell P. Whiplash injury and brain damage: an experimental study. JAMA 1968;204:285-9.

  16. Alexander R, Sato Y, Smith W et al. Incidence of impact trauma with cranial injuries ascribed to shaking. Am J Dis Child 1990;144:724-6.

  17. Talvik I, Randell C, Talvik T. Shaken baby syndrome and a baby’s cry. Acta Pædiatrica. 2008;97:782–785.

  18. Glick J, Stanley K. Inflicted traumatic brain injury: advances in evaluation and collaborative diagnosis. Pediatr Neurosur 2007;43:436-41.

  19. Starling SP, Holden JR, Jenny C. Abusive head trauma: the relationship of perpetrators to their victims. Pediatrics 1995;95:259-62.

  20. King WJ, MacKay M, Sirnick A. Shaken-Baby Syndrome in Canada; clinical characteristics and outcomes of hospital cases. CMAJ 2003;168:155-159.

  21. Guenther E, Powers A. Sristava R, Bonkowsky J Abusive head trauma in children presenting with apparent lifethreatening event. J Pediatr 2010;157:821-825.

  22. Adamsbaum C, Grabar S, Mejean N, Rey-Salmón C. Abusive head trauma: Judicial admissions highlight violent and repetitive shaking. Pediatrics 2010;126:546-555.

  23. Levin AV, Christian CW. Committee on child abuse and neglect. The eye examination in the evaluation of child abuse. Pediatrics 2010;126:376-380.

  24. Matschke J, Voss Jj, Obi N et al. Nonaccidental head injury is the most common cause of subdural bleeding in infants. Pediatrics 2010;124:1587-1594.

  25. Sieswerda–Hoogendoorn T, Boss S, Epicack B et al. Abusive head trauma Part 1. Clinical aspects. Eur J Pediatr 2012;171:415-423.

  26. Thackeray JD, Hibbard R, Dowd MD. Intimate partner violence: The role of the pediatrician. Pediatrics 2010;125:1094-1100.

  27. Starling SP Patel S, Burke BL et al. Analysis of perpetrator admissions to inflicted traumatic brain injury in children. Arch Pediatr Adolesc Med 2004;158:454-458.

  28. Barr RG, Barr BIS M, Fujiwara T. et al. Do educational materials change knowledge and behavior about crying and shaken baby syndrome? A randomized controlled trial. CMAJ 2009;180:727-33.

  29. Ludwig S, Warman M. Shaken baby syndrome. A review of 20 cases. Ann Emerg Med 1984;13:104-107.

  30. Loredo Abdalá A, Trejo Hernández J, Jordán González N y cols. Maltrato infantil y síndrome de muerte súbita del lactante: Estrategias para el diagnóstico diferencial. Bol Med Hosp Infant Mex 2007;63:269-275.

  31. Amara G. Violencia intrafamiliar. En: Dulanto Gutiérrez E. La familia: Un espacio de encuentro y crecimiento para todos. Editores de Textos mexicanos México 2004, pp. 413-435.

  32. Le Roy, Rebolledo MI, Moraga MF y cols. Nutrición del niño con enfermedades neurológicas prevalentes. Rev Chil Pediatr 2010;81:103-113.

  33. Krous HF, Beckwith JB, Byard RW. Sudden infant death syndrome and unclassified sudden infant deaths a definitional and diagnostic approach. Pediatrics 2004;114:234- 238.

  34. Levin A. Retinal hemorrhages; Pediatr Clin N Amer 2009;56:333-344.

  35. Diaz-Olavarrieta C, García Piña CA, Loredo Abdalá A, Paz F, García SG, Schilmann A. Abusive head trauma at a tertiary care children´s hospital in Mexico City. A preliminary study. Child Abuse & Neglect 2011;35:915-923.

  36. Gabaeff SC. Challenging the pathophysiologic connection between subdural hematoma, retinal hemorrhage and shaken baby síndrome. Western Journal of Emergency Medicine 2011;XII:144-158.




2020     |     www.medigraphic.com