Animal models of pediatric abusive head trauma

Abstract

Background Abusive head trauma (AHT), previously known as the shaken baby syndrome, is a severe and potentially fatal form of traumatic brain injury in infant children who have been shaken, and sometimes also sustained an additional head impact. The clinical and autopsy findings in AHT are not pathognomonic and, due to frequent obfuscation by perpetrators, the circumstances surrounding the alleged abuse are often unclear. The concept has evolved that the finding of the combination of subdural hemorrhage, brain injury, and retinal hemorrhages (“the triad”) is the result of shaking of an infant (“shaken baby syndrome”) and has led to the ongoing controversy whether shaking alone is able to generate sufficient force to produce these lesions. Objective In an attempt to investigate whether shaking can engender this lesion triad, animal models have been developed in laboratory rodents and domestic animal species. This review assesses the utility of these animal models to reliably reproduce human AHT pathology and evaluate the effects of shaking on the immature brain. Results Due largely to irreconcilable anatomic species differences between these animal brains and human infants, and a lack of resemblance of the experimental head shaking induced by mechanical devices to real-world human neurotrauma, no animal model has been able to reliably reproduce the full range of neuropathologic AHT changes. Conclusion Some animal models can simulate specific brain and ophthalmic lesions found in human AHT cases and provide useful information on their pathogenesis. Moreover, one animal model demonstrated that shaking of a freely mobile head, without an additional head impact, could be lethal, and produce significant brain pathology.

Retinodural haemorrhage of infancy, abusive head trauma, shaken baby syndrome: The continuing quest for evidence

“…Animal models have similarly failed to support the shaking hypothesis. Finnie and Blumbergs concluded in 2022 that no animal model has been able to reliably reproduce the full range of neuropathological changes attributed to AHT 27 …”

Clinical and Forensic Investigation Protocols for Diagnosing Abusive Head Trauma: A Literature Review

“…In addition to subdural hematomas, it is possible to have axonal lesions due to the tearing of the white and gray matter, but also retinal lesions. These injuries are more frequent in children due to the larger size of the head compared to the body, the high water content, poor control of head movements, and the myelination process still not being complete [16][17][18]. Among the various hypotheses to explain the phenomenon of retinal hemorrhages, the most accredited would concern tearing of the vessels at the level of the adhesion structures between the vitreous and retina, papilla-retina, and macula-vitreous.…”

False Controversy Regarding Abusive Head Trauma Endangers Vulnerable Children

“…There is extensive evidence in the medical literature supporting the conclusion that both acceleration/deceleration and contact forces to the head can cause brain injury, intracranial bleeding, spinal haemorrhage and/or ligamentous injury, and retinal haemorrhage (Pierce et al, 2002). Biomechanical studies in animals confirm that shaking alone can cause brain injury (Finnie et al, 2012;Finnie & Blumbergs, 2022;Vester et al, 2019). A recent study reports a case series of 10 infants in which an adult witnessed another adult shaking the child.…”