Infantile retinal haemorrhages in the absence of brain and bodily injury

Scheller, Joseph

doi:10.1111/apa.14043

Cited by 9 publications

(11 citation statements)

References 8 publications

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“…However, an eye examination was not always done within 48 hours of admission in the present study, and subtle retinal hemorrhage might disappear [21]. On the other hand, Scheller reported ten cases of retinal hemorrhage with no evidence of brain injury and suggested that clinicians should reassess the importance of retinal hemorrhage in the setting of suspected AHT [22]. Mechanisms that cause retinal hemorrhage other than vitreoretinal traction, such as abrupt increases in intracranial pressure, have also been suggested [23].…”

Section: Plos Onementioning

confidence: 67%

Infantile subdural hematoma in Japan: A multicenter, retrospective study by the J-HITs (Japanese head injury of infants and toddlers study) group

Akutsu

Nonaka

Kato³

et al. 2022

PLoS ONE

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Objective Subdural hematoma in infants or toddlers has often been linked to abuse, but it is not clear how many cases actually occur and how many are suspected of abuse. The purpose of this study was to investigate subdural hematoma in infants and toddlers in Japan. Methods This multicenter, retrospective study reviewed the clinical records of children younger than 4 years with head trauma who were diagnosed with any finding on head computed tomography (CT) and/or magnetic resonance imaging (MRI), such as skull fracture and/or intracranial injury. A total of 452 children were included. The group suspected to have been abused was classified as nonaccidental, and the group considered to have been caused by an accident was classified as accidental. Subdural hematoma and other factors were examined on multivariate analysis to identify which factors increase the risk of nonaccidental injuries. Results Of the 452 patients, 158 were diagnosed with subdural hematoma. Subdural hematoma was the most common finding intracranial finding in head trauma in infants and toddlers. A total of 51 patients were classified into the nonaccidental group, and 107 patients were classified into the accidental group. The age of patients with subdural hematoma showed a bimodal pattern. The mean age of the accidental group with subdural hematoma was significantly older than that in the nonaccidental group (10.2 months vs 5.9 months, respectively. p < 0.001). Multivariate analysis showed that patients under 5 months old, retinal hemorrhage, and seizure were significant risk factors for nonaccidental injury (odds ratio (OR) 3.86, p = 0.0011; OR 7.63, p < 0.001; OR 2.49, p = 0.03; respectively). On the other hand, the odds ratio for subdural hematoma was 1.96, and no significant difference was observed (p = 0.34). Conclusions At least in Japanese children, infantile subdural hematoma was frequently observed not only in nonaccidental but also in accidental injuries. In infants with head trauma, age, the presence of retinal hemorrhage, and the presence of seizures should be considered when determining whether they were abused. Subdural hematoma is also a powerful finding to detect abuse, but care should be taken because, in some ethnic groups, such as the Japanese, there are many accidental cases.

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Section: Plos Onementioning

confidence: 67%

Infantile subdural hematoma in Japan: A multicenter, retrospective study by the J-HITs (Japanese head injury of infants and toddlers study) group

Akutsu

Nonaka

Kato³

et al. 2022

PLoS ONE

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“…Based on the rationale that subdural haemorrhage and retinal haemorrhage are independent of fractures, while each of these findings is also considered as highly indicative of physical abuse, the co-occurrence of such findings most likely placed these infants in the maltreatment category. However, although intracranial findings and ocular findings are indisputably independent of fractures, certain kinds of non-traumatic subdural effusions, such as benign external hydrocephalus with or without acute haemorrhage, are associated with retinal haemorrhage [33,34], and infantile rickets is associated with all types of hydrocephalus [35]. Thus, it is possible that concomitant intracranial pathology, ocular pathology, and certain kinds of fractures have a common non-traumatic underlying cause in infantile rickets.…”

Section: Discussionmentioning

confidence: 99%

Rib fractures in infancy, case-series and register case-control study from Sweden

Högberg

Thiblin

2021

Journal of Pediatric Endocrinology and Metabolism

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Objectives To assess cases with rib fractures in infants under observation for or with an abuse diagnosis, and to compare risk factors with that in infants with fractures but no abuse diagnosis. Methods Design was case-series and register case-control of infants (aged <1 year) with rib fractures. Data was clinical records for the case-series (n = 26) and from national health registers for the case-controls (n = 28 and n = 31). Outcome measures were maternal and perinatal characteristics, reasons for appointment, examination, diagnoses, blood tests, and radiologic findings. Results The case-series had a median age of 70 days. A majority were detected through a skeletal survey for abuse investigation. Sixteen were boys, three were preterm and six were small-for-gestational age. Three carers had noticed popping sound from the chest; no infants showed signs of pain at physical examination. Mean number of fractures was 4.2, and 24 had callus. Bone mineralisation was scarcely reported. Metabolic panel was not uniformly analysed. The register case-control had a median age of 76 days, sharing risk factors such as maternal overweight/obesity, male sex, prematurity, and being small-for-gestational age. Cases more often had subdural haemorrhage, retinal haemorrhage, or long-bone fractures, controls more often had neonatal morbidity, respiratory infection, or a fall accident. Detection of fracture at time of a major surgery (n = 6) and rickets/vitamin D deficiency (n = 5) appeared in both groups, but was delayed among the cases. Conclusions Rib fractures in young infants, diagnosed as abuse, are usually asymptomatic and healing. A substantial proportion had metabolic risk factors, suggesting false positive cases.

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“…Bilateral, extensive bleeding in several retinal layers has been regarded as a key feature of abusive head trauma [ 6 , 7 , 36 , 41 , 42 , 53 , 56 ]. However, RH may not be pathognomonic for abusive head traumas; they can also be seen in infants not related to abuse, e.g., in a large number of healthy newborns [ 37 , 50 , 70 ], in infants with “macrocephaly” [ 55 , 64 ], after “high-risk” deliveries [ 58 ], following acute life-threatening events [ 5 ], and after cardiopulmonary resuscitation [ 33 , 54 , 57 ]. RHs have also been documented in premature infants; contrary to the rapid resolution of the bleeding one usually sees in most newborns, the bleeding in preterms tend to be long lasting [ 18 ].…”

Section: Clinical and Radiological Findingsmentioning

confidence: 99%

Is external hydrocephalus a possible differential diagnosis when child abuse is suspected?

Scheller¹,

Wester

2021

Acta Neurochir

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Background Criteria for diagnosing abusive head trauma (AHT) or “shaken baby syndrome” are not well defined; consequently, these conditions might be diagnosed on failing premises. Methods The authors have collected a total of 28 infants, from the US (20) and Norway (8), suspected of having been violently shaken, and their caregivers had been suspected, investigated, prosecuted or convicted of having performed this action. Among 26 symptomatic infants, there were 18 boys (69%) and 8 girls (31%)—mean age 5.1 month, without age difference between genders. Results Twenty-one of 26 symptomatic children (81%) had a head circumference at or above the 90 percentile, and 18 had a head circumference at or above the 97 percentile. After macrocephaly, seizure was the most frequent initial symptom in 13 (50%) of the symptomatic infants. Seventeen (65%) of the symptomatic infants had bilateral retinal haemorrhages, and two had unilateral retinal haemorrhages. All infants had neuroimaging compatible with chronic subdural haematomas/hygromas as well as radiological characteristics compatible with benign external hydrocephalus (BEH). Conclusions BEH with subdural haematomas/hygromas in infants may sometimes be misdiagnosed as abusive head trauma. Based on the authors’ experience and findings of the study, the following measures are suggested to avoid this diagnostic pitfall: medical experts in infant abuse cases should be trained in recognising clinical and radiological BEH features, clinicians with neuro-paediatric experience should always be included in the expert teams and reliable information about the head circumference development from birth should always be available.

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Infantile retinal haemorrhages in the absence of brain and bodily injury

Cited by 9 publications

References 8 publications

Infantile subdural hematoma in Japan: A multicenter, retrospective study by the J-HITs (Japanese head injury of infants and toddlers study) group

Infantile subdural hematoma in Japan: A multicenter, retrospective study by the J-HITs (Japanese head injury of infants and toddlers study) group

Rib fractures in infancy, case-series and register case-control study from Sweden

Is external hydrocephalus a possible differential diagnosis when child abuse is suspected?

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