Vitamin K deficiency mimicking child abuse

Brousseau, Tonia; Kissoon, Niranjan; McIntosh, Bruce

doi:10.1016/j.jemermed.2005.02.009

Cited by 31 publications

(14 citation statements)

References 21 publications

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“…[16][17][18][19] Regarding AHT, the literature tends to focus on the need to rule out underlying coagulation disorders as the etiology of the brain injury for the obvious legal implications. [37][38][39] A study by Hymel et al 27 found that half of their cohort with AHT had elevated INR at admission; among study patients who died, coagulation abnormalities were more common and severe. They concluded that in the presence of parenchymal brain damage, it is unlikely that this type of coagulation abnormality can be attributed to a preexisting bleeding diathesis.…”

Section: Discussionmentioning

confidence: 99%

Elevated admission international normalized ratio strongly predicts mortality in victims of abusive head trauma

Leeper

Nasr

McKenna

et al. 2016

Journal of Trauma and Acute Care Surgery

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Section: Discussionmentioning

confidence: 99%

Elevated admission international normalized ratio strongly predicts mortality in victims of abusive head trauma

Leeper

Nasr

McKenna

et al. 2016

Journal of Trauma and Acute Care Surgery

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“…It is uncommon for bleeding disorders to present with intracranial haemorrhage except for vitamin K deficiency [7,45]. It is mostly seen in breastfed babies who do not receive supplemental vitamin K. In some cases an underlying disease is present [15,33,40,42].…”

Section: Clinical Findings and Differential Diagnosismentioning

confidence: 99%

Educational paper

Sieswerda‐Hoogendoorn

Boos

Spivack

et al. 2011

Eur J Pediatr

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Abusive Head Trauma (AHT) refers to the combination of findings formerly described as shaken baby syndrome. Although these findings can be caused by shaking, it has become clear that in many cases there may have been impact trauma as well. Therefore a less specific term has been adopted by the American Academy of Pediatrics. AHT is a relatively common cause of childhood neurotrauma with an estimated incidence of 14–40 cases per 100,000 children under the age of 1 year. About 15–23% of these children die within hours or days after the incident. Studies among AHT survivors demonstrate that approximately one-third of the children are severely disabled, one-third of them are moderately disabled and one-third have no or only mild symptoms. Other publications suggest that neurological problems can occur after a symptom-free interval and that half of these children have IQs below the 10th percentile. Clinical findings are depending on the definitions used, but AHT should be considered in all children with neurological signs and symptoms especially if no or only mild trauma is described. Subdural haematomas are the most reported finding. The only feature that has been identified discriminating AHT from accidental injury is apnoea. Conclusion: AHT should be approached with a structured approach, as in any other (potentially lethal) disease. The clinician can only establish this diagnosis if he/she has knowledge of the signs and symptoms of AHT, risk factors, the differential diagnosis and which additional investigations to perform, the more so since parents seldom will describe the true state of affairs spontaneously.

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“…A number of relatively uncommon pediatric disorders have now been described that can be associated with the triad including glutaric aciduria-type 1, vitamin K deficiency, Menke disease, hemophagocytic lymphohistiocytosis, and others. 3,4,78,115,116 These conditions are mimics of SBS, and unfortunately wrongful diagnoses of child abuse in these cases have been made under the SBS rubric. Clearly, pediatricians faced with an infant with the triad or pathologists faced with an autopsy of an infant with the triad may not have been aware that these rare disorders can mimic SBS because the association had not yet been recognized.…”

Section: A Flawed Sbs Literaturementioning

confidence: 99%

Overrepresentation of Males in Traumatic Brain Injury of Infancy and in Infants With Macrocephaly

Miller

2010

American Journal of Forensic Medicine &Amp; Pathology

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Shaken baby syndrome (SBS) has been thought to be caused by violent shaking of an infant and is characterized by the triad of findings: subdural hematoma (SDH), retinal hemorrhages, and neurologic abnormalities. The triad is not specific for SBS and can be seen in accidental trauma and in certain medical conditions. Recent observations, however, question whether SBS exists. Herein, we review the gender differences in 3 groups of infants with traumatic brain injury: (1) neonates with SDH from birth trauma, (2) infants with SDH from accidental trauma, and (3) infants with SDH from SBS. Gender differences are also presented in a fourth group of infants with macrocephaly related to increased extra-axial fluid spaces (IEAFS). Compared with the expected male frequency of 51.4% in newborns, there was a statistically significant overrepresentation of males in each of the 4 groups-65.3%, 62.2%, 62.6%, and 68.8%, respectively. We believe that the most likely explanation for these findings relates to the larger head size of the male compared with the female which has several relevant consequences. First, the larger head circumference of a male newborn compared with a female newborn may increase the likelihood that a male newborn will incur a small SDH from the minor trauma of the birthing process that can later rebleed and present with a symptomatic SDH that could be misdiagnosed as SBS and child abuse. Second, a short fall would have a greater likelihood of causing a SDH in a male infant than a female infant who could subsequently become symptomatic from hours to weeks later and could thus present as an unexplained SDH. Third, infants with macrocephaly related to IEAFS may be at increased risk for developing a SDH from the larger head size and greater tautness of the bridging vessels in the extra-axial fluid spaces. We believe that many infants who have been diagnosed with SBS have been given incorrect diagnoses of child abuse. Rather, their SDH may occur as a result of a small SDH from the birthing process that enlarges during early infancy, a short fall, or from macrocephaly with IEAFS.

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Vitamin K deficiency mimicking child abuse

Cited by 31 publications

References 21 publications

Elevated admission international normalized ratio strongly predicts mortality in victims of abusive head trauma

Elevated admission international normalized ratio strongly predicts mortality in victims of abusive head trauma

Educational paper

Overrepresentation of Males in Traumatic Brain Injury of Infancy and in Infants With Macrocephaly

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