Nonaccidental Trauma (Shaken Baby Syndrome)
Martha A. Howard, MD
The diagnosis of nonaccidental trauma cannot be made upon isolated physical examination findings. It requires the careful synthesis of information from physical and ophthalmic examinations and radiologic and laboratory studies.
Shaken baby syndrome is a subset of abusive head trauma that occurs when a baby is forcefully shaken, causing bleeding in the brain and eyes secondary to accelerationdeceleration forces.
EPIDEMIOLOGY
Majority <12 months of age, almost always <5 years of age.
Risk factors:
Prematurity.
Multiple medical problems/disabilities.
Male gender.
HISTORY
Out of proportion with extent of injuries.
May be vague and/or inconsistent.
Mental status deterioration, seizures, respiratory depression.
SIGNS AND SYMPTOMS (TYPICALLY NONSPECIFIC)
Poor feeding.
Vomiting.
Apnea.
Irritability.
Seizures.
Decreased tone.
Decreased consciousness.
 FIGURE 29.1. Diagram showing various types of hemorrhage seen in nonaccidental trauma patients. |
OPHTHALMOLOGIC FINDINGS
Common (Fig. 29.1):
Retinal hemorrhages (85% of cases) (Fig. 29.2).
Location:
Preretinal or vitreous.
Intraretinal (flame and dot blot).
Subretinal.
Tend to cluster in posterior pole but may extend throughout fundus.
Can be too numerous to count.
Usually bilateral but may be unilateral or asymmetric.
Last days to months, depending on location and severity, and it is impossible to date the hemorrhages by their appearance.
Circumferential macular folds.
Retinoschisis.
Other:
Periorbital hematoma.
Eyelid laceration.
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