1105 Outcome after Inflicted Traumatic Brain Injury in Shaken Baby Syndrome: Neurosurgical Approach

Abstract

Background and Aims Shaken Baby Syndrome (SBS) is a severe form of child abuse caused by violent shaking leading to severe head injuries, causing mild-severe long-term disabilities and death. The study aims to explore medium/long-term consequences of SBS comparing children undergoing neurosurgery with hematoma evacuation/ cranioplasty with those with hematoma evacuation or no surgery. Methods A cohort of 21 children with SBS, admitted to Pediatric Department/Padua Hospital (2003-2011), was followed-up. Each clinical record was reviewed collecting information on onset, acute course, ophthalmologic examinations, neuroimaging, treatment and procedures, family history and social background. Cases were followed-up at 3, 6 and 12 months after trauma, every year. The assessment included fundus evaluation and visual function, neuroradiological exams (MRI). Results 21 cases were reviewed (M:F=2:1.1), 12 foreigners, 9 italians. Mean age at onset: 5.7 months (range 1.2-18). Mean age at last follow-up evaluation: 30.4 months (range 5-82). Mean follow-up duration: 24.6 months (range 1-73.5). In acute phase 8/19 underwent neurosurgical intervention and 1/21 underwent eye surgery. 20/21 showed retinal hemorrhages, 21/21 cerebral hemorrhages, 11/21 cerebellar hemorrhages, 5/10 spinal subdural hematoma, 4/21 skull fractures, 6/21 other body region fractures. At last follow-up evaluation resulted: 2/21 hemiplegia, 1/21 paraplegia, 1/21 tetraplegia, 2/21 cortical visual impairment, 3/21 visual field deficits, 4/21 strabismus. 10/21 underwent cognitive and behavioural assessment demostrating in 6 cases global delay and in 4 cases delay in specific functions (locomotor, eye and hand coordination, performance scale). Surgical procedure's video will be shown. Conclusions SBS may influence child development and therapeutical surgical approach seems crucial.