Clinical case: Discovery of Shaken Baby Syndrome in the course of Streptococcus Agalactiae Septicemia

Background/Aims : Shaken Baby Syndrome (SBS) is an abusive head trauma entity and represents a severe form of child abuse. We describe the clinical case of a 2-month-old child who, in the course of hospitalization for Streptococcus Agalactiae sepsis, presented an unfavorable clinical course leading to the accidental discovery of SBS and detail the clinical and diagnostic elements allowing it to be detected and managed in a multidisciplinary manner.

Methods This is a male child, the couple's first child, the mother already having 3 other children from previous unions. His antecedents are marked by prematurity at 30 weeks 3 / 7th, late neonatal sepsis at day 6 of birth due to E. Aerogenes with associated meningitis. A brain MRI performed before the child was discharged from the neonatal ward was found to be normal. He is admitted at the age of 2 1/2 months of actual age and 3 weeks of corrected age with a clinical picture of severe malaise in the infant and septic shock. Additional examinations show an Hb at 6.6g / dL, a hematocrit at 27.3%, white blood cells at 2270 / m3, platelets at 137,000 / mm3, a CRP at 75 mg / l. The blood culture will come back positive for Streptococcus Agalactiae, the lumbar puncture will be negative. The child was initially be treated by broad-spectrum antibiotic therapy and then on amoxicillin for 14 days. He evolved well infectiously with rapid defervescence of both temperature and inflammatory syndrome, reflecting a correct response to antibiotic therapy. However, axial and peripheral hypotonia persisedt as well as fluctuating eye tracking. These clinical signs were explored by transfontanellar ultrasound which will highlight images of echogenic subdural collection 3 mm thick on the left and anechoic fluid collection 2 mm thick on the right.

Results :
A brain MRI confirmed subdural plurifocal hematomas and a fundus of bilateral retinal haemorrhages diagnosing shaken baby syndrome.
During the assessment, one of the parents will admit having shaken the child violently on several occasions. Clinically and in longitudinal follow-up, the child will develop an epileptic syndrome treated with Valproic Acid as well as a psychomotor delay associating delay in walking and speech, as well as fine motor disorders and will benefit from multidisciplinary follow-up.

Conclusion : Shaken Baby Syndrome is a form of serious child abuse that needs to be recognized and diagnosed in order to initiate prompt medical care and protection for the child.