Shaken Baby Syndrome: review of a series of 24 cases

Background/Aims : We propose a review of 24 cases of children with a diagnosis of shaken baby syndrome admitted to the university pediatric service over a period of 12 years.
Methods : We defined the inclusion criteria on the basis of: diagnostic criteria used in the literature, namely multifocal subdural hematomas associated or not with retinal haemorrhages or unifocal subdural hematoma associated with retinal haemorrhages. All clinical situations were taken care of in a multidisciplinary medical and psychosocial way.
Results : Out of 24 children, the sex ratio is 1 and the average age is 3.5 months.
Neonatal factors: 25% (n=6) of children had a twin and two sets of twins had shaken baby syndrome. 37% had stayed in neonatology and 16% were premature < 36 weeks gestational age
Symptoms that led to the diagnosis: 30% had convulsions or even status epilepticus, 35% had severe apnea, 15% had vomiting, 15% a rapid increase in head circumference, 25% associated apnea and convulsions, 5 % were diagnosed following an investigation following the diagnosis made on the twin.
Clinical lesions: 60% of the children had plurifocal subdural hematomas associated with retinal haemorrhages, 34% had plurifocal subdural hematomas but no retinal haemorrhages, 6% had unifocal subdural hematomas associated with retinal haemorrhages. 62% of the children were admitted to the intensive care unit and of these 46% benefited from endo-tracheal intubation and invasive ventilation. A neuro-surgical intervention was necessary in 30% of cases. In 33% of cases, bone fractures were found on complete skeletal radiography.
Sequels : 41% of children were on antiepileptic treatment three months after discharge from hospital. 12.5% progressed to cerebral palsy, 37.5% developed a developmental delay (attention and learning disorders, language disorders, dysgraphia, dyscalculia, etc.), 21% retained visual sequelae.
Psycho-social factors: Our sample comes from all socio-cultural backgrounds. In 29% of the cases the author admitted the facts during the hospitalization (among these we find 57% of the fathers and 43% of the mothers). A report to the youth assistance services was made in 100% of cases. At the end of the psychosocial assessment, 37.5% of the children had to be placed outside the family environment.
Conclusion : shaken baby syndrome is a complex pathology that is related to child abuse. Its clinical and psychological consequences in the short and long term are very important.