| McCabe,
C.F. & Donahue, S.P. (2000). Prognostic indicators for
vision and mortality in shaken baby syndrome.
Arch Opthalmol, 118,
373-377. |
| Objective |
To
study ocular and nonocular signs of patients diagnosed as having "shaken
baby syndrome" and determine prognostic indicators for vision and mortality. |
| Methods |
Researchers
reviewed the medical charts of child abuse cases involving bilateral retinal
hemorrhages. They paid particular attention to visual function and
pupillary light reaction at the time of admission as well as the location
of the retinal hemorrhage, neuroimaging findings, ventilatory requirement
and associated skeletal injuries. The information was obtained from
the charts was compared with visual prognosis and mortality. |
| Results |
There
were thirty cases that met the criteria for review. On the first
visit the mean age of the children was 9.3 months and 12 (40%) children
had at least fix-and-follow vision. The researchers found that preretinal
and intraretinal hemorrhages were more common (93% [n=28] and 100% [n=30]),
respectively than vitreous hemorrhages (10% [n=3]). Subdural
hematomas were detected in 21 patients (70%). There were 20 children
(67%) who had seizures and 16 (53%) required ventilators. There were
bruises and long bone fractures found in 14 (47%). Eight patients
died. All patients with nonreactive pupils on initial visit died,
while patients with a pupillary light reaction lived. Six (86%) of
7 patients with midline shift post trauma died, whereas 21 (91%) of 23
with no midline shift lived. At the follow-up, retinal hemorrhages
had resolved in nearly all children by 4 months, and 16 children (73%)
had at least fix-and-follow vision. A correlation was found between
the need for ventilator support and poor vision. |
|
Conclusion
|
Nonreactive
pupils and midline shift of the brain structures correlate highly with
mortality. Ventilatory requirement, but not visual acuity on presentation,
predicts visual outcome. |
