Shaken baby syndrome: a common variant of non-accidental head injury in infants.
BACKGROUND
Recent cases of child abuse reported in the media have underlined the importance of unambiguous diagnosis and appropriate action. Failure to recognize abuse may have severe consequences. Abuse of infants often leaves few external signs of injury and therefore merits special diligence, especially in the case of non-accidental head injury, which has high morbidity and mortality.


METHODS
Selective literature review including an overview over national and international recommendations.


RESULTS
Shaken baby syndrome is a common manifestation of non-accidental head injury in infancy. In Germany, there are an estimated 100 to 200 cases annually. The characteristic findings are diffuse encephalopathy and subdural and retinal hemorrhage in the absence of an adequate explanation. The mortality can be as high as 30%, and up to 70% of survivors suffer long-term impairment. Assessment of suspected child abuse requires meticulous documentation in order to preserve evidence as well as radiological, ophthalmological, laboratory, and forensic investigations.


CONCLUSIONS
The correct diagnosis of shaken baby syndrome requires understanding of the underlying pathophysiology. Assessment of suspected child abuse necessitates painstaking clinical examination with careful documentation of the findings. A multidisciplinary approach is indicated. Continuation, expansion, and evaluation of existing preventive measures in Germany is required.
Matschke
Jakob
J
Forensische Neuropathologie, Institut für Neuropathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg. matschke@uke.de
Herrmann
Bernd
B
Sperhake
Jan
J
Körber
Friederike
F
Bajanowski
Thomas
T
Glatzel
Markus
M
D002649:Child Abuse / Q000145:classification / Q000175:diagnosis* / Q000401:mortality*; D016489:Head Injuries, Closed / Q000145:classification / Q000175:diagnosis* / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D038642:Shaken Baby Syndrome / Q000145:classification / Q000175:diagnosis* / Q000401:mortality*; D015996:Survival Rate; D009626:Terminology as Topic