Long-term outcome of the shaken baby syndrome and medicolegal consequences: a case report.
BACKGROUND
Studies of long-term outcome of the shaken baby syndrome (SBS) are scarce, but they usually indicate poor outcome.


OBJECTIVE
To describe long-term outcome of a child having sustained a SBS, to ascertain possible delayed sequelae and to discuss medicolegal issues.


METHODS
We report a single case study of a child having sustained a SBS, illustrating the initial clinical features, the neurological, cognitive and behavioural outcomes as well as her social integration.


RESULTS
The child sustained diffuse brain injuries, responsible for spastic right hemiplegia leading to secondary orthopaedic consequences, as well as severe cognitive impairment, worsening over time: the developmental quotient measured at 15 months of age was 55 and worsened as age increased. At 6 years and 8 months, the child's IQ had fallen to 40. Behavioural disorders became apparent only after several months and precluded any social integration. The child eventually had to be placed in a specialised education centre at age 5.


CONCLUSIONS
The SBS has a very poor outcome and major long-standing sequelae are frequent. Cognitive or behavioural sequelae can become apparent only after a long sign-free interval, due to increasing demands placed on the child during development. This case report confirms severity of early brain lesions and necessity for an extended follow-up by a multi-disciplinary team. From a medicolegal point of view, signaling the child to legal authorities allows protection of the child, but also conditions later compensation if sequelae compromise autonomy.
Laurent-Vannier
A
A
Service de rééducation des pathologies neurologiques acquises de l'enfant, hôpital national de Saint-Maurice, Saint-Maurice, France. a.laurentvannier@hopital-saint-maurice.fr
Toure
H
H
Vieux
E
E
Brugel
D G
DG
Chevignard
M
M
D001925:Brain Damage, Chronic / Q000209:etiology* / Q000534:rehabilitation; D017028:Caregivers / Q000331:legislation & jurisprudence; D002649:Child Abuse / Q000331:legislation & jurisprudence*; D002653:Child Behavior Disorders / Q000209:etiology; D002674:Child, Institutionalized / Q000331:legislation & jurisprudence* / Q000523:psychology; D002675:Child, Preschool; D003072:Cognition Disorders / Q000209:etiology; D035881:Compensation and Redress / Q000331:legislation & jurisprudence*; D018450:Disease Progression; D004828:Epilepsies, Partial / Q000188:drug therapy / Q000209:etiology; D005500:Follow-Up Studies; D005602:France; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D007223:Infant; D007326:Institutionalization; D019221:Mandatory Reporting; D011379:Prognosis; D012166:Retinal Hemorrhage / Q000209:etiology; D038642:Shaken Baby Syndrome / Q000150:complications* / Q000453:epidemiology