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Neonatal Injuries in Child Abuse Follow-up

  • Author: Nitin C Patel, MD, MPH, FAAN; Chief Editor: Amy Kao, MD  more...
 
Updated: May 15, 2015
 

Further Outpatient Care

See the list below:

  • The patient may require continued physical and occupational therapy after discharge.
  • Continued follow-up with a neurologist is recommended.
  • Closely watch the patient for spasticity, and control this with medication as needed.
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Further Inpatient Care

See the list below:

  • Further inpatient rehabilitation therapy may be indicated to manage the acute intracranial pathology, depending on the severity of injury.
  • If long-term inpatient care is required, the patient should be transferred to a pediatric rehabilitation unit for maximal multidisciplinary care.
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Inpatient & Outpatient Medications

See the list below:

  • Antiepileptic medication may be indicated if evidence of seizures is noted.
  • Neurosurgeons tend to prescribe prophylactic therapy for all patients. However, this practice is not a universal recommendation.
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Complications

The main complications after shaken baby syndrome affect the neurologic and visual systems.

After retinal hemorrhages resolve, the following visual complications may occur: macular thinning, retinal pigment epithelial atrophy, and visual loss.

Wilkinson et al showed that the degree of retinal hemorrhage reflects the degree of neurologic injury.[16]

Patients with bilateral retinal hemorrhages tend to have acute, severe neurologic injury.

Large subhyaloid hemorrhage, vitreous hemorrhage, or diffuse involvement of the fundus is likely to be associated with severe neurologic injury.

Neurologic complications include varying degrees of learning disabilities, spasticity and weakness, hydrocephalus, developmental delay, acquired microcephalus, seizures, hearing loss, and cortical blindness.

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Prognosis

The prognosis depends on the severity of the neurologic injury and the involvement of other organ systems.

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Patient Education

For excellent patient education resources, visit eMedicineHealth's Children's Health Center. Also, see eMedicineHealth's patient education article Child Abuse.

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Contributor Information and Disclosures
Author

Nitin C Patel, MD, MPH, FAAN Professor of Clinical Pediatrics and Neurology, Southern Illinois University School of Medicine; Private Practice, Columbia Center for Child Neurology

Nitin C Patel, MD, MPH, FAAN is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Headache Society, Child Neurology Society

Disclosure: Nothing to disclose.

Coauthor(s)

Bhagwan I Moorjani, MD, FAAP, FAAN Consulting Staff, Department of Neuroscience, Director, Department of Neuroscience, Division of Evoked Response Laboratory, Children's National Medical Center

Bhagwan I Moorjani, MD, FAAP, FAAN is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Robin D Riggins, RN, MSN, CPNP Pediatric Nurse Practitioner, Department of Pediatric Neurology, University of Missouri Health Care Hospitals and Clinics

Robin D Riggins, RN, MSN, CPNP is a member of the following medical societies: National Association of Pediatric Nurse Practitioners, American Association of Neuroscience Nurses

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Kenneth J Mack, MD, PhD Senior Associate Consultant, Department of Child and Adolescent Neurology, Mayo Clinic

Kenneth J Mack, MD, PhD is a member of the following medical societies: American Academy of Neurology, Child Neurology Society, Phi Beta Kappa, Society for Neuroscience

Disclosure: Nothing to disclose.

Chief Editor

Amy Kao, MD Attending Neurologist, Children's National Medical Center

Amy Kao, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, Child Neurology Society

Disclosure: Have stock from Cellectar Biosciences; have stock from Varian medical systems; have stock from Express Scripts.

Additional Contributors

Robert Stanley Rust, Jr, MD, MA Thomas E Worrell Jr Professor of Epileptology and Neurology, Co-Director of FE Dreifuss Child Neurology and Epilepsy Clinics, Director, Child Neurology, University of Virginia School of Medicine; Chair-Elect, Child Neurology Section, American Academy of Neurology

Robert Stanley Rust, Jr, MD, MA is a member of the following medical societies: Child Neurology Society, Society for Pediatric Research, American Headache Society, International Child Neurology Association, American Academy of Neurology, American Epilepsy Society, American Neurological Association

Disclosure: Nothing to disclose.

References
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CT scan shows a subdural hematoma.
CT scan shows cerebral edema with loss of gray matter–white matter distinction.
T1-weighted MRIs reveal bilateral chronic subdural hematomas as well as severe encephalomalacia involving the parietal, occipital, and temporal lobes.
T1-weighted MRIs show chronic bilateral subdural hematomas.
T2-weighted MRIs show encephalomalacia after shaken baby syndrome.
Sagittal MRIs show chronic subdural hematoma.
Funduscopic image shows intraretinal hemorrhages, subhyaloid hemorrhages, localized hemorrhagic choroid detachments, and thin retinal folds.
Flair and T2 images reveal intrahemispheric bleeding.
 
 
 
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