Neonatal Injuries in Child Abuse Follow-up

  • Author: Nitin C Patel, MD, MPH; Chief Editor: Amy Kao, MD   more...
 
Updated: Aug 29, 2011
 

Further Inpatient Care

  • 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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Further Outpatient Care

  • 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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Inpatient & Outpatient Medications

  • 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 resolved, 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.[14]
    • 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 eMedicine's Children's Health Center. Also, see eMedicine's patient education article Child Abuse.

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Contributor Information and Disclosures
Author

Nitin C Patel, MD, MPH  Professor of Clinical Neurology and Child Health, Department of Child Health, Chief for Developmental Pediatrics and Child Neurology, Specialist in Pediatrics/Neurology, University of Missouri Hospital and Clinics at Columbia

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

Disclosure: Nothing to disclose.

Coauthor(s)

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: American Association of Neuroscience Nurses and National Association of Pediatric Nurse Practitioners

Disclosure: Nothing to disclose.

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.

Specialty Editor Board

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: American Academy of Neurology, American Epilepsy Society, American Headache Society, American Neurological Association, Child Neurology Society, International Child Neurology Association, and Society for Pediatric Research

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

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, and 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 Academy of Pediatrics, American Epilepsy Society, and Child Neurology Society

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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