Neonatal Injuries in Child Abuse Follow-up

Updated: Jul 24, 2018
  • Author: Nitin C Patel, MD, MPH, FAAN; Chief Editor: Amy Kao, MD  more...
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Follow-up

Further Outpatient Care

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  • 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

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  • 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

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  • 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. [20]

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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