BACKGROUND: Shaken baby syndrome is widely discussed in the literature. This syndrome is considered as a variant of child maltreatment syndrome. In the English-language literature, there are data on high incidence of this syndrome and difficult diagnosis. There are no such diagnosis in the Russian and reports devoted to this issue.
OBJECTIVE: To assess the incidence and nature of injuries following child maltreatment/shaken baby syndrome in infants and young children.
METHODS: We analyzed case records of 3668 patients aged 1-36 month between 2017 and 2021 with injury/suspected traumatic brain injury (TBI). Mild TBI was in 47.2% of patients, moderate and severe - in 56.8% of patients. Twenty-eight children admitted with GCS score 3-8. CT was performed in case of risk factors for intracranial injuries (1703 patients). Abnormalities were found in 71.6% of cases. Sixty-four children required surgical treatment. Overall mortality rate was 0.7%.
RESULTS: Accidental trauma was found in 3664 cases. We verified child maltreatment/shaken baby syndrome in only 4 (0.1%) cases. At the alleged moment of injury, there were male persons (cohabitant or guardian) with the child that is consistent with literature data. In all 4 cases, we observed severe combined TBI. In one case, brain damage was regarded as a result of chronic trauma. Indeed, MRI diagnosed thrombosis of bridging veins along convexital parts of the frontal, parietal and occipital lobes. There were GOS grade I in 2 patients (death), grade III in 1 patient (severe disability) and grade IV in 1 patient (recovery).
CONCLUSIONS: Child maltreatment/shaken baby syndrome is less common among infants and young children in the Russian Federation. This may be due to national, cultural and religious traditions. Indeed, infants and children under 3 years of age are cared for by female persons. The mechanism of injury (shaking) leads to typical multiple injuries involving various organs and systems. These damages require multidisciplinary approach to diagnosis and treatment. MRI-confirmed thrombosis of bridging veins may be an additional diagnostic sign indicating the mechanism of injury.
В литературе широко обсуждается один из тяжелейших видов сочетанной черепно-мозговой травмы (ЧМТ) — синдром тряски младенца (Shaken baby syndrome), который рассматривается как один из вариантов синдрома жестокого обращения с детьми. В англоязычной литературе имеются указания на высокую частоту встречаемости синдрома и трудности диагностики при таком механизме травмы. В РФ такого диагноза нет, а публикации по этому вопросу практически отсутствуют.
UNASSIGNED: Оценить частоту встречаемости и характер повреждений при синдроме жестокого обращения/синдроме тряски младенца у младенцев и детей раннего возраста по данным ГБУЗ «Научно-исследовательский институт неотложной детской хирургии и травматологии Департамента здравоохранения города Москвы».
UNASSIGNED: Проанализированы истории болезни 3668 пациентов в возрасте от 1 мес до 3 лет, госпитализированных с 2017 по 2021 г. с травмой/подозрением на ЧМТ. Легкая ЧМТ была у 47,2% пациентов, среднетяжелая и тяжелая — у 56,8%. Госпитализированы с уровнем бодрствования 3—8 баллов по шкале комы Глазго 28 детей. Компьютерная томография выполнялась при наличии риск-факторов внутричерепных повреждений (1703 пациента), патология выявлена в 71,6% случаев. Хирургическое лечение потребовалось 64 детям. Летальность в группе в целом составила 0,7%.
UNASSIGNED: В 3664 случаях имела место неумышленная травма (accidental trauma), и только в 4 — верифицирован синдром жестокого обращения с детьми/синдром тряски младенца, что составило 0,1%. В предполагаемый момент получения травмы с ребенком находились лица мужского пола (сожитель или опекун), что соответствует данным литературы. Во всех 4 наблюдениях имела место тяжелая сочетанная ЧМТ. В 1 случае повреждения мозга расценены как результат хронической травмы — при магнитно-резонансной томографии (МРТ) диагностированы тромбозы мостиковых вен вдоль конвекситальных отделов лобных, теменных и затылочных долей. По шкале исходов Глазго 2 пациента вышли в 1-ю группу (смерть), 1 — в 3-ю группу (глубокая инвалидизация) и 1 — восстановился в пределах 4-й группы.
UNASSIGNED: Синдром жестокого обращения/синдром тряски младенца среди младенцев и детей раннего возраста в РФ встречается реже, что может быть связано с национально-культурными и религиозными традициями, согласно которым уход за младенцами и детьми до 3 лет осуществляют лица женского пола. Механизм травмы (тряска) приводит к характерным множественным повреждениям с вовлечением различных органов и систем организма, что требует мультидисциплинарного подхода в диагностике и лечении. Тромбоз мостиковых вен, верифицированный при МРТ головного мозга, может быть дополнительным диагностическим признаком, указывающим на механизм травмы.

Child abuse is a major cause of morbidity and mortality in the United States. The leading cause of child physical abuse related deaths is abusive head trauma, formerly known as shaken baby syndrome, making the rapid identification and assessment of these children critical. The clinical presentation of cases of abusive head trauma ranges from neurological complaints, such as seizures, to vague or subtle symptoms, such as vomiting. This results in frequent missed diagnoses of abusive head trauma. The identification of abusive head trauma relies on a thorough medical history and physical examination, followed by lab evaluation and imaging. The goal of the evaluation is to discover further injury and identify possible underlying non-traumatic etiologies of the patient\'s symptoms. In this article we present a framework for the assessment of abusive head trauma and provide information on common presentations and injuries, as well as differential diagnoses. A strong foundational knowledge of abusive head trauma will lead to greater recognition and improved safety planning for victims of this unfortunate diagnosis.

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Severe, too many to count retinal hemorrhages (RH) in infants have been associated with abusive head trauma, but can occur in short falls. An 8-month-old male fell backward from a height of 26 cm, landing on his buttocks then hitting the back of his head on a vinyl floor. The fall was videotaped. Acute subdural hemorrhages were found along with extensive, too many to count intra-RH in both eyes. Falls from small heights on to the occiput can lead to extensive RH of the type often associated with abusive head trauma.

Child abuse is a global problem. Shaken baby syndrome (SBS) is a result of child abuse, with shaking being the most common form of maltreatment, causing mortality or severe brain damage in infants. A lack of awareness of SBS among current and future healthcare professionals can have serious consequences. To date, no studies have been conducted in Saudi Arabia to examine student nurses\' awareness of SBS, so we sought to assess this issue in an academic institution in Riyadh, Saudi Arabia. For this questionnaire-based study, we employed a cross-sectional, descriptive design. The target population was nursing students from every year of study in the institution\'s five-year undergraduate nursing programme, who received an online questionnaire during the 2022-2023 academic year. The data were analysed using descriptive and inferential statistical analysis. Of the 293 respondents, 100.0% confirmed that they were not aware of SBS through their nursing curricula, and 62.1% reported not being made aware of SBS at all during their academic journey. The majority of participants were unaware of the negative consequences of shaking a baby. Most were not aware that shaking a baby vigorously can cause permanent blindness (73.4%), postural impairments (56.7%), sleep disorders (61.1%), or convulsions (60.1%). The results of our study revealed a statistically significant relationship between nursing students\' awareness of SBS and both their year of study and marital status. Those at higher academic levels and those who were married were more aware of SBS. To improve nursing students\' knowledge of SBS and help them to better inform the public of this syndrome, particularly parents, child maltreatment topics should be added to nursing curricula in Saudi Arabia, and their importance should be emphasised. This will help reduce the prevalence and burden of SBS nationally.

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Abusive head trauma (AHT) is an extreme form of physical child abuse, a subset of which is shaken baby syndrome (SBS). While traumatic injury in children is most readily observed as marks of contusion on the body, AHT/SBS may result in internal injuries that can put the life of the child in danger. One pivotal sign associated with AHT/SBS that cannot be spotted with the naked eye is retinal injury (RI), an early sign of which is retinal hemorrhage (RH) in cases with rupture of the retinal vasculature. If not addressed, RI can lead to irreversible outcomes, such as visual loss. It is widely assumed that the major cause of RI is acceleration-deceleration forces that are repeatedly imposed on the patient during abusive shaking. Still, due to the controversial nature of this type of injury, few investigations have ever sought to delve into its biomechanical and/or biochemical features using realistic models. As such, our knowledge regarding AHT-/SBS-induced RI is significantly lacking. In this mini-review, we aim to provide an up-to-date account of the traumatology of AHT-/SBS-induced RI, as well as its biomechanical and biochemical features, while focusing on some of the experimental models that have been developed in recent years for studying retinal hemorrhage in the context of AHT/SBS.

Uncertainties and controversies surround \"shaken baby syndrome\" or infant \"abusive head trauma\". We explore Vinaccia v The Queen (2022) 70 VR 36; [2022] VSCA 107 and other selected cases from Australia, the United Kingdom and the United States. On expert opinion alone, a \"triad\" of clinical signs (severe retinal haemorrhages, subdural haematoma and encephalopathy) is dogmatically attributed diagnostically to severe deliberate shaking with or without head trauma. However, the evidence for this mechanism is of the lowest scientific level and of low to very low quality and therefore unreliable. Consequently, expert opinion should not determine legal outcomes in prosecuted cases. Expert witnesses should reveal the basis of their opinions and the uncertainties and controversies of the diagnosis. Further, the reliability of admissions of guilt while in custody should be considered cautiously. We suggest abandonment of the inherently inculpatory diagnostic terms \"shaken baby syndrome\" and \"abusive head trauma\" and their appropriate replacement with \"infantile retinodural haemorrhage\".

OBJECTIVE: Shaken baby syndrome (SBS), a subset of abusive head trauma, results from non-accidental, violent head shaking. Most survivors suffer permanent neurological sequelae. Accurate diagnosis is imperative and remains challenging. The purpose of this study is to describe ocular injuries and associated neurotrauma in suspected SBS.
METHODS: We retrospectively surveyed the National Trauma Data Bank 2008-2014 for patients ≤ 3 years old admitted for suspected SBS. Statistical analysis was performed with SPSS software. Significance was set at p < 0.05.
RESULTS: Three hundred forty-seven (13.9%) of 2495 patients who were ≤ 3 years old were admitted with abusive head trauma and ocular injuries which resulted from suspected SBS. Most were < 1 year old (87.9%) and male (54.2%). Common eye injuries were retinal hemorrhages (30.5%), eye/adnexa contusion (14.7%), and retinal edema (10.7%). Common neurotrauma were subdural (75.5%), subarachnoid (23.9%), and intracerebral hemorrhage (ICH) (10.4%). Mean (SD) Injury Severity Score was severe, 20.2 (8.2), and Glasgow Coma Score was moderate, 9.2 (12.8). The mortality rate was 16.7%. Retinal hemorrhages were not significantly associated with one type of neurotrauma over others. Ocular/adnexa contusion (OR 4.06; p < 0.001) and commotio retinae/Berlin\'s edema (OR 5.27; p < 0.001) had the greatest association with ICH than other neurotrauma. Optic neuropathy (OR 21.33; p < 0.001) and ICH (OR 3.34; p < 0.001) had the highest associated with mortality.
CONCLUSIONS: Our study supports previous studies showing that retinal and subdural hemorrhages were the most common ocular injury and neurotrauma in SBS, respectively. However, we did not find a significant propensity for their concurrence. Commotio retinae/Berlin\'s edema was significantly associated with both intracerebral and subdural hemorrhages.