EPOS

European Paediatric Ophthalmological Society

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Retinal haemorrhages in the differential diagnosis of child abuse

Serra Alicia¹, Morales Marta¹, Curcoy Ana², Trenchs Victoria², Prat Joan¹, Catala Jaume^1
1Hospital Sant Joan de Deu - Ophthalmology, ²Hospital Sant Joan de Deu - Pediatrics

Introduction: Shaken baby syndrome (SBS) is an extremely serious form of abusive head trauma that occurs when a child is subjected to rapid acceleration, deceleration, and rotational forces, with or without impact, resulting in a unique constellation of intracranial, intraocular, and cervical spinal cord injuries. Retinal hemorrhages (RH) are one of the most characteristic findings, but can be associated with accidental head trauma and with a variety of systemic illnesses, not enough documented in the literature. Aim: To determine the prevalence of retinal hemorrhages in head trauma due to vertical fall, convulsions, apnoea or whooping cough with the purpose of facilitating the differential diagnosis of the cases of shaken baby syndrome. Methods: Prospective study on children aged 15 days to 2 years admitted to our hospital with one of the diagnosis listed above over a period of two years (may 2004 - may 2006). A complete neurological examination and dilated fundus examination were performed within 72 hours of admission. If RH were detected, further investigation was undertaken to rule out systemic disorder or maltreatment. Results: 516 children were included, with the following diagnosis: 182 children with first seizure, 154 with head trauma due to vertical fall, 109 with apnoea and 71 with whooping cough. RH were found in 7 patients: 3 after accidental vertical fall (in all cases brain haemorrhage was found in MRI), one after cardiopulmonary reanimation for apnoea, and 3 cases were admitted for first seizure but further investigation confirmed SBS Conclusion: Accidental head trauma can produce RH in association with brain haemorrhages. Convulsions, cough or apnoea alone are unlikely to cause retinal haemorrhages in children less than 2 years. Therefore, if retinal haemorrhages are detected, investigation into the possibility of non-accidental injury is essential. In addition, it is important to carry out a funduscopic examination in all infants with an apparent unprovoked seizure, as the documentation of retinal haemorrhages could be the clue to maltreatment diagnosis.