Shaken baby syndrome update

Shaken baby syndrome, or SBS, may be on the way out – in name only. The American Academy of Pediatrics is about to recommend a new, more descriptive name, abusive head trauma, or AHT, said Vincent Palusci, MD, of the New York University School of Medicine.

The expected name change does nothing to change the problem. AHT is believed to affect 30 infants per 100,000 live births, Palusci said. The hospital costs exceed $1 billion annually in the US alone.

“This behavior causes more traumatic brain injuries in young kids than accidental injury, including vehicle crashes,” Palusci said. “There are a lot of injuries out there that we never see.”

One reason for the name change is that SBS injuries are seldom caused by shaking alone, he continued. Blunt-impact trauma and secondary injuries are common, but the overriding feature is traumatic injury to the head.

Bruising or other visible injuries are not always present in AHT, cautioned Andrew Sirotnak of Denver’s Kempe Center at the University of Colorado. Clinicians must be alert to subdural hemorrhage, retinal hemorrhage, and other hidden damage caused by movement of the brain within the skull. Injuries may extend into the neck and possibly into the cervical, thoracic, and lumbar spine.

CT is typically the first-line imaging technology used in cases of suspected AHT, Sirotnak said. He said MRI of the head and neck are more sensitive to intracranial injury than CT, and recommended MRI for first-line imaging. MR venography offers clearer identification of venous thrombosis, and MR spectroscopy is more readily identifies lactate. Diffusion-weighted MR imaging is the most effective means to identify shear injuries that often fail to appear in other imaging methods.