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Funduscopic lesions associated with mortality in shaken baby syndrome
1Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison 53705, USA.
Insights
Ophthalmic findings like retinal folds and lack of visual response can predict fatal outcomes in shaken baby syndrome (SBS) cases. Early detection aids in assessing injury severity.
Area of Science:
- Ophthalmology
- Pediatrics
- Neurology
Background:
- Shaken baby syndrome (SBS) involves intraocular and intracranial hemorrhage in children due to violent shaking.
- SBS often results in fatal intracranial injuries.
- Ocular findings in SBS include hemorrhage, retinal folds, and retinoschisis.
Purpose of the Study:
- To determine if acute ophthalmologic findings can predict a fatal outcome in SBS.
- To establish the prognostic value of ophthalmic examinations in suspected SBS cases.
Main Methods:
- A review of ophthalmic findings and outcomes in 10 pediatric patients diagnosed with SBS.
- Analysis of funduscopic characteristics and initial visual response.
Main Results:
- Seven patients survived; three died.
- Circular perimacular retinal folds (p=0.048) and peripheral retinoschisis (p=0.012) were significantly associated with fatal outcomes.
- Lack of initial visual response also correlated with a fatal outcome (p=0.033).
Conclusions:
- Ophthalmic examination is crucial for diagnosing and predicting outcomes in SBS.
- Specific findings like circular perimacular retinal folds and peripheral retinoschisis can indicate severe central nervous system injury.
- These ophthalmic signs aid in assessing the prognosis of shaken baby syndrome.
Purpose:
The shaken baby syndrome (SBS) has been defined as a syndrome of intraocular and intracranial hemorrhage in young children, thought to be caused by violent shaking inflicted by an adult. In many cases SBS is fatal as a result of intracranial injury. Intraocular findings include hemorrhage, which may be accompanied by characteristic retinal folds or retinoschisis lesions. This study was performed to determine whether acute ophthalmologic findings might predict a fatal outcome.
Methods:
A consecutive series of 10 patients meeting a strict definition of SBS was reviewed for ophthalmic findings at presentation and outcome.
Results:
Seven patients survived, and three died. Of the six funduscopic characteristics identified in these patients, two were significantly associated with a fatal outcome: circular perimacular retinal folds found in four patients (p = 0.048) and peripheral retinoschisis lesions seen in three patients (p = 0.012). Lack of visual response at initial examination was also significantly associated with a fatal outcome (p = 0.033).
Conclusions:
Ophthalmic examination of children with suspected SBS is important for prognostic as well as diagnostic purposes. Circular perimacular retinal folds, peripheral retinoschisis lesions, and lack of visual response correlated with fatal neurologic trauma and may be useful in predicting severity of central nervous system injury in shaken baby syndrome.
