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Animal models of pediatric abusive head trauma
John W Finnie1,2, Peter C Blumbergs3
1Discipline of Anatomy and Pathology, Adelaide Medical School, Adelaide, Australia. john.finnie@adelaide.edu.au.
Insights
Animal models struggle to fully replicate abusive head trauma (AHT) pathology due to species differences. However, some models show shaking alone can cause severe brain injury and retinal hemorrhages in infants.
Area of Science:
- Neuroscience
- Pediatrics
- Forensic Pathology
Background:
- Abusive head trauma (AHT), formerly shaken baby syndrome, is a severe brain injury in infants caused by shaking, often with head impact.
- AHT diagnosis is challenging due to non-specific findings and obscured circumstances.
- The 'triad' of subdural hemorrhage, brain injury, and retinal hemorrhages is debated regarding causation by shaking alone.
Purpose of the Study:
- To evaluate the utility of animal models in reproducing human AHT pathology.
- To assess the effects of shaking on the immature brain using animal models.
Main Methods:
- Review of animal models (rodents, domestic animals) developed to study AHT.
- Assessment of head-shaking protocols and their resemblance to human neurotrauma.
Main Results:
- Animal models exhibit significant species-specific anatomic differences from human infants.
- Experimental head shaking often fails to replicate real-world human neurotrauma.
- No animal model has fully reproduced the complete range of AHT neuropathology.
Conclusions:
- While unable to fully replicate AHT, some animal models simulate specific lesions and aid in understanding pathogenesis.
- One model demonstrated that shaking a freely mobile infant head, without impact, can be lethal and cause brain pathology.
Background:
Abusive head trauma (AHT), previously known as the shaken baby syndrome, is a severe and potentially fatal form of traumatic brain injury in infant children who have been shaken, and sometimes also sustained an additional head impact. The clinical and autopsy findings in AHT are not pathognomonic and, due to frequent obfuscation by perpetrators, the circumstances surrounding the alleged abuse are often unclear. The concept has evolved that the finding of the combination of subdural hemorrhage, brain injury, and retinal hemorrhages ("the triad") is the result of shaking of an infant ("shaken baby syndrome") and has led to the ongoing controversy whether shaking alone is able to generate sufficient force to produce these lesions.
Objective:
In an attempt to investigate whether shaking can engender this lesion triad, animal models have been developed in laboratory rodents and domestic animal species. This review assesses the utility of these animal models to reliably reproduce human AHT pathology and evaluate the effects of shaking on the immature brain.
Results:
Due largely to irreconcilable anatomic species differences between these animal brains and human infants, and a lack of resemblance of the experimental head shaking induced by mechanical devices to real-world human neurotrauma, no animal model has been able to reliably reproduce the full range of neuropathologic AHT changes.
Conclusion:
Some animal models can simulate specific brain and ophthalmic lesions found in human AHT cases and provide useful information on their pathogenesis. Moreover, one animal model demonstrated that shaking of a freely mobile head, without an additional head impact, could be lethal, and produce significant brain pathology.
