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Trauma in infants less than three months of age
G Stewart1, K Meert, N Rosenberg
1Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit 48201.
Insights
In infants under three months, abuse or neglect is a significant cause of serious injury, often leading to repeated trauma. Medical professionals should consider abuse/neglect in injured infants due to the high risk of subsequent injuries.
Area of Science:
- Pediatric Traumatology
- Child Abuse and Neglect
- Forensic Pediatrics
Background:
- Infants under three months are a vulnerable population susceptible to severe traumatic injuries.
- Distinguishing between accidental injuries and those resulting from abuse or neglect is critical for appropriate intervention.
- Previous studies have indicated differences in injury patterns between abused and accidentally injured infants.
Purpose of the Study:
- To evaluate the characteristics of traumatic injuries in infants less than three months of age.
- To assess the risk of subsequent trauma in infants with identified abuse or neglect.
- To compare injury patterns and healthcare utilization between abused/neglected and accidentally injured infants.
Main Methods:
- Retrospective review of medical records for 111 infants under three months presenting with traumatic injuries.
- Data collection included injury mechanisms, fracture types, hospitalization, and social service interventions.
- Follow-up evaluation of medical records one year post-injury to assess subsequent trauma and healthcare use.
Main Results:
- 28% of injuries were attributed to abuse/neglect, while 72% were accidental (primarily falls).
- Abuse/neglect group showed higher rates of skull fractures (including diastatic and multiple fractures) and intracranial hemorrhages.
- The abuse/neglect group had more extremity fractures, higher hospitalization rates, and increased social service involvement.
- While previous emergency department visits were similar, the abuse/neglect group showed a significant decline in subsequent ED visits post-trauma.
- Infants in the abuse/neglect group demonstrated a tendency for more subsequent traumatic injuries.
Conclusions:
- Abuse/neglect should be strongly considered in any seriously injured infant under three months.
- The distinct injury patterns and higher risk of recurrent trauma in abused/neglected infants necessitate early identification and intervention.
- Understanding these differences is crucial for pediatricians and healthcare providers to ensure infant safety and prevent future harm.
Abstract:
We evaluated the characteristics of traumatic injury and risk for subsequent trauma in infants less than three months of age (n = 111). Medical records were reviewed at presentation and one year later. Injury was due to abuse/neglect in 28%, whereas 72% were accidentally injured. Falls were the most common mechanism of accidental injury (67%). The percentage of infants with skull fractures was greater in the abuse/neglect group than in the accidental group (7/31 vs 7/80; P < 0.05) with a tendancy toward more diastatic and multiple skull fractures (6/7 vs 2/7) as well as intracranial hemorrhages (3/7 vs 0/7). More infants in the abuse/neglect group suffered extremity fractures (4/31 vs 2/80; P < 0.05). Hospitalization was more frequent (12/31 vs 8/80; P < 0.001), as was social or protective service intervention (25/31 vs 17/80; P < 0.001), in the abuse/neglect group. The two groups showed no difference in the number of previous emergency department (ED) visits; however, the use of the ED declined significantly in the abuse/neglect group following the trauma (0.81 +/- 1.2 vs 1.5 +/- 2.1 visits; P < 0.05). The abuse/neglect group tended to have a greater number of subsequent traumatic injuries than those accidentally injured. Abuse/neglect should be considered in any seriously injured infant less than three months of age because of the likelihood of subsequent trauma.