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[Severe head injuries in neonates and infants: physiopathological and therapeutic aspects]
J D Giroux1, E Finel, D Soupre
1Néonatologie-maternité et réanimation pédiatrique, CHU Morvan, Brest, France.
Insights
Severe head injuries in infants, including obstetrical trauma and shaken infant syndrome, require prompt neurological evaluation using tools like the Bicêtre scale. Early diagnosis and management of brain lesions and hematomas are crucial for preventing hypovolemic shock and ensuring optimal outcomes.
Area of Science:
- Pediatric Neurology
- Neonatal Critical Care
- Neurotrauma
Context:
- Infants with severe head injuries often present with specific etiologies like obstetrical trauma, battered infant syndrome, or shaken infant syndrome.
- Accurate neurological assessment is vital, with the Bicêtre scale serving as a sensitive indicator of clinical progression.
Purpose:
- To outline the diagnostic and management strategies for severe head injuries in infants.
- To emphasize the importance of timely intervention for improving patient outcomes.
Summary:
- Neurological evaluation in infants necessitates specialized pediatric scales, such as the Bicêtre scale.
- Transfontanellar ultrasound is an initial diagnostic tool, but computerized tomography scans are essential for detailed assessment of brain lesions and hematomas.
- Management involves hemodynamic and hydroelectrolytic support, control of intracranial hypertension, sedation, and potential neurosurgical intervention.
Impact:
- Highlights the critical role of advanced imaging and prompt medical and surgical interventions in managing infant head trauma.
- Underscores the need for early detection and treatment to prevent severe complications like hypovolemic shock.
Abstract:
Severe head injuries in infants have specific circumstances such as obstetrical injury, battered infant, shaken infant. Pediatric scales must be used for neurological evaluation, the Bicêtre scale being a sensitive index of clinical course. Transfontanellar ultrasound can be useful as first line tool of evaluation of brain injury, but computerized tomography scan is necessary to correctly assess the brain lesions and the presence of hematoma. Hemorragic lesions can rapidly lead to hypovolemic state which must be prevented, or treated without delay. Treatment requires hemodynamics and hydroelectrolytic support, measures to control intracranial hypertension, sedation, and neurosurgical intervention according to the hemorragic lesions.