Shaken baby syndrome and a triple-dose strategy for its prevention

Shaken Baby Syndrome Education for Mothers Awaiting Appointments in Rural OB/GYN Office

A partnership between a nursing program and a rural obstetric office provided education to pregnant and postpartum women about coping with infant crying and the dangers of shaking a baby. Undergraduate nursing students delivered the Period of PURPLE Crying (PURPLE) educational program to 148 mothers. Change in knowledge about infant crying and the community clinical experience was evaluated. Pre and post intervention data were collected. Descriptive statistics indicated higher scores on mothers' posttest for knowledge about normal newborn crying behaviors and coping strategies. Students further developed the role of educator and researcher. These findings suggest the intervention contributed to mothers' improved knowledge about infant crying. Results of the pilot study are encouraging because the intervention had a significant effect on mothers' knowledge about infant crying and Shaken Baby Syndrome (SBS).

The effect of a shaken baby syndrome prevention program on Turkish mothers' awareness and knowledge: A randomized controlled study

PURPOSE

This study aimed to develop an evidence-based education program to increase mothers' awareness and knowledge of shaken baby syndrome (SBS) and evaluate program effectiveness.

DESIGN AND METHODS

Mothers with babies between 2 and 4 months of age were completed the study (intervention group = 43 and control group = 44). This single-blind randomized controlled study was conducted between September 2020 and February 2021. The intervention group participated in an 8-week follow-up. Outcome variables were assessed at baseline and 8 weeks after commencement of the intervention, which included measures to evaluate the administration of the shaken baby syndrome prevention program (SBSPP). The study was approved by ClinicalTrials.gov NCT04568538.

RESULTS

Scores for the SBS assessment survey were significantly higher in the intervention group than in the control group.

PRACTICE IMPLICATIONS

Developing effective interventions for SBS is an important public health goal. This study is the first to prove the effectiveness of an SBSPP conducted by nurses in Turkey. We believe that the implementation of this program in a larger sample will make a significant contribution to SBS reduction. Pediatric nurses identify the needs of parents with babies younger than 6 months and support them to manage this process correctly.

Simulation of the Impact of Programs for Prevention and Screening of Pediatric Abusive Head Trauma

Primary prevention programs of pediatric abusive head trauma (PAHT) exist and early screening is proposed, but negative effects of mislabeling parents as abusers, an important issue, are not well documented. The aim of our study was to simulate the possible impact of programs for the primary prevention and screening of PAHT. We developed Markov models that simulate the life histories of PAHT with no intervention, with primary prevention program only, with screening program, and with both programs in a hypothetical cohort of 800,000 newborns in a high-income country. Screening program would be addressed to all families until children are 2 years old, during repeated consultations. Potential side effects for parents being mislabeled as abusers were supposed to increase the probability of PAHT and decrease participation in screening. Time horizon was 2 years with cycles of 15 days. Outcomes were number of deaths and abused children avoided. Uncertainty was specified with probability distributions. After 2 years, the median number of deaths avoided through primary prevention would vary from 6 (95% confidence interval [CI] 2-11) to 28 (95% CI 6-51) per 100,000 newborns. Screening could prevent up to 6 (95% CI 0-29) or cause up to 66 (95% CI 0-361) deaths per 100,000 children born alive. The impact of both programs was uncertain. Our model confirmed the potential benefits of primary prevention and documented the uncertainty associated with screening of PAHT.

Self-Reported Prevalence and Risk Factors for Shaking and Smothering Among Mothers of 4-Month-Old Infants in Japan

Background

To estimate the prevalence of shaking and smothering and to determine risk factors in a population-based sample of mothers with 4-month-old infants in Japan.

Methods

We administered a questionnaire to women who participated in a 4-month health checkup program in Aichi Prefecture, Japan (n = 6487; valid response rate, 66.8%), and assessed frequency of shaking and smothering during the past 1 month, as well as maternal, infant, and familial characteristics. Associations of shaking, smothering, and either shaking or smothering with possible risk factors were analyzed using multiple logistic regression.

Results

Self-reported prevalence of shaking, smothering, and either shaking or smothering at least once during the past month was 3.9% (95% confidence interval [CI], 3.5%–4.4%), 2.7% (95% CI, 2.3%–3.1%), and 5.4% (95% CI, 4.9%–6.0%) respectively. Several different risk factors were found for shaking and smothering. Risk factors for either shaking or smothering were age 34 years or younger (especially 24 years or younger), age 40 years or older, full-time working, later attendance at 4-months health checkup, primiparity, living in a detached house, living on the 2nd floor or higher (especially on the 10th floor or higher), economic adversity, perceived excessive crying, and postpartum depression. Protective factors against infant abuse were living in a four-room house and having a larger number of people to consult with.

Conclusions

Self-reported prevalences of shaking and smothering among mothers in Japan were similar to prevalences reported in western countries. These finding may be useful for identifying mothers at increased risk of shaking and smothering their infants.

Shaken Baby Syndrome: a review

Shaken Baby Syndrome occurs in infants as a result of the brain pushing against the skull due to severe acceleration-deceleration forces. Symptoms of Shaken Baby Syndrome include subdural, subarachnoid, and retinal hemorrhages. MRI and ocular examinations are used to determine the extent of mental and visual damage and β-amyloid precursor protein immunohistochemical staining is used to detect axonal injuries. Surgeries such as Subdural hemorrhage (SDH) evacuation surgery and the Burr hole craniotomy are used to treat Shaken Baby Syndrome; however, the prognosis is poor in many cases. Because of the severity of Shaken Baby Syndrome and its traumatic and sometimes fatal effects, it is important to educate new parents, nurses, and doctors on the syndrome in order to prevent incidents.

Hush now baby: mothers' and fathers' strategies for soothing their infants and associated parenting outcomes

OBJECTIVES

The purpose of this study was to examine the types of soothing behaviors used by mothers and fathers of infants, differences in use trajectories over time, and associated parenting outcomes.

METHODS

A longitudinal study of 241 families expecting their second child was performed. Data were collected at 1, 4, and 8 postnatal months and included measures of parental soothing techniques, involvement in soothing, distress in response to infant crying, and parenting self-efficacy.

RESULTS

The average number of soothing techniques used was 7.7 for mothers and 5.9 for fathers. Soothing frequency decreased over time, and change patterns of soothing differed over time by gender. In couples who shared responsibility for soothing, fathers felt more efficacious in parenting and mothers were less upset by infant crying.

DISCUSSION

Clinicians are encouraged to support fathers' engagement in infant soothing, facilitate the development of fathers' parenting confidence, and promote fathers' involvement in children's health and health care.

The neonatal nurse's role in preventing abusive head trauma

Abusive head trauma in infants occurs in 24.6 to 39.8 per 100,000 infants in developed countries. Abusive head trauma refers to any type of intentional head trauma an infant sustains, as a result of an injury to the skull or intracranial contents from a blunt force and/or violent shaking. The clinical question was: what evidence-based interventions have been implemented by neonatal nurses to prevent abusive head trauma in infants? PubMed was searched to obtain English language publications from 2005 to May 2014 for interventions focused on preventing abusive head trauma using the key term "shaken baby syndrome." A total of 10 studies were identified that met the inclusion criteria. All of the interventions targeted prevention of abusive head trauma with information about abusive head trauma/shaken baby syndrome and the "normal" infant crying behaviors. Interventions taught parents why infants cried, how to calm the infants, ways to cope with inconsolable infants, and how to develop a plan for what to do if they could not cope anymore. Parents who participated in the interventions were consistently able to explain the information and tell others about the dangers of shaking infants compared to the control parents. Only 2 studies calculated the preintervention abusive head trauma rate and the postintervention frequency of abusive head trauma. Each found significant differences in abusive head trauma.

A systematic review of universal campaigns targeting child physical abuse prevention

The purpose of this review was to better understand the impact of universal campaign interventions with a media component aimed at preventing child physical abuse (CPA). The review included 17 studies featuring 15 campaigns conducted from 1989 to 2011 in five countries. Seven studies used experimental designs, but most were quasi-experimental. CPA incidence was assessed in only three studies and decreased significantly in two. Studies also found significant reductions in relevant outcomes such as dysfunctional parenting, child problem behaviors and parental anger as well as increases in parental self-efficacy and knowledge of concepts and actions relevant to preventing child abuse. The following risk factors were most frequently targeted in campaigns: lack of knowledge regarding positive parenting techniques, parental impulsivity, the stigma of asking for help, inadequate social support and inappropriate expectations for a child's developmental stage. The evidence base for universal campaigns designed to prevent CPA remains inconclusive due to the limited availability of rigorous evaluations; however, Triple-P is a notable exception. Given the potential for such interventions to shift population norms relevant to CPA and reduce rates of CPA, there is a need to further develop and rigorously evaluate such campaigns.

Predicting the decisions of hospital based child protection teams to report to child protective services, police and community welfare services

This study examines judgments made by hospital-based child protection teams (CPTs) when determining if there is reasonable suspicion that a child has been maltreated, and whether to report the case to a community welfare agency, to child protective services (CPS) and/or to the police. A prospective multi-center study of all 968 consecutive cases referred to CPTs during 2010-2011 in six medical centers in Israel. Centers were purposefully selected to represent the heterogeneity of medical centers in Israel in terms of size, geographical location and population characteristics. A structured questionnaire was designed to capture relevant information and judgments on each child referred to the team. Bivariate associations and multivariate multinomial logistic regressions were conducted to predict whether the decisions would be (a) to close the case, (b) to refer the case to community welfare services, or (c) to report it to CPS and/or the police. Bivariate and multivariate analyses identified a large number of case characteristics associated with higher probability of reporting to CPS/police or of referral to community welfare services. Case characteristics associated with the decisions include socio-demographic (e.g., ethnicity and financial status), parental functioning (e.g., mental health), previous contacts with authorities and hospital, current referral characteristics (e.g., parental referral vs. child referral), physical findings, and suspicious behaviors of child and parent. Most of the findings suggest that decisions of CPTs are based on indices that have strong support in the professional literature. Existing heterogeneity between cases, practitioners and medical centers had an impact on the overall predictability of the decision to report. Attending to collaboration between hospitals and community agencies is suggested to support learning and quality improvement.

Early coagulopathy is an independent predictor of mortality in children after severe trauma

To determine whether early coagulopathy affects the mortality associated with severe civilian pediatric trauma, trauma patients younger than 18 years admitted to a pediatric intensive care unit from 2001 to 2010 were evaluated. Patients with burns, primary asphyxiation, preexisting bleeding diathesis, lack of coagulation studies, or transferred from other hospitals more than 24 h after injury were excluded. Age, sex, race, mechanism of injury, initial systolic blood pressure, Glasgow Coma Scale score, Injury Severity Score, prothrombin time, partial thromboplastin time, platelet count, and international normalized ratio were recorded. An arterial or venous blood gas was performed, if clinically indicated. Coagulopathy was defined as an international normalized ratio greater than 1.2. The primary outcome was in-hospital mortality. Secondary outcomes were lengths of intensive care unit and hospital stay. Eight hundred three patients were included in the study. Overall mortality was 13.4%. The incidence of age-adjusted hypotension was 5.4%. Early coagulopathy was observed in 37.9% of patients. High Injury Severity Score and/or hypotension were associated with early coagulopathy and higher mortality. Early coagulopathy was associated with a modest increase in mortality in pediatric trauma patients without traumatic brain injury (TBI). In contrast, the combination of TBI and early coagulopathy was associated with a fourfold increase in mortality in this patient population. Early coagulopathy is an independent predictor of mortality in civilian pediatric patients with severe trauma. The increase in mortality was particularly significant in patients with TBI either isolated or combined with other injuries, suggesting that a rapid correction of this coagulopathy could substantially decrease the mortality after TBI in pediatric trauma patients.

Abusive head trauma in children: a literature review

OBJECTIVE

To review the scientific literature on pediatric abusive head trauma as a form of physical abuse against infants and young children, highlighting the prevalence, signs and symptoms, consequences, risk factors for its occurrence, and prevention strategies.

DATA SOURCE

The MEDLINE, SciELO, LILACS, and Web of Science databases from 2001 to 2012 were reviewed, using the terms "shaken baby syndrome" and "abusive head trauma" in English, Spanish, and Portuguese.

DATA SYNTHESIS

Pediatric abusive head trauma is defined as injury to the skull or intracranial contents of a infant or child younger than 5 years due to intentional abrupt impact and/or violent shaking. It occurs mainly in infants and children under 1 year of age, and may result in severe consequences, from physical or mental disabilities to death. Although there are specific signs for this form of abuse, they can be mistaken for common illnesses in children or accidental head injury; thus, clinical training of professionals involved in the assessment of cases to attain the correct diagnosis is crucial. Prevention strategies should include early identification of cases, as well as parental education on child development, especially on the infant's crying pattern.

CONCLUSIONS

Considering the severity of abusive head trauma in children, it is critical that prevention strategies be implemented and evaluated in the Brazilian context. It is suggested that its incidence indicators be assessed at the national level.

Descriptive factors of abusive head trauma in young children--United States, 2000-2009

OBJECTIVE

Abusive head trauma (AHT) is a leading cause of severe injury in maltreated children in the United States. There is little research from nationally representative datasets available to characterize young children who had AHT compared to non-abusive head trauma (NAHT).

METHODS

Using the recent CDC AHT case definition, we performed a retrospective analysis of 2000, 2003, 2006 and 2009 hospitalization data using the Kids' Inpatient Database (KID) from the Healthcare Cost and Utilization Project. Logistic regression was used to compare AHT to NAHT patients <2 years of age. Socio-demographic data and indicators of socioeconomic status (i.e., insurance status and household income), presence of chronic conditions, injury severity (i.e., length of hospital stay and vital status), hospital specialization (i.e., hospital type), hospital region, and season of admission were used as independent variables.

RESULTS

A weighted sample of 7,603 AHT and 25,339 NAHT patients was identified. National rates for AHT were 39.8 per 100,000 population for children <1 year and 6.8 per 100,000 population for children 1 year old. Compared to NAHT, children with AHT were more often <1 year of age (adjusted odds ratio [aOR]=2.66; 95% confidence interval [CI]: 2.35-3.01), male (aOR=1.10; 95% CI: 1.01-1.20), enrolled in Medicaid (aOR=2.78; 95% CI: 2.49-3.11), hospitalized longer (aOR=8.26; 95% CI: 7.24-9.43), died during hospitalization (aOR=5.12; 95% CI: 4.01-6.53), and seen at children's hospitals (aOR=1.97; 95% CI: 1.63-2.38) and hospitals outside the Northeast [aOR=2.65 (95% CI: 2.10-3.33) for the Midwest, 1.90 (95% CI: 1.52-2.38) for the South and 1.93 (95% CI: 1.45-2.57) for the West, respectively].

CONCLUSIONS

The results confirm that injuries from AHT are more severe and more often lethal than other head injuries. Socioeconomically disadvantaged families with children <1 year are an important focus for primary prevention. The associations of AHT, compared to NAHT with hospital type and hospital region warrant further investigation. Referral or reporting patterns, or true differences in the incidence may contribute to the identified associations.