ROLE OF APNEA IN NONACCIDENTAL HEAD-INJURY

We hypothesize that apnea induced by shaking or by shaking combined wi th impact plays a major role in the pathophysiology of nonaccidental h ead trauma and accounts for the poor outcome in this subgroup of patie nts. In a retrospective study of 28 children who suffered significant nonaccidental head injury, 57% had a history of apnea prior to hospita lization, 82% were intubated upon admission, and 71% had early seizure s. For further evidence of ischemia and hypoxia, the first recorded bl ood pressure was <80 in 50% and the arterial pH <7.3 in 54%. Seventy-o ne percent had diffuse brain swelling which is characteristic of cereb ral hypoxia and/or ischemia on the first CT scan. None of the children who had clinical evidence of cerebral hypoxia or ischemia had a good outcome, We conclude that trauma-induced apnea causes cerebral hypoxia and/or ischemia which is more fundamental to outcome than the mechani sm of injury (shaken vs. shaken with impact), subdural hemorrhage, sub arachnoid hemorrhage, diffuse axonal injury, parenchymal shear, or bra in contusion.