Shaken baby syndrome

Purpose: To examine the comprehensive ophthalmologic experience with the sh aken baby syndrome at one medical center, including clinical findings, auto psy findings, and the outcome of survivors. Design: Retrospective, noncomparative case series. Participants: One hundred twenty-three children admitted from January 1987 through December 1998 for subdural hematomas of the brain secondary to abus e were included, Methods: Clinical features of eye examinations of the patients during their admission and after discharge and histopathologic observations for patient s who died were retrieved from medical records and statistically analyzed. Main Outcome Measures: Visual response and pupillary response on initial ex amination, fundus findings, final vision, neurologic outcome of survivors, and death. Results: Ninety percent of the patients had ophthalmologic assessments. Ret inal hemorrhages were detected in 83% of the examined children. The retinal hemorrhages were bilateral in 85% of affected children and varied in type and location. Nonophthalmologists missed the hemorrhages in 29% of affected patients. Poor visual response, poor pupillary response, and retinal hemor rhage correlated strongly with the demise of the child. One child who died had pigmented retinal scars from previous abuse, a condition not previously observed histopathologically to our knowledge. One fifth of the survivors had poor vision, largely the result of cerebral visual impairment. Severe n eurologic impairment correlated highly with loss of vision. Conclusions: Shaken baby syndrome causes devastating injury to the brain an d thus to vision. Retinal hemorrhages are extremely common, but vision loss is most often the result of brain injury. The patient's visual reaction an d pupillary response on presentation showed a high correlation with surviva l. Good initial visual reaction was highly correlated with good final visio n and neurologic outcome. According to the literature, when retinal hemorrh ages are found in young children, the likelihood that abuse occurred is ver y high. Nonophthalmologists' difficulty in detecting retinal hemorrhages ma y be an important limiting factor in identifying shaken babies so they can be protected from further abuse. (C) 2000 by fhe American Academy of Ophtha lmology.