Franke I, Pingen A, Schiffmann H, Vogel M, Vlajnic D, Ganschow R, Born M
Department of Pediatrics, Medical Center, University of Bonn, Adenauerallee 119, 53113 Bonn, Germany.
Department of Pediatrics, Clinical Center, Nuremburg, Germany.
Child Abuse Negl. 2014 Jul;38(7):1267-74. doi: 10.1016/j.chiabu.2014.01.021. Epub 2014 Mar 14.
Posterior rib fractures are highly indicative of non-accidental trauma (NAT) in infants. Since 2000, the "two-thumbs" technique for cardiopulmonary resuscitation (CPR) of newborns and infants has been recommended by the American Heart Association (AHA). This technique is similar to the grip on an infant's thorax while shaking. Is it possible that posterior rib fractures in newborns and infants could be caused by the "two-thumbs" technique? Using computerized databases from three German children's hospitals, we identified all infants less than 12 months old who underwent professional CPR within a 10-year period. We included all infants with anterior-posterior chest radiographs taken after CPR. Exclusion criteria were sternotomy, osteopenia, various other bone diseases and NAT. The radiographs were independently reviewed by the Chief of Pediatric Radiology (MB) and a Senior Pediatrician, Head of the local Child Protection Team (IF). Eighty infants with 546 chest radiographs were identified, and 50 of those infants underwent CPR immediately after birth. Data concerning the length of CPR was available for 41 infants. The mean length of CPR was 11min (range: 1-180min, median: 3min). On average, there were seven radiographs per infant. A total of 39 infants had a follow-up radiograph after at least 10 days. No rib fracture was visible on any chest X-ray. The results of this study suggest rib fracture after the use of the "two-thumbs" CPR technique is uncommon. Thus, there should be careful consideration of abuse when these fractures are identified, regardless of whether CPR was performed and what technique used. The discovery of rib fractures in an infant who has undergone CPR without underlying bone disease or major trauma warrants a full child protection investigation.
婴儿后肋骨骨折高度提示非意外性创伤（NAT）。自2000年以来，美国心脏协会（AHA）推荐了用于新生儿和婴儿心肺复苏（CPR）的“双拇指”技术。这种技术类似于摇晃婴儿时对其胸部的握持方式。新生儿和婴儿的后肋骨骨折有可能是由“双拇指”技术导致的吗？我们利用来自三家德国儿童医院的计算机数据库，确定了在10年期间接受专业心肺复苏的所有12个月以下婴儿。我们纳入了所有在心肺复苏后拍摄了前后位胸部X光片的婴儿。排除标准包括胸骨切开术、骨质减少、各种其他骨骼疾病和非意外性创伤。X光片由儿科放射科主任（MB）和当地儿童保护团队负责人、资深儿科医生（IF）独立进行评估。我们确定了80名婴儿，共546张胸部X光片，其中50名婴儿在出生后立即接受了心肺复苏。41名婴儿有关于心肺复苏时长的数据。心肺复苏的平均时长为11分钟（范围：1 - 180分钟，中位数：3分钟）。每名婴儿平均有7张X光片。共有39名婴儿在至少10天后进行了随访X光检查。在任何胸部X光片上均未发现肋骨骨折。本研究结果表明，使用“双拇指”心肺复苏技术后发生肋骨骨折并不常见。因此，无论是否进行了心肺复苏以及使用了何种技术，当发现这些骨折时都应谨慎考虑是否存在虐待行为。在没有潜在骨骼疾病或重大创伤的情况下，对接受过心肺复苏的婴儿发现肋骨骨折，需要进行全面的儿童保护调查。
