Antonietti J, Resseguier N, Dubus J-C, Scavarda D, Girard N, Chabrol B, Bosdure E
Service de médecine infantile et de spécialité pédiatriques (children's medical department and pediatric specialties), CHU Timone enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France.
Laboratoire de santé publique (EA 3279) (public health laboratory), faculté de Médecine de la Timone, 27, boulevard Jean Moulin, 13385 Marseille cedex 5, France.
Arch Pediatr. 2019 Jan;26(1):21-29. doi: 10.1016/j.arcped.2018.10.002. Epub 2018 Dec 14.
There are few studies that have investigated the long-term outcome of children who have been victims of shaken baby syndrome (SBS). However, the consequences appear to be significant and the data available from a social point of view are scarce. The main objective of this study was to define the medical and social outcome in 2016 of the infants who were victims of SBS and admitted to one of the Marseille university hospitals. The number of patients followed by a specialized team was evaluated along with their clinical state, living conditions, and whether a social support system such as the Child welfare system had been put into place.
The study was retrospective and descriptive. Patients under 1 year of age who were hospitalized between January 2005 and December 2013 and manifested clinical and paraclinical characteristics enabling the diagnosis of SBS were included in the study. The diagnosis was certain, probable, or possible according to the definitions given by the consensus of the 2011 shaken baby health authority conference (HAS).
Eighty babies qualified for the study, three of whom died in intensive care. Only ten of these patients (12.9%) had regular (annual) neuropediatric check-up during the whole study period. Thirty-seven patients (48%) had an annual neuropediatric check-up during the first 2 years only following the diagnosis. Only 12 of the children (15.6%) were still being followed after the age of 6. The children were followed up on average for 2.5 years (29.6 months). In 24 cases (31%), the last medical visit revealed an abnormal neurological examination including multiple disabilities due to spastic quadriplegia and severe intellectual deficit, which led to total dependency in half of these cases. Forty-four patients (57%) had a normal neurological examination. Concerning the babies' social outcome, 50 patients (64.9%) had returned home, 12 (15.6%) benefited, from educational assistance at the patient's home (AEMO) following the ruling of a children's judge, and 19 (24.7%) were still placed in foster care (ASE). The average foster care placement lasted 34.7 months.
Long-term medical follow-up for children having sustained serious head injury as a result of abuse is inadequate. Sequelae such as multiple disabilities are less frequent than described in the literature. According to this study, a longer-term follow-up is necessary for children suffering from sequelae such as learning disabilities than what is actually possible in our center.
很少有研究调查过遭受摇晃婴儿综合征（SBS）的儿童的长期预后情况。然而，其后果似乎很严重，从社会角度来看，可用数据却很匮乏。本研究的主要目的是确定2016年在马赛大学医院之一住院的遭受SBS的婴儿的医学和社会预后情况。评估了由专业团队跟踪的患者数量，以及他们的临床状况、生活条件，还有是否建立了诸如儿童福利系统之类的社会支持系统。
本研究为回顾性描述性研究。纳入2005年1月至2013年12月期间住院的1岁以下患者，这些患者具有临床和辅助检查特征，能够诊断为SBS。根据2011年摇晃婴儿健康权威会议（HAS）共识给出的定义，诊断为确定、很可能或可能。
80名婴儿符合研究条件，其中3名在重症监护室死亡。在整个研究期间，这些患者中只有10名（12.9%）进行了定期（每年一次）的神经儿科检查。37名患者（48%）仅在诊断后的头两年进行了年度神经儿科检查。6岁以后仍在接受跟踪的儿童只有12名（15.6%）。这些儿童平均随访了2.5年（29.6个月）。在24例（31%）中，最后一次医学检查显示神经学检查异常，包括因痉挛性四肢瘫和严重智力缺陷导致的多种残疾，其中一半病例导致完全依赖他人。44名患者（57%）神经学检查正常。关于婴儿的社会预后，50名患者（64.9%）已回家，12名（15.6%）根据儿童法官的裁决在患者家中接受了教育援助（AEMO），19名（24.7%）仍被安置在寄养机构（ASE）。平均寄养安置持续了34.7个月。
因虐待而遭受严重头部损伤的儿童的长期医学随访不足。诸如多种残疾之类的后遗症比文献中描述的要少见。根据本研究，对于患有学习障碍等后遗症的儿童，需要比我们中心实际可能进行的更长时间的随访。
