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Síndrome do bebé abanado – experiência de 10 anos de um Serviço de Cuidados Intensivos Pediátricos
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Advisor(s)
Abstract(s)
Introdução: O Síndrome do Bebé Abanado é uma das causas de lesão não acidental mais difíceis de diagnosticar.
Objetivos: Caracterizar os doentes internados no Serviço de Cuidados Intensivos Pediátricos (SCIP) com Síndrome do Bebé Abanado.
Material e Métodos: Estudo retrospetivo dos doentes internados no SCIP do Centro Hospitalar de São João com o diagnóstico
de Síndrome de Bebé Abanado de 1 de Janeiro de 1999 a 31 de Dezembro de 2009.
Resultados: Foram internadas oito crianças com diagnóstico de Síndrome do Bebé Abanado. A média de idades foi de 4,1 meses e cinco doentes eram do sexo masculino.
Um caso apresentava história de traumatismo. O motivo de recurso aos cuidados de saúde mais frequente foram as crises convulsivas com paragem respiratória/cardiorrespiratória (50%).
Verificou-se hemorragias retinianas bilaterais em 6 doentes
(75%). Em todos a tomografia a axial computorizada cerebral mostrou
hematomas subdurais. Sete doentes (87,5%) necessitaram de ventilação mecânica e cinco (62,5%) de suporte inotrópico.
O tempo médio de internamento no SCIP foi de 5,25 dias (1-11 dias). Verificou-se um óbito. Verificou-se uma hemiparésia transitória
num doente. Três casos apresentaram uma epilepsia de novo e défices na acuidade visual ou auditiva e num caso houve
perda das aquisições prévias com um atraso moderado a severo do desenvolvimento psicomotor.
Conclusão: O Síndrome do Bebé Abanado resultou, na nossa série, em elevada morbilidade com a presença de sequelas
a longo prazo em cinco doentes (62,5%) compatíveis com os dados publicados em outras séries. A mortalidade encontrada foi
inferior à apresentada em estudos anteriores (12,5%). A presença de história traumática só foi referida num caso e, apesar de todos terem apresentado hematomas subdurais, 25% dos casos não tinham hemorragias retinianas. A apresentação clínica foi muito grave na grande maioria dos casos, sendo fundamental
um elevado grau de suspeição.
Introduction: Shaken baby syndrome is one of the causes of non-accidental injury most dificult to diagnose. Objectives: To characterize the patients hospitalized in the intensive care unit with shaken baby syndrome. Material and Methods: Retrospective study of patients admitted at the Paediatric Intensive Care Unit with shaken baby syndrome from 1 January 1999 to 31 December 2009. Results: There were eight children with shaken baby syndrome. The mean age was 4.1 months and five patients were male. One patient had a history of trauma. The most frequent cause of admission were epileptic seizures with cardiorespiratory/ respiratory arrest (50%). Bilateral retinal haemorrhages were present in six patients (75%). The CT scan showed subdural haematomas in all patients. Seven patients (87.5%) required mechanical ventilation, and five (62.5%) required inotropic support. The mean length of hospitalization was 5.25 days (1-11 days). One patient died. Three patients showed no sequelae. There was a transient hemiparesis in one patient. Three patients presented epilepsy and deficits in visual acuity or hearing and in one case there was loss of prior acquisitions with a moderate to severe retardation of psychomotor development. Conclusion: In our study Shaken Baby Syndrome resulted in high morbidity with long-term sequelae in five patients (62,5%), consistent with data published in other series. The mortality rate was lower than in previous studies (12.5%). The presence of traumatic history was mentioned only in one case and, although all of them presented subdural haematomas, 25% of cases had no retinal haemorrhages. The clinical presentation was very severe and in most cases a high degree of suspicion is necessary in the diagnosis.
Introduction: Shaken baby syndrome is one of the causes of non-accidental injury most dificult to diagnose. Objectives: To characterize the patients hospitalized in the intensive care unit with shaken baby syndrome. Material and Methods: Retrospective study of patients admitted at the Paediatric Intensive Care Unit with shaken baby syndrome from 1 January 1999 to 31 December 2009. Results: There were eight children with shaken baby syndrome. The mean age was 4.1 months and five patients were male. One patient had a history of trauma. The most frequent cause of admission were epileptic seizures with cardiorespiratory/ respiratory arrest (50%). Bilateral retinal haemorrhages were present in six patients (75%). The CT scan showed subdural haematomas in all patients. Seven patients (87.5%) required mechanical ventilation, and five (62.5%) required inotropic support. The mean length of hospitalization was 5.25 days (1-11 days). One patient died. Three patients showed no sequelae. There was a transient hemiparesis in one patient. Three patients presented epilepsy and deficits in visual acuity or hearing and in one case there was loss of prior acquisitions with a moderate to severe retardation of psychomotor development. Conclusion: In our study Shaken Baby Syndrome resulted in high morbidity with long-term sequelae in five patients (62,5%), consistent with data published in other series. The mortality rate was lower than in previous studies (12.5%). The presence of traumatic history was mentioned only in one case and, although all of them presented subdural haematomas, 25% of cases had no retinal haemorrhages. The clinical presentation was very severe and in most cases a high degree of suspicion is necessary in the diagnosis.
Description
Keywords
Hematomas subdurais hemorragias retinianas síndrome do bebé abanado Retinal haemorrhages shaken baby syndrome subdural haematomas
Citation
Nascer e Crescer 2013; 22(2): 72-74