Approach
Treatment of infants with abusive head trauma is dependent on the type of injury. In severe cases, management focuses on supportive care because brain damage and other injuries sustained from abuse are generally irreversible.[38][58] Care needs to be coordinated across a variety of teams.
Emergency treatment
The infant’s airway, breathing, circulation, and cervical spine control should be assessed and stabilised immediately.[59] An important goal of stabilisation is to avoid secondary injury to the traumatised brain from hypoxia, hypotension, or raised intracranial pressure.[58]
Cardiopulmonary resuscitation, supplemental oxygen, and tracheal intubation may be necessary. Glucose should be administered to correct hypoglycaemia. Benzodiazepines may be required to treat persistent seizures.[60] Attempts should be made to reduce intracranial pressure with medical or surgical intervention.[61]
Severely injured infants may have haematological abnormalities (e.g., anaemia or coagulopathies), which could require blood transfusion or replacement of coagulation factors (e.g., with fresh frozen plasma or platelet transfusion).[62]
Urgent treatment of other abusive injuries such as intra-abdominal injury or unstable fractures may also be necessary.
Interdisciplinary management
Commonly, management of abusive head trauma requires involvement of social workers, child protection team physicians, radiologists, neurosurgeons or neurologists, ophthalmologists, and possibly orthopaedic surgeons.
Evaluation of differential diagnosis may also require the input of geneticists, metabolic experts, and haematologists.
Child protection/legal issues
It is important to consult with the hospital child protection team and social work services as soon as possible when a case of potential child abuse is identified.[1][22]
If there are other children in the home, child protection services will assess the risk of re-injury of the patient, and risk to other children with the same carer. After assessing the family and other carers, child protection services may remove children from exposure to the offending carer. Additionally, the majority of cases of abusive head trauma will be referred to the police or the relevant authorities for criminal investigation.
The accurate diagnosis of abuse is important to protect the patient and other children from ongoing abuse, and to avoid accusations of abuse in cases where medical findings may be explained by underlying medical disorders (e.g., coagulation defects, metabolic disease, or infection).
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