Ali ANNAGÜR, Hüseyin ALTUNHAN, Bilge Burçak ANNAGÜR, Sabahattin ERTUĞRUL, Rahmi ÖRS

Shaken Baby Syndrome Suggestive of the Diagnosis of Osteogenesis Imperfecta in Newborn

Fiziksel çocuk istismarı, hafif yumuşak doku yaralanmasından ölüme neden olan ağır beyin hasarına kadar değişen geniş bir yelpazede ortaya çıkabilmektedir. Çocuklarda ciddi ve ölümcül yaralanmaların başlıca nedeni fiziksel istismar sonucu oluşan kafa travmasıdır ve başlıca; dıştan gözlenen travma izleri, subdural hemoraji, retinal hemoraji klinik triadı ile ortaya çıkmaktadır. Yazımızda geç neonatal sepsis ve osteogenezis imperfekta tanısı ile merkezimize sevk edilen 20 günlük bir bebekte hırpalanmış bebek sendromu olgusunu sunduk. Yirmi günlük iken huzursuzluk, emmeme şikâyeti ile dış merkez çocuk acil servisine götürülen hasta sepsis düşünülmüş ve bu sırada çekilen grafilerinde çok sayıda kırık saptanması üzerine, osteogenezis imperfekta tanısı da düşünülerek hastanemize sevk edilmişti. Ekstremite muayenesinde her iki kol ve sol baldırda şişlik, ekimoz ve hareket kısıtlılığı mevcuttu. Ekstremite grafilerinde her iki humerus ve sol femurda cisim kırığı saptandı. Çoğunlukla aile bireyleri tarafından verilen yanlış öykü veya hekimin dikkatsiz aldığı öykü ile tanısı güçleşen, ciddi mortalite ve morbiditeye neden olan fizik istismarın tanısında radyolojik incelemelerin önemi büyüktür. Ailenin verdiği öykü ile radyolojik bulgular arasındaki uyumsuzluk hekim için uyarıcı olmalı ve radyolojik veriler dikkatle incelenmelidir

Anahtar Kelimeler:

Hırpalanmış bebek sendromu, fiziksel çocuk istismarı, yenidoğan, osteogenezis imperfekta

Shaken Baby Syndrome Suggestive of the Diagnosis of Osteogenesis Imperfecta in Newborn

Physical child abuse may occur in a broad range of disorders from a mild soft tissue injury to a severe brain damage leading to death. The head trauma resulted from physical abuse is the main reason for the severe and fatal injuries in children, and arises with the clinical triad of externally seen trauma signs, subdural hemorrhage and retinal hemorrhage. In this article, we report a case of shaken baby aged 20-day, who was referred to our clinic with the diagnosis of late neonatal sepsis and osteogenesis imperfecta. A 20-day-old baby was presented to the emergency department of an outer health center with the complaints of restlessness and non-breastfeeding was considered as sepsis, and subsequently when multiple fractures were detected in the radiological investigations, a diagnosis of osteogenesis imperfecta was also considered, and the baby was referred to our hospital. In the examination of the extremities, he had swelling, ecchymose and limited mobility in both arms and the left calf. The extremity radiograms revealed body fractures in both humeri and the left femur. Radiological investigations are very important for the diagnosis of physical abuse, which causes serious mortality and morbidity and is usually difficult to diagnose because of a wrong medical history given by family members or a history taken by the physician carelessly. Discordance between the history given by the family and the radiological findings should be warning for the physician, and the radiological findings must be assessed carefully.

Keywords:

Shaken baby syndrome physical child abuse, newborn, osteogenesis imperfecta, multiple fractures,

PDF

___

Ayva M, Aksoy MC. Child abuse and neglected: Orthopedic aspects. (Turkish) Hacettepe Med J 2004;35:27-35.
Yağmur F, Asil H, Per H, Aslan D, Çoşkun A. Shaken baby syndrome and 3 cases. (Turkish) Forensic Med J 2010;24(1):42-9.
Johnson CF. Abuse and neglect of children. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF Eds. Nelson Textbook of Pediatrics, 18th. Ed. Philadelphia: Saunders Co, 2007;171-84.
Kara B, Biçer Ü, Gökalp AS. Child abuse. (Turkish) Ped Health Dis J 2004;47:140-51.
Beyaztaş FY, Oral R, Bütün C, Beyaztaş A, Büyükkayhan D. Physically abused child: four cases report. (Turkish) Ped Health Dis J 2009;52:75-80.
Or Uslu RI. Childhood Psychiatric Disorders Related with an Increased Risk of Child Abuse. Turkiye Klinikleri J Pediatr Sci 2008;4(6):12-7.
Çamurdan AD. Neglect of Children. Turkiye Klinikleri J Pediatr Sci 2008;4(6):25-30.
Mraz MA. The physical manifestations of shaken baby syn- drome. J Forensic Nurs 2009;5:26-30.
Yağmur F, Asil H, Canpolat M, Per H, Coşkun A. Short Distance Falls and Shaken Baby Syndrome: Case Report. Turkiye Klinikleri J Med Sci 2010;30(2):766-71.
Balcı E, Gün İ, Mutlu Şarlı Ş, et al. Still an unknown topic: child abuse and “shaken baby syndrome”. Ulus Travma Acil Cerrahi Derg 2011;17(5):430-4.
Aşırdizer M. The attıtudes of medical doctors to child abuse or women abuse victims applied to emergency ser- vices. Turkiye Klinikleri J Surg Med Sci 2006;2(50):39-48.
Şahin F. Abused Children. Turkiye Klinikleri J Pediatr Sci 2008;4(6):1-5.
Dubowitz H, Bennett S. Physical abuse and neglect of chil- dren. Lancet 2007;369:1891-9.
Altimier L. Shaken baby syndrome. J Perinat Neonatal Nurs 2008;22:68-76.
Ulukol B. Shaken Baby Syndrome. Turkiye Klinikleri J Ped Surg 2008;1(1):28-36.
Pakiş I, Elmas I. Ölümcül. Assessment of Findings of the Central Nervous System and Ophthalmological Signs in Fatal Child Abuse Cases. Turkiye Klinikleri J Foren Med 2008;5(2):50-9.
Matschke J, Herrmann B, Sperhake J, Körber F, Bajanowski T, Glatzel M. Shaken baby syndrome: a common variant of non-accidental head injury in infants. Dtsch Arztebl Int 2009;106:211-7.
Togioka BM, Arnold MA, Bathurst MA, et al. Retinal hem- orrhages and shaken baby syndrome: an evidence-based review. J Emerg Med 2009;37:98-106.
Gholve PA, Hosalkar HS, Wells L. Common fractures. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF Eds. Nelson Textbook of Pediatrics, 18th. Ed. Philadelphia: Saunders Co, 2007;2834-41.
Ablin DS, Greenspan A, Reinhart M, Grix A. Differentiation of child abuse from osteogenesis imperfecta. AJR Am J Roentgenol 1990;154:1035-46.
Paterson CR, McAllion SJ. Classical osteogenesis imper- fecta and allegations of nonaccidental injury. Clin Orthop Relat Res 2006;452:260-4.
Hekimsoy Z. Osteogenesis Imperfecta: Review. Turkiye Klinikleri J Endocrin 2009;4(3):85-91.
Stotts AK. Orthopaedic aspects of child abuse. Cur Opin Orthop 2007;18:550-4.
Önal Ç. Child abuse. Turkiye Klinikleri J Pediatr Sci 2007;3(1):27-9.
Demirci Ş, Doğan KH, Günaydın G, Erkol Z. The siblings Left to Die by Their Mothers: Two Case Reports. Turkiye Klinikleri J Foren Med 2009;6(2):86-91