Object
Title: SBS in the aspect of the theory of increased infant crying : analysis of medical and sociodemographic factors in SBS
Abstract:
Abusive Head Trauma (AHT) and Shaken Baby Syndrome (SBS) are forms of head trauma in infants resulting from: violent shocks, blows to the head, or a combination of both. The shaking mechanism leads to trauma, the consequences of which may be: subdural hematoma, diffuse axonal damage, brain edema, retinal hemorrhages, fractures of long bones and ribs, and death. The injury may be severe or less serious, often without any signs of external injuries. Brain injuries in young children are different in nature from those in older children and adults due to the unique nature of developmental differences in the skull, brain, and neck before the age of four. Characteristic features of a small child include a flexible skull, rapid growth of the brain and skull, a much larger and heavier head in relation to their body weight than in older children, a large number of unmodified axons, and a subarachnoid space that is wider than in later years of life. The head, which is large and heavy in relation to the rest of the body, is not yet adequately supported by the weak, immature musculature of the neck, which makes it mare unstable and allows a greater range of head movement and brain movement when exposed to forces during an injury. These anatomical features of infants make them particularly susceptible to the forces experienced during shaking. There is a wide range of clinical symptoms in Sha ; ken Baby Syndrome. The mildest can be so non-specific that damage may never be discovered , up to the most severe, when the child is in a state of limited contact, with possible seizures. lmmediately after the incident, the child will present symptoms that are elear to the caregiver who knows the child. These non-specific symptoms may include: feeding · problems, vomiting, lethargy or, conversely, increased irritability. Most often minimized by caregivers, parents or medical staff, they will often be attributed to a viral disease or so-called colic. In some cases, previous injury is only recognized after the child has been injured again or a chronic subdural hematoma has developed and the head circumference has widened. The long-term effects in children who experience Shaken Baby Syndrome are still the least studled area of the clinical sequelae of the syndrome. However, available data show that only about 30% o1 hospitalized children function satisfactorily in the following years. Many children present wlth impaired cognitive functions, its characteristic feature being a graduał deterioration of IQ with age. There are also behavioral disorders that often prevent social integration. Cognitive and behavioral consequences may not be visible immediately, but may become apparent later as the demands placed on the child increase during development. Studygoals The aim of the first st ; udy was a retrospective analysis and prospective study of cases of Shaken Baby Syndrome against the background of all cases of head injuries in children under one year of age hospitalized in the University Children's Hospital in Krakow in 2013-2022. The aim of the second study was to determine how caregivers deal with the increased amount of crying in the first months of children's lives and their knowledge about Shaken Baby Syndrome and its clinical relationships. Materiał and test method The first study included 76 patients admitted urgently by the Hospital Emergency Department, consulted or treated at the Department o1 Neurosurgery and the lntensive Care Unit of the University Children's Hospital in Krakow in the years 2013-2022 due to suspected or confirmed brain injury. The study group included 38 girls (50%) and 38 boys {50%). The first group, assessed during the diagnostic process as showing no signs of non-accidental head injury, inciuded 51 patients. In the second group, suspected of SBS, but ultimately without such a diagnosis, 11 patients· were qualified, and in the third group, in which the diagnosis of SBS was made, 14 patients were qualified. Sociodemographic characteristics, physical symptoms, and consistency of caregiver history were analyzed in all three patient groups. The second study involved 319 parents/guardians of children from four months to four years o ; f age, including the division into chronically iii children treated at the University Children's Hospital and healthy children under the care of pediatrie clinics. The subjects were female and małe adults (18 years of age or older). For the purposes of the study, an original questionnaire was created, taking into account the issues examined by the author. So far, similar research has not been carried out in Poland, and the analysis of the publications has shown that there is no test method that could be adapted to Polish conditions and used to assess the issues of interest to the author. The aim of the second study was: to determine the level of parents' awareness of the causes of the baby's crylng, to determine the ways in whlch parents deal with the stage of increased crylng in the infant, to assess the level of parents' frustration resulting from the inability to soothe the child, to describe the mechanisms of coping with stress related to crying, difficulties in calming down the child, determining the level of awareness of SBS among caregivers. Results The analysis showed significant relationships in the first study. The three study groups differed in terms of: the incidence of subdural hematomas, hematomas in the soft tissues of the head, retinal hematomas, intracranial hypertension, petechiae, method o1 treatment, history given by parents, prematurity, other diseases, num ; ber of hospital stays and whether injuries were reported by parents. parents. However, there were no differences between the groups in the presence of: subarachnoid hematomas, epidural hematomas, long bone and skull fractures and symptoms. The analysis showed that the age of children with SBS was statistlcally significantly lower than the age of children without SBS (p = 0.001). However, no statistically significant difference was observed between the group suspected of SBS and the confirmed group. The second study showed a number of significant relationships. There was a strong relationship between the parents' subjective assessment of the intensity of crying and the amount of crying expressed in hours; the type of methods used and their number were selected depending on the amount of crying, and their effectiveness was assessed negatively, with particular emphasis on the lack of effećtiveness o1 commonly used drugs for so-called colic. Frustration caused by difficulties in soothing the child during crying attacks differentiated the sense of effectiveness in the parenting role, and depressive symptoms were more often recorded in mothers of children experlencing a higher level of frustration. Only 15.5% of women with symptoms 01 depression sought professional help. Children with hlgher amounts of crying were more likely to be fed only formula milk, compared to children fed only ; naturally. Crylng and lack of milk were the basis for the decision to feed with formula milk. irhe amount of crying was assessed similarly in the first-bom and subsequent children, and there were no differences in the intensity o1 crying in children depending on the method of feeding. There was no relationship between the amount of crying in children born prematurely, while children with health problems cried significantly longer in the subjective assessment of their parents. There was no relationship between the mother's education and knowledge about colic, but the relationship between the mother's education and the declared knowledge about SBS was confirmed. In generał, 31.03% o1 respondents declared knowledge about the existence of SBS, although knowledge of the possible consequences of the syndrome in this group was poor. Conclusions The study showed that a significant proportion of children in the group suspećted of SBS were highly likely to have features of non-accidental injuries. The management of suspected Shaken Baby Syndrome should be interdisciplinary. The consistency of the history given by caregivers with the type of the infants' injuries and previous medical interventions are important in the diagnostic process. The author o1 the study believes that the diagnosis of SBS should be introduced into the international classification of diseases due to its unique natu ; re, including the presence of risk factors specific to the syndrome. Awareness of the existence of SBS and its possible consequences among caregivers is too low. Knowledge about increased crying as a normal developmental stage in infants remalns beyond the reach o1 the average Polish parent. Prevention is the only effective way to prevent SBS. Education should be provided to parents of all newborns before the event occurs.
Place of publishing:
Level of degree:
Degree grantor:
Rada Dyscypliny Nauki medyczne
Promoter:
Wojciechowski, Piotr ; Starowicz-Filip, Anna
Date issued:
Identifier:
Call number:
Language:
Access rights:
Object collections:
Last modified:
Dec 30, 2024
In our library since:
Dec 30, 2024
Number of object content hits:
6
Number of object content views in PDF format
0
All available object's versions:
http://dl.cm-uj.krakow.pl:8080/publication/5176
Show description in RDF format:
Show description in OAI-PMH format:
| Edition name | Date |
|---|---|
| ZB-141584 | Dec 30, 2024 |
Objects
Similar
Franczak-Young, Anita
Hałabuda, Agata
Krupa, Mariusz
