ABSTRACT
Objective: The first months after birth is a very difficult period for mothers who are trying to get used to their baby. In particular, it can be even more difficult for mothers with frequent crying babies. The aim of this study is to determine the factors that may cause shaking and shaking of babies aged 1-4 months by their mothers. Material and Methods: A total of 180 mothers were included in our descriptive and cross-sectional study. Research data were compiled using the Edinburgh Postpartum Depression Scale, the Fragile Infant Scale, and the mother and infant descriptive characteristics form. Results: When the variables of mothers and babies and the state of being shaken by their mothers were examined, it was seen that none of the variables were effective. In addition, the frequency of swinging during the day was 5.3±3.2, the frequency of rocking to sleep was 5.7±3.8, the frequency of swinging in the car was 2.9±2.8, and the frequency of playing the game of being thrown into the air was 3.4±3.3. Babies with a high frequency of crying shake about 1.5 times more than babies who do not cry. The mothers' mean depression scores were found to be 12.1±7, and the fragile infant perception mean score was 31.9±5.3. In the correlation analysis, no statistically significant relationship was found between mothers' depression scale score and fragile baby perception scale score and shaking their babies. The first three practices preferred by the mothers when their babies started to cry were shaking (66.6%), breastfeeding/feeding (63.8%) and pacifier (23.3%), respectively. It was determined that the first three practices preferred by the mothers when the babies continued to cry were shaking (61.1%), breastfeeding/ feeding (58.3%), and playing the throwing game (53.8%), respectively. Conclusion: The results of our study showed that the babies of the mothers included in the study had a low risk for shaken baby syndrome, especially in this period when abuse against children increased with the restrictions that came to the fore in the coronavirus disease-2019 epidemic. Copyright © 2022 by Türkiye Klinikleri.
ABSTRACT
Background: Abusive Head Trauma (AHT) is a syndrome of life-threatening intracranial injuries. The COVID-19 pandemic imposed new stresses upon socially vulnerable populations, but the relationships between social vulnerability, COVID-19 and AHT outcomes are not known. We investigated whether patient or social factors predicted survival after AHT and whether these factors and outcomes were modified during COVID-19. Methods: A single-institution database was queried for all admissions of children with a confirmed diagnosis of AHT from 2018-2021. Clinical information, radiographs and clinic follow-up data were reviewed. Social vulnerability index (SVI) was calculated based on published methods (atsdr.cdc.gov). Univariate and multivariate analyses were performed. Results: One hundred and three cases of AHT were reviewed. Median age at presentation was 4 months (IQR 2-10) in the overall cohort, males outnumbered females overall (76 males, 27 females). 18 patients died (17.5%), higher than previously reported rates. Nonsurvivors had higher social vulnerability index (.867 vs .719, p=0.004);71% had high social vulnerability compared to 39% of survivors. There was no difference in fatality rate before (19%) or during (15%) COVID-19. All nonsurvivors were intubated on admission, compared to 36% of survivors (p<0.001) and all nonsurvivors were comatose compared to 29% of survivors (p<0.001);61% of nonsurvivors had cardiac arrest on admission compared to 3% of survivors (p<0.001). The injury severity score of nonsurvivors was higher than that of survivors (27 vs 17, p=0.02 in univariate analysis). Nonsurvivors were less likely to have multiple fractures (11% vs. 43%, p=0.01). Nonsurvivors were more likely to have bilateral hypoxic ischemic injury (HII, 89% vs 29%, p< 0.001, Crude OR for survival 0.33, p<0.001, p=0.017 in multivariate analysis). There was no difference in rates or types of neurosurgical intervention, intracranial hemorrhage location, or presence of spinal hemorrhage between nonsurvivors and survivors. Discussion: Mortality from AHT in our series was higher than previously reported: more than one out of six children in our series did not survive. Although nonsurvivors were more likely to live in highly vulnerable social settings, COVID-19 did not change survival rate. Nonsurvivors are more likely to present in coma requiring intubation and in cardiac arrest. Subdural hematomas are seen in survivors and non-survivors but surgical mass lesions are rare and surgery does not improve survival. We identify a strong association between completed bilateral HII on admission and fatality in AHT. The high mortality of AHT in association with HII, and the low efficacy of intervention after completed HII supports a public health effort towards treatment and prevention focusing on socially vulnerable communities.