1/9. Intravitreal tPA and SF6 promote clearing of premacular subhyaloid hemorrhages in shaken and battered baby syndrome.BACKGROUND AND OBJECTIVE: child abuse is a serious problem in many cultures. The ocular signs of shaken baby include intraretinal, subretinal, and preretinal hemorrhages. The hemorrhages may be unilateral or bilateral and are seen in 50% to 80% of patients. Previous treatment was limited to observation or vitrectomy, but some observed eyes develop amblyopia, and pediatric vitrectomy has many complications. patients: We report 4 eyes in 2 children with shaken baby syndrome in whom we administered intravitreal tissue plasminogen activator (tPA) in an attempt to resolve preretinal hemorrhages earlier than observation alone without the complications of vitrectomy. The tPA dose ranged from 12.5-25 microg per injection. Eyes were injected once weekly for 3 consecutive weeks. Each time 0.25 cc of sulfur hexafluoride gas was also injected. RESULTS: Within 1 week following the last tPA administration, complete resolution of the preretinal hemorrhage was seen. There were no associated ophthalmic complications. CONCLUSION: Intravitreal tPA with an expansive gas is an alternative method to observation or vitrectomy for resolution of preretinal hemorrhages in battered babies and may allow faster resolution of hemorrhages without the complications of vitrectomy.- - - - - - - - - - ranking = 1keywords = baby syndrome, baby (Clic here for more details about this article) |
2/9. Retinal findings in children with intracranial hemorrhage.PURPOSE: To identify the incidence of Terson's syndrome in children. DESIGN: Prospective, observational case series. PARTICIPANTS: Fifty-seven consecutive children with known intracranial hemorrhage from nonabuse causes. methods: Dilated fundus examination to detect intraretinal hemorrhages or other abnormalities. MAIN OUTCOME MEASURES: Presence or absence of intraretinal hemorrhages or other abnormalities. RESULTS: Fifty-five patients (96%) had no evidence of intraretinal or vitreous hemorrhage. Two patients had abnormal retinal examinations. One patient had a single dot hemorrhage associated with presumed infectious white retinal lesions. The second patient had three flame and two deeper dot intraretinal hemorrhages after a motor vehicle accident (1.5% incidence of retinal hemorrhage). CONCLUSIONS: retinal hemorrhage is uncommon in children with intracranial hemorrhage not resulting from shaken baby syndrome. The maximal incidence of intraretinal hemorrhage in children with nonabuse intracranial hemorrhage is 8%.- - - - - - - - - - ranking = 0.1999908637754keywords = baby syndrome, baby (Clic here for more details about this article) |
3/9. Shaking infant trauma induced by misuse of a baby chair.A 2 month old infant presented with bilateral subdural haemorrhages and bilateral subhyaloid haemorrhage. The parent admitted to forceful bouncing of the child in a baby rocker. Experiments showed that violent rocking in the chair could produce extreme alternating acceleration/deceleration forces in excess of those induced by shaking alone. Such handling could not be interpreted as accidental mismanagement and the abusive nature of the process was graphically shown in video recordings of the experiment. Prosecution resulted in a conviction for cruelty, and a suspended sentence.- - - - - - - - - - ranking = 0.00022840561489938keywords = baby (Clic here for more details about this article) |
4/9. Retinal haemorrhages in premature infants: a pathogenetic alternative diagnosis to child abuse.PURPOSE: To present the occasional observation of retinal haemorrhages in premature babies, as a diagnostic alternative to those observed as part of shaken baby syndrome. methods: We carried out an observational study on 11 infants in whom retinal and/or vitreous haemorrhages had been observed within their first months of life. Ten infants were under surveillance for retinopathy of prematurity (ROP), with gestational ages and birth weights in the ranges of 27--34 weeks and 790--1665 g, respectively. One infant was diagnosed with Zellweger's syndrome and one received substitution therapy for coagulation factor II deficiency. The last child had been delivered at 38 weeks, weighing 2070 g; he died on day 5 from severe brain oedema with incarceration and extensive bilateral fundus bleeding. RESULTS: Four of the 11 infants had some evidence of ROP, and two later received retinal ablation therapy. Contrary to the quick absorption (<1-2 weeks only) usually seen in most newborn term infants, the ocular bleeding in preterms was generally longstanding. A quick increase in intracranial pressure probably played a role in the lethal case with delivery near term, and one infant received lung physiotherapy for pneumonia at the age of 6 months. Some bleeding appeared to be truly postnatal (i.e. it was observed as a new occurrence during the course of surveillance). CONCLUSIONS: In the series under study there was no suspicion of child abuse. In term infants, retinal haemorrhages are extremely rare except when due to shaking, but other diseases should be ruled out, coagulopathies in particular. We suggest that prematurity as such is added to the list of possibly underlying causes when retinal bleedings are evaluated in very small infants and shaken baby mechanisms are suspected.- - - - - - - - - - ranking = 0.20003654489838keywords = baby syndrome, baby (Clic here for more details about this article) |
5/9. pregnancy after vitrectomy for proliferative diabetic retinopathy.A 26-year-old female with insulin-dependent diabetes of 16 years duration had a vitrectomy for a dense non-resolving vitreous haemorrhage. Two months later she became pregnant. She delivered a healthy baby and despite the known adverse effects of pregnancy on retinopathy no deterioration occurred in visual acuity or in retinal appearance.- - - - - - - - - - ranking = 4.5681122979875E-5keywords = baby (Clic here for more details about this article) |
6/9. Retinal folds in the shaken baby syndrome.We examined two children with presumed shaken baby syndrome. Both children suffered severe, indirect closed head trauma with intracranial hemorrhage, sharply increased intracranial pressure, and extensive neurologic damage. In addition to extensive retinal and preretinal hemorrhages, bilateral symmetric white ring-shaped retinal folds were seen encircling the macula outside the vascular arcades. These retinal folds may be a hallmark of shaking injuries in child abuse victims.- - - - - - - - - - ranking = 0.99995431887702keywords = baby syndrome, baby (Clic here for more details about this article) |
7/9. Homozygous protein c deficiency: observations on the nature of the molecular abnormality and the effectiveness of warfarin therapy.An infant with severe homozygous protein c deficiency was brought to medical attention because of purpura fulminans and severe bilateral vitreous hemorrhages in the neonatal period. Infusions of fresh frozen plasma were given for 8 months. On two occasions, attempts to decrease the frequency of fresh frozen plasma infusions to less than twice a day led to episodes of microangiopathic hemolysis, fibrinolysis, and acute renal failure. infarction of skin and subcutaneous tissues did not recur. Both episodes were controlled after reinstitution of fresh frozen plasma. Complications of therapy with fresh frozen plasma included hyperproteinemia and hypertension. warfarin therapy was instituted when the baby was 8 months of age, followed by a gradual withdrawal of fresh frozen plasma therapy. The dose of warfarin required to maintain the prothrombin time in a range of 1.8 to 2.2 times normal varied considerably during short periods, a phenomenon that may have been due to several factors: hypercatabolism of the drug with prolonged administration, abnormality of liver function, variation in levels of serum albumin, fluctuations in drug dosage secondary to oral administration, and variations in dietary vitamin k. Protein C determinations by immunologic and functional assays consistently showed detectable but reduced protein C antigen levels with undetectable activity levels, suggesting that a dysproteinemia rather than a deficiency of synthesis is responsible for the child's coagulopathy.- - - - - - - - - - ranking = 4.5681122979875E-5keywords = baby (Clic here for more details about this article) |
8/9. Retinal folds in Terson syndrome.BACKGROUND: Perimacular retinal folds have been reported in the shaken baby syndrome, but have not been described in adults with Terson syndrome. methods: The authors present two patients with perimacular retinal folds in adults with Terson syndrome. In one patient, electron microscopy was used to examine the membrane spanning the fold. RESULTS: The membrane spanning the perimacular fold was found to be internal limiting membrane. The pathogenesis of these perimacular folds found in adults sustaining direct head trauma is probably different from that previously described for folds seen in infant eyes with shaken baby syndrome. CONCLUSION: Retinal folds occurring in Terson syndrome are clinically similar to those seen in the shaken baby syndrome.- - - - - - - - - - ranking = 0.59997259132621keywords = baby syndrome, baby (Clic here for more details about this article) |
9/9. Ocular manifestations in shaken baby syndrome.In the absence of external physical signs, child abuse is not easy to diagnose. shaken baby syndrome is a unique form of child abuse where the only consistent external physical signs are its ocular manifestations. We report two cases which illustrate the typical presentation, with hallmarks of this syndrome, namely intraocular and intracranial haemorrhages. The visual prognosis of these infants are usually poor.- - - - - - - - - - ranking = 0.99995431887702keywords = baby syndrome, baby (Clic here for more details about this article) |