Shaken Baby Syndrome in Brazil: a 6 years’ data analysis

Síndrome do Bebê Sacudido no Brasil: análise de dados em 6 anos

• Carolina Carmona Pinheiro Machado (1)    
• Valdecir Boeno Spenazato Júnior (2)    
• Álvaro Alves de Sá Júnior (3)    
• Aline Rabelo Rodrigues (3)    
• João Pedro de Oliveira Daflon (4)    
• Ricardo Santos de Oliveira (5)    
• Matheus Fernando Manzolli Ballestero (6)    

• https://doi.org/10.22290/jbnc.2023.340115
• J Bras Neurocirur 34 (1): 64-68, 2023

Resumo

Introdução: O Trauma Craniano Violento (TCV) engloba atos de violência em crianças menores de 5 anos que provocam lesões cerebrais e nas demais estruturas do sistema nervoso central. Objetivo: expor dados estatísticos nacionais com o intuito de verificar a incidência do TCV em diferentes regiões do Brasil e comparar com a incidência durante a pandemia. Métodos: Trata-se de uma análise epidemiológica retrospectiva, cujos dados foram obtidos por meio de consulta ao Departamento de Informática do Sistema Único de Saúde (DATASUS), de Morbidade Hospitalar do SUS (SIH/SUS). Foram coletados dados anuais registrados dentre o período de janeiro de 2016 a dezembro de 2021 em cada região federativa do Brasil acerca do número de casos notificados de indivíduos dentre a faixa etária de 0 a 4 anos, sem distinção de gênero ou caráter de atendimento, incluídos como descritores “Traumatismo Craniano” e “Síndrome dos Maus-Tratos”. Posteriormente, foi calculada a incidência dos casos notificados em cada região. Resultados: Entre 2016 e 2021, notificou-se 45.556 casos, dos quais a grande maioria (19.936) é referente à região sudeste (44%). Nos anos de 2020 e 2021, período referente à pandemia da COVID-19, observou-se os menores índices de notificação. Conclusão: Analisando as incidências por região, o Sul mostrou maior número, mesmo possuindo melhor Índice de Desenvolvimento Humano. Concluiu-se que a situação socioeconômica tem fraca influência em comparação à situação emocional dos cuidadores como fator de risco.

Palavras-chave

Síndrome do Bebê Sacudido; Maus-tratos; Lesão cerebral; Trauma Craniano Violento

Abstract

Introduction: Abusive Head Trauma (AHT) is every act of abuse inflicted on children under 5 years old that can cause injury to the brain or other structures of the central nervous system. Objective: to expose national data and statistics with the purpose of verifying the incidence of AHT in the different Brazilian regions and comparing with the incidence during the pandemics. Methods: A retrospective and analytical study was performed to evaluate the incidence of abusive head trauma to children up to 4 years old in Brazil. The data was collected in the Brazilian epidemiological information database using the keywords “Intracranial Trauma” and “Abuse Syndrome”, the age group was up to 4 years old, from January 2016 to December 2021 from the five different federative regions. Then, it was calculated the incidence of the reported cases in each region (North, Northeast, Midwest, Southeast and South). Results: From 2016 to 2021 45,556 cases were reported, the Southeast had 44% of the cases and during the pandemics period (2020 to 2021) there was a decrease in reporting. Conclusion: When analyzing the incidence per region, the South had the highest one even with a greater Human Development Index, indicating a poor influence of socio economics status to the number of cases compared to the emotional issue as a more important factor.

Keywords

Shaken Baby Syndrome; Child abuse; Brain injuries; Abusive Head Trauma

References

1. Kemp AM, Jaspan T, Griffiths J, et al. Neuroimaging: what neuroradiological features distinguish abusive from non-abusive head trauma? A systematic review. Arch Dis Child. 2011;96(12):1103-12. http://dx.doi.org/10.1136/archdischild-2011-300630. PMid:21965812.

2. Hinds T, Shalaby-Rana E, Jackson AM, Khademian Z. Aspects of abuse: abusive head trauma. Curr Probl Pediatr Adolesc Health Care. 2015;45(3):71-9. http://dx.doi.org/10.1016/j.cppeds.2015.02.002. PMid:25771265.

3. De Paula MCG, Pereira CU, Rabelo NN. Shaken Baby Syndrome: literature review in the last 5 years. Arch Pediat Neurosurg. 2020;2(2):e39. http://dx.doi.org/10.46900/apn.v2i2(May-August).39.

4. Narang SK, Fingarson A, Lukefahr J, et al. Abusive head trauma in infants and children. Pediatrics. 2020;145(4):e20200203. http://dx.doi. org/10.1542/peds.2020-0203. PMid:32205464.

5. Wright J, Painter S, Kodagali SS, et al. Disability and visual outcomes following suspected abusive head trauma in children under 2 years. Arch Dis Child. 2021;106(6):590-3. http://dx.doi.org/10.1136/ archdischild-2019-318638. PMid:32665266.

6. Kwak YH. Diagnosis of abusive head trauma: neurosurgical perspective. J Korean Neurosurg Soc. 2022;65(3):370-9. http://dx.doi. org/10.3340/jkns.2021.0284. PMid:35468707.

7. Wester K, Stridbeck U, Syse A, Wikström J. Re-evaluation of medical findings in alleged shaken baby syndrome and abusive head trauma in Norwegian courts fails to support abuse diagnoses. Acta Paediatr. 2022;111(4):779-92. http://dx.doi.org/10.1111/apa.15956. PMid:34041784.

8. Orman G, Kralik SF, Meoded A, Desai N, Risen S, Huisman TAGM. MRI findings in pediatric abusive head trauma: a review. J Neuroimaging. 2020;30(1):15-27. http://dx.doi.org/10.1111/jon.12670. PMid:31696594.

9. Depallens S, Favrod C, Maeder P, San Millan D, Cheseaux JJ. Early diagnosis of abusive head trauma to avoid repetitive shaking events. Glob Pediatr Health. 2022;9:2333794X211067037. PMid:35224142.

10. Brasil. Conselho Federal de Medicina. Decreto de consolidação Nº 204 (Cap. 1, Seção 1, Artigo 2). Diário Oficial da União; Brasília; 17 Feb 2016.

11. Brasil. Ministério da Saúde. DATASUS: Departamento de Informática do Sistema Único de Saúde [Internet]. Brasília (DF): Ministério da Saúde; 1988. Available from https://datasus.saude.gov.br/informacoes-de-saude-tabnet/. Accessed: 4/20/2022.

12. Cowley LE, Adesman A. The challenge of identifying pediatric abusive head trauma during the COVID-19 pandemic. Pediatrics. 2021;148(1):e2021050612. http://dx.doi.org/10.1542/peds.2021-050612. PMid:33879522.

13. Lãzãrescu AM, Benichi S, Blauwblomme T, et al. Abusive head trauma in infants during the COVID-19 pandemic in the Paris metropolitan area. JAMA Netw Open. 2022;5(8):e2226182. http://dx.doi.org/10.1001/ jamanetworkopen.2022.26182. PMid:36040743.

14. Sidpra J, Abomeli D, Hameed B, Baker J, Mankad K. Rise in the incidence of abusive head trauma during the COVID-19 pandemic. Arch Dis Child. 2021;106(3):e14. http://dx.doi.org/10.1136/ archdischild-2020-319872. PMid:32616522.

15. Instituto de Pesquisa Econômica Aplicada. Radar IDHM: evolução do IDHM e de seus índices componentes no período de 2012 a 2017 [Internet]. Brasília (DF): IPEA; 2019. Available from: http://repositorio. ipea.gov.br/handle/11058/9150. Accessed: 8/10/2022.

16. Instituto Brasileiro de Geografia e Estatística [Internet]. Rio de Janeiro: IBGE; 2019. Available from: https://www.ibge.gov.br. Accessed: 8/10/2022.

17. Gordy C, Kuns B. Pediatric abusive head trauma. Nurs Clin North Am. 2013;48(2):193-201. http://dx.doi.org/10.1016/j.cnur.2013.01.013. PMid:23659807.

18. Lopes NRL, Williams LCA. Avaliação do conhecimento sobre trauma craniano violento por pais brasileiros. Psicol, Teor Pesqui. 2016;32(2):1-11. http://dx.doi.org/10.1590/0102-3772e32223.

19. Barlow KM, Thomson E, Johnson D, Minns RA. Late neurologic and cognitive sequelae of inflicted traumatic brain injury in infancy. Pediatrics. 2005;116(2):e174-85. http://dx.doi.org/10.1542/peds.2004- 2739. PMid:16061571.

20. Jackson JE, Beres AL, Theodorou CM, Ugiliweneza B, Boakye M, Nuño M. Long-term impact of abusive head trauma in young children: outcomes at 5 and 11 years old. J Pediatr Surg. 2021;56(12):2318-25. http://dx.doi.org/10.1016/j.jpedsurg.2021.02.019. PMid:33714452.

21. Cheon JE, Kim JH. Imaging of abusive head trauma: a radiologists’ perspective. J Korean Neurosurg Soc. 2022;65(3):397-407. http://dx.doi. org/10.3340/jkns.2021.0297. PMid:35483021.

22. Lopes NR, Eisenstein E, Williams LC. Abusive head trauma in children: a literature review. J Pediatr (Rio J). 2013;89(5):426-33. http:// dx.doi.org/10.1016/j.jped.2013.01.011. PMid:23850113.

23. Lind K, Toure H, Brugel D, Meyer P, Laurent-Vannier A, Chevignard M. Extended follow-up of neurological, cognitive, behavioral and academic outcomes after severe abusive head trauma. Child Abuse Negl. 2016;51:358-67. http://dx.doi.org/10.1016/j.chiabu.2015.08.001. PMid:26299396.

24. Manfield J, Oakley K, Macey JA, Waugh MC. Understanding the five-year outcomes of abusive head trauma in children: a retrospective cohort study. Dev Neurorehabil. 2021;24(6):361-7. http://dx.doi.org/1 0.1080/17518423.2020.1869340. PMid:33478304.

25. Badger S, Waugh MC, Hancock J, Marks S, Oakley K. Short term outcomes of children with abusive head trauma two years post injury: A retrospective study. J Pediatr Rehabil Med. 2020;13(3):241-53. http:// dx.doi.org/10.3233/PRM-190624. PMid:32831205.

26. Wilson TA, Gospodarev V, Hendrix S, Minasian T. Pediatric abusive head trauma: ThinkFirst national injury prevention foundation. Surg Neurol Int. 2021;12(526):526. http://dx.doi.org/10.25259/SNI_194_2021. PMid:34754576.

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1 Medical student, University of Fortaleza, Fortaleza, CE, Brazil.

2 Medical student, University of Sapucaí’s Valley – Univás, Pouso Alegre, MG, Brazil.

3 Medical student, Federal University of Jataí – UFJ, Jataí, GO, Brazil.

4 Medical student, University Center Organ Mountains – UNIFESO, Teresópolis, RJ, Brazil.

5 MD, PhD, Professor at Neurosurgery Division, Department of Surgery and Anatomy, Ribeirão Preto Faculty of Medicine – FMRP, University of São Paulo – USP, Ribeirão Preto, SP, Brazil.

6 MD, Adjunct Professor, Department of Medicine, Federal University of São Carlos, São Carlos, SP, Brazil.

 

Received Dec 13, 2022

Accepted Dec 23, 2022