HEAD INJURIES IN INFANTS (0-1 YEARS)

1. D. Voinescu¹, Saceleanu²*, I. Luca-Husti³, I. Rusu⁵, A.V. Ciurea^3,4

“Carol Davila” University of Medicine and Pharmacy Bucharest Faculty of Medicine

1. Elias Emergency Hospital Neurosurgical Department “Lucian Blaga” University, Faculty of Medicine
2. Neurosurgery Department
3. “Sanador” Clinical Hospital, Bucharest; Carol Davila” University of Medicine and Pharmacy Bucharest Faculty of Medicine
4. Neurosurgical Departament
5. Bucharest Emergency University Hospital Neurosurgical Departament

   *Corresponding author. E-mail:

HEAD INJURIES IN CHILD (0-1 YEARS) (Abstract): Head injuries are one of  the  major causes of morbidity and mortality in children. The most  common  causes are  falls  from the  same level.  Boys  are twice  more  prone  to head injuries than girls.  The  traumatic path ology  of the first 3 years of life is completely different when  compared  to that  of adults.  Material and methods: Retrospective study of all infants aged  0-1 years admitted  for  head  injuries to the pediatric neurosurgery departments of “Bagdasar-Arseni” Hospital  and  “Sanador”  Hospi- tal in Bucharest. This 17-year study (January 1^st, 2000-December 31^st, 2016) included 509 patients aged 0 to 3 years.  Results: Of these,  111 (21.8 %) were aged under 1 year,  presented  to the Emergency Department (ED), were hospitalized for at least 24- hour  observation, and  were diagnosed with at least one traumatic head injury visible  on  the  imaging studies.  The level of consciousness in infants was assessed by using a variant of the Glasgow Coma Scale (GCS) adapted to this age (0-1 years), namely Pediatric  Glasgow  Coma  Scale  (PGCS).  CT with Bone-window is the first investigation in case of  a  head  injury.  Conclusions:  Infants show a different pathology from that at other ages. Head injuries in infants pose multiple di f- ficulties related to diagnosis, complications and follow-up. The data obtained from  unen-  hanced CT scans constitute an emergency assessment. Keywords:  HEAD  INJURY,  CHILD 0-1 YEARS, CT SCAN, PEDIATRIC NEUROSURGERY, GLASGOW COMA SCALE, GLASGOW PEDIATRIC COMA SCALE

Head injuries (HI) are one of the most important causes of  mortality,  morbidity and transient or permanent disability in the general population, both in adults and in children. In the USA, the incidence of HI among the children aged 0-4 years is about 1256/100,000 population (1, 2).

The clinical manifestations of pediatric and adult HI differ even when they share a common cause. Raimondi (1998) empha- sized the importance of the differences be- tween adult and pediatric pathology con- cluding that” the newborn is not a baby, the baby is not a school child”, just ”the teenag- er is not a child” and even more ”adults are completely different from children” (3).

The most common causes of HI in in- fants are accidental falls from  the  same level or from height, traffic accidents in which children may be involved both as passengers and as pedestrians,  accidents with various objects and child abuse (4).

When an infant presents to the Emer- gency Department with head injury, unen- hanced CT brain scan is the initial imaging modality of choice. This is the “gold- standard” investigation for  head  injuries, and is preferred due to its accessibility and good visualization of bleeding injuries, solutions of continuity in calvaria with or without dural or cerebral expansion in the bone gap or cerebral edema lesions (5).

MATERIAL AND METHODS

All patients with HI aged 0 to 3 years admitted to the departments of pediatric neurosurgery of “Bagdasar-Arseni” Hospital and “Sanador” Hospital in Bucharest be- tween January 1^st, 2000 and December 31^st, 2016 were included in this 17-year study. Of the 509 pediatric patients, 111  (21.8  %) were aged under 1 year. In this study group, we encountered a category of  injuries  caused by obstetrical trauma related to fetal dystocia or instrumental delivery.

All patients included in the study were admitted for at least 24-hour  observation, and were diagnosed with at least one post- traumatic injury visible on imaging studies. To analyze patients’ state of conscious- ness, the authors used the Pediatric Glas- gow Coma Scale (PGCS), a variant of the Glasgow Coma Scale (GCS) adapted for pediatric patients (6) (tab. I).

TABLE I

Pediatric Glasgow Coma Scale (6)

Best verbal response	Best eye response	Best motor response
No verbal response (1p)	No eye opening (1p)	No motor response (1p)
Inconsolable, Agitated (2p)	Eyes open to pain (2p)	Extension to pain (2p)
Inconsistently inconsolable,Moaning (3p)	Eyes open to speech (3p)	Abnormal flexion to pain (3p)
Cries but consolable,abnormal interactions (4p)	Eyes open spontaneously (4p)	Infant withdraws from pain (4p)
Smiles, orients to sounds,follows objects (5p)	N/A	Infant withdraws from touch (5p)
N/A	N/A	Infant moves spontaneously (6p)

RESULTS

The level of consciousness determined with PGCS in the 0-1-year group is pre- sented in Table II.

As to the etiology of HI in infants the most common causes in this study group were falls from the same level or from another level and traffic accidents. A  spe- cial category is represented by the injuries caused by physical aggression (tab. III).

TABLE II

PGCS evaluation of the level of con- sciousness in the 111 infants

GPCS	No. of cases	Percentage
15-13 points	79	71.1
12-9 points	20	17.9
<8 points	12	10.8
Total	111	100.00

 

TABLE III

Causes of head injuries in infants (0-1 years)

Cause	No. of cases	Percentage
Fall from the same level	41	36.9
Fall from another level	35	31.5
Road accidents	23	20.7
Accidents at play	5	4.5
Aggression (Child abuse)	4	3.
Other causes	3	2.7
Total	111	100

 

His are extremely varied, a frequent finding pallor, encountered in all  study  cases. Infants who were in pain were agi- tated and anxious. Another clinical catego-  ry was the symptoms of increased intracra-nial pressure expressed by the anterior fontanelle bulging, vomiting, convulsive events, motor  deficiencies  or  anisocoria and alteration of consciousness in various degrees (tab. IV).

TABLE IV

Clinical Symptomatology reported at Emergency Room

Clinical symptomatology	No. of cases	Percentage
Pallor skin	111	100
Irritability with agitation	60	54.1
Irritability and drowsiness	42	37.8
Anterior fontanelle bulging	39	35.1
Vomiting	26	23.4
Convulsive seizures	21	18.9
Motor deficits	15	13.5
Anisocoria	9	8.1
Impaired consciousness/coma state	12	10.8

 The post-traumatic injuries seen on CT scans most frequently encountered in the hospitalized patients (111 cases; 21.8%) were: skull fractures of several types, ceph- alohematoma, extradural hematomas and DAIs (tab. V).

Acest studiu se regaseste integral in Revista Medico Chirurgicala a Societatii de Medici si Naturalisti din Iasi, Volumul 121, Numarul 2, Aprilie-Iunie 2017.

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https://www.revmedchir.ro/index.php/revmedchir/article/view/100/76