The observations by British doctors Marta C. Cohen and Irene Scheimberg find that brain hemorrhages associated with brain hypoxic damage commonly attributed to shaken baby syndrome can occur as a result of cerebral hypoxia, which occurs when the body’s tissues don’t receive enough oxygen.
Their findings could have significant implications for people charged with, or convicted of, shaken baby syndrome.
The National Center on Shaken Baby Syndrome says an estimated 1,200 to 1,400 U.S. children are injured or killed by shaking each year. These new findings could have an impact on those numbers.
Shaken baby syndrome is generally suspected when a child has three symptoms known as “the triad”: subdural hemorrhage, retinal hemorrhages and brain edema without a record of being involved in a car accident or a fall from a high distance.
But Cohen and Scheimberg say their findings based on their routine practice show that intradural hemorrhage “is frequent in fetal, perinatal, and neonatal postmortems.” They also note that during labor, pressure from contractions and maternal pushing with increased of intracranial venous pressure could result in retinal hemorrhages, another symptom in “the triad.” None of the babies involved in their study showed any evidence of head injuries.
The doctors examined 25 babies who died before birth and 30 newborns, and found evidence of bleeding in the brain—specifically subdural hemorrhages. This kind of bleeding has commonly been thought to result from torned bridging veins and to indicate infant abuse, although in the cases studied that was not a possibility. Instead, the specialists demonstrate that the source of the bleeding in their cases was the dura matter itself.
Birth trauma can produce tentorial or falx tears, which give rise to subdural hemorrhages, according to the article. This bleeding in the brain is among the more common forms of cranial birth trauma. But Cohen and Scheimberg also found subdural hemorrhage associated with intradural hemorrhage without tentorial or falx tears and explain how the free blood can ooze from the intradural hemorrhage.
Their study shows a correlation between the degree of hypoxia, the extent of intradural hemorrhage, and presence of subdural hemorrhage. The authors call for more studies of this relationship and of the causes of bleeding in newborn brains.
Pediatric and Developmental Pathology is published by the Society for Pediatric Pathology and the Pediatric Pathology Society. Pediatric and Developmental Pathology is the premiere journal dealing with the pathology of disease from conception through adolescence. For more information, see www.pedpath.org.
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