The neurodevelopmental outcome in infants who have sustained a subdural haemorrhage from non-accidental head injury



Subdural haemorrhage (SDH) in infants arises most commonly from non-accidental head injury (NAHI) from shaking. Patients present with a varied severity of illness and a variety of symptoms and signs. Data on long-term outcome of the survivors are not widely reported. The aim of this paper is to describe the physical and educational outcomes of children <2 years diagnosed with non-accidental head injury and formulate guidelines on follow-up. Data on 65 children <2 years with non-accidental head injury and subdural haemorrhage diagnosed on CT/MRI/postmortem were extracted from the hospital and community notes and education reports. The Kings Outcome Scale for Childhood Head Injury (KOSCHI) was used. Sixteen children died (24.6%), 13 within 6 weeks and three 5 years after the injury. Of the 45 children followed up (follow-up time 21.7–103 months), 25 had a good outcome, six were moderately disabled and 11 were severely disabled, while three were in persistent vegetative state. Problems identified included cerebral palsy—16, ongoing seizures—5, visual problems—11, speech and language problems—17 and behavioural problems—13. Of the 29 children of school age on whom data were available, 12 children had a statement of educational needs. In conclusion, young children who survive non-accidental head injury can have significant physical, cognitive and behavioural problems. Regular follow-up by a multidisciplinary team, which includes a community paediatrician, therapists, school health personnel and ophthalmologic services, until the child is established in school may facilitate early identification of emerging problems and optimize management. Care must be taken not to discharge children with good outcomes, as behavioural and cognitive problems can emerge with time. Only a prospective study will help outline the subtle problems that can emerge with time in children with a so-called good outcome. Copyright © 2004 John Wiley & Sons, Ltd.