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Abstract
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The concept of shaken baby syndrome is an unfortunate example of a theory being adopted by consensus rather than being supported by science and clinical observation. The proposed causative mechanism, shaking, is often contaminated by incidents involving actual head trauma. Flaws in the biomechanical theory underlying the concept, and flaws in the “confessional” literature used to support the concept have been reviewed by others.
In recent years, the concept of shaken baby syndrome has taken on increasingly pejorative labels, such as “abusive head injury,” and now “inflicted brain injury.” One group of authors, Maguire et al., claim that their systematic review, the largest of its kind, offers for the first time a valid “statistical probability” of inflicted brain injury when certain key features are present.
One of the “key features” upon which Maguire et al. base their opinion, retinal hemorrhages, has long been known to be associated with raised intracranial pressure from any cause, as in Terson’s syndrome and following vitamin C or vitamin K deficiency. Relying solely on this “key feature” can have disastrous consequences for the child’s caregivers.
Under these circumstances, inappropriate accusations of child abuse could be appropriately avoided by doing the recognized, accepted, and pertinent laboratory tests for deficiency of vitamins C or K. It is likewise pertinent to ask in how many cases, in the “largest review of its kind,” was the modified prothrombin time known as the PIVKA test (proteins induced by vitamin K antagonism or absence) performed? And, how often was serum level of vitamin C estimated?
In light of what is now known about the effects of nutritional deficiencies, the diagnosis of inflicted brain injury should not be accepted unless pertinent nutritional disorders have specifically been excluded. |