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J Paediatr Child Health. 2019 Dec 23. doi: 10.1111/jpc.14736. [Epub ahead of print]

Neonatal head injuries: A prospective Paediatric Research in Emergency Departments International Collaborative cohort study.

Author information

1
Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.
2
Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
3
Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.
4
Schools of Medicine, Divisions of Emergency Medicine and Paediatrics, University of Western Australia, Perth, Western Australia, Australia.
5
Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia.
6
Child Health Research Centre, The University of Queensland, Medical Research Institute, Brisbane, Queensland, Australia.
7
Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
8
Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia.
9
Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
10
Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia.
11
Emergency Department, Kidzfirst Middlemore Hospital, Auckland, New Zealand.
12
Emergency Department, Bristol Royal Hospital for Children, Bristol, United Kingdom.
13
Faculty of Health & Life Sciences, University of the West of England, Bristol, United Kingdom.
14
Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
15
Emergency Department, Starship Children's Health, Auckland, New Zealand.
16
Liggins Institute, University of Auckland, Auckland, New Zealand.
17
Department of Women's and Child Heath, University of Padova, Padova, Italy.

Abstract

AIM:

To characterise the causes, clinical characteristics and short-term outcomes of neonates who presented to paediatric emergency departments with a head injury.

METHODS:

Secondary analysis of a prospective data set of paediatric head injuries at 10 emergency departments in Australia and New Zealand. Patients without neuroimaging were followed up by telephone call. We extracted epidemiological information, clinical findings and outcomes in neonates (≤28 days).

RESULTS:

Of 20 137 children with head injuries, 93 (0.5%) occurred in neonates. These were mostly fall-related (75.2%), commonly from a care giver's arms, or due to being accidentally struck by a person/object (20.4%). There were three cases of non-accidental head injuries (3.2%). Most neonates were asymptomatic (67.7%) and many had no findings on examination (47.3%). Most neonates had a Glasgow Coma Scale 15 (89.2%) or 14 (7.5%). A total of 15.1% presented with vomiting and 5.4% were abnormally drowsy. None had experienced a loss of consciousness. The most common findings on examination were scalp haematoma (28.0%) and possible palpable skull fracture (6.5%); 8.6% underwent computed tomography brain scan and 4.3% received an ultrasound. Five of eight computed tomography scan (5.4% of neonates overall) showed traumatic brain injury and two of four (2.2% overall) had traumatic brain injury on ultrasound. Thirty-seven percent were admitted, one patient was intubated and none had neurosurgery or died.

CONCLUSIONS:

Neonatal head injuries are rare with a mostly benign short-term outcome and are appropriate for observation. However, non-accidental injuries need to be considered.

KEYWORDS:

emergency department; head injury; neonates

PMID:
31868278
DOI:
10.1111/jpc.14736

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