Journal
JOURNAL OF PAEDIATRICS AND CHILD HEALTH
Volume 56, Issue 5, Pages 764-769Publisher
WILEY
DOI: 10.1111/jpc.14736
Keywords
emergency department; head injury; neonates
Categories
Funding
- National Health and Medical Research Council (Centre of Research Excellence for Paediatric Emergency Medicine), Canberra, Australia [GNT1046727, GNT1058560]
- Murdoch Children's Research Institute, Melbourne, Australia
- Emergency Medicine Foundation, Brisbane, Australia [EMPJ-11162]
- Perpetual Philanthropic Services, Australia [2012/1140]
- Auckland Medical Research Foundation, Auckland, New Zealand [3112011]
- A+ Trust (Auckland District Health Board), Auckland, New Zealand
- WA Health Targeted Research Funds 2013, Perth, Australia
- Townsville Hospital, Townsville, Australia
- Health Service Private Practice Research and Education Trust Fund, Townsville, Australia
- Victorian Government's Infrastructure Support Program, Melbourne, Australia
- Royal Children's Hospital Foundation, Melbourne, Australia
- Melbourne Children's Clinician Scientist Fellowship, Melbourne, Australia
- NHMRC Practitioner Fellowship, Canberra, Australia
- Health Research Council of New Zealand [HRC13/556]
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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.
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