"Abusive head injuries among infants are serious, with about one quarter of infants dying from their injuries and at least one half of the survivors suffering significant neurological impairments," said Mark S. Dias, M.D., pediatric neurosurgeon and associate professor of neurosurgery, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, and director of the shaken baby syndrome education program. "Our study shows that an effective prevention campaign could potentially save the lives of many children and significantly improve the lives of many others."
The study titled, "Preventing Abusive Head Trauma Among Infants and Young Children: A Hospital-Based, Parent Education Program," was published April 4, 2005 in Pediatrics, the official journal of the American Academy of Pediatrics.
The study, led by Dias, began in 1998 and included 16 hospitals in an eight-county region of western New York State served by the Women and Children's Hospital of Buffalo. The goals of the program were to develop a standardized education program about shaken baby syndrome for parents of all newborn infants in the region before leaving the hospital, to assess parents' knowledge about the dangers of violent shaking, and to track the use of the education program through the use of commitment statements, agreements signed by parents that show that they received and understood the educational materials.
Nurses at the hospitals were trained by nurse educators to provide pamphlets, discuss them with parents and show a short video. Nurses were to specifically seek out fathers or father-figures who are more often involved in shaken baby syndrome cases. The parents were then asked to sign commitment statements, which also gathered demographic and other information about the responders.
The regional incidence of abusive head injuries among infants and children less than 36 months of age was tracked from December 1998 to May 2004 and was compared to the regional incidence during the five years before the program began, and to the incidents of abusive head trauma in infants in the state of Pennsylvania from 1996 to 2002.
A total of 64,205 commitment statements were recorded out of 94,409 live births during the study period. During the six years before the study began, 49 cases of abusive head injury were identified, or 41.5 cases per 100,000 live births. During the study period, only 21 cases of abusive head injury were recorded, or 22.2 cases per 100,000 live births.
"This translates to a 47 percent reduction in the frequency of abusive head injuries from shaken baby syndrome during the study program and shows that the education program is effective in reducing shaken baby syndrome," Dias said. "Although many parents we spoke with had heard of shaken baby syndrome, providing parents with this information at that special time, just after the birth of their children, appeared to provide a critical reminder that resulted in fewer cases of abuse."
The statewide incidence of abusive head injuries in Pennsylvania did not change significantly from 1996 to 2002, suggesting that the reductions in New York state were specifically related to the patient education program.
"This simple program costs less than $10 per infant and was designed to require less than 15 minutes," Dias said. "When compared to the initial hospitalization and ongoing medical costs for treatment that can average nearly $300,000 per child, this study shows that a small investment of time and money can truly make a difference."
A similar education program has since been implemented in Pennsylvania, where, in 2002, the Commonwealth mandated shaken baby syndrome education for all 127 hospitals with maternity wards. The program began in May 2002 in central Pennsylvania and was expanded to statewide in 2004. In addition, the pilot program in western New York was expanded to include a second brief education reminder for parents at the infant's first visit with pediatric care provider.
"Although we may never be able to completely eliminate abusive head injury from shaken baby syndrome," Dias said, "we hope that a systematic approach to prevention will at least reduce it to a fraction of its present level."
In addition to Dias, study authors were: Kim Smith, R.N., Kathy deGuehery, R.N., Paula Mazur, M.D., F.A.A.P., Veetai Li, M.D., Departments of Neurosurgery and Pediatrics, Women's and Children's Hospital, Buffalo, N.Y., and Michele L. Shaffer, Ph.D., Department of Health Evaluation Sciences, Penn State College of Medicine, Penn State Hershey Medical Center.
This study was supported by grants from the New York State (William B. Hoyt Memorial) Trust Fund, the Matthew Eappen Foundation, and WNY health insurers (Blue Cross/Blue Shield of Western New York, Independent Health, and Univera Healthcare.)
Journal
PEDIATRICS