Non-accidental brain injury has three injury phases that make each traumatic brain injury unique. It is not always possible to predict how a child will respond to the phases of traumatic brain injury. Each injury phase may cause further insult to the initial injury. These injury phases rapidly occur in sequence with phase two and three happening concurrently. Careful management of non-accidental injury requires identification of these phases of injury pattern, and therefore, it is common to see providers adjust therapies in response to the child’s clinical presentation and symptoms. Prevention and front-loading therapies are used to achieve to the best clinical outcome possible. Secondary injuries may unfold in response to inflammation and evolution of the original injury.
The first injury phase is the primary injury sustained from the abuser’s assault. This phase involves the actual traumatic event, followed by the initial neural damage, damage to adjacent glial tissue and the initial inflammatory response that immediately follows the event.
The second injury phase is when the brain swelling may contribute to the deterioration of the child’s neurological status. This phase may increase intracranial pressure and may impair blood flow to key areas of the child’s brain, including the injury site(s) and adjacent structures. This is the phase where infection may arise or complications associated with increased intracranial pressure may unfold for the injured child. Increased intracranial pressure may cause impaired blood flow to the child’s brain; with higher intracranial pressure leading to worsening neurological impairment. Impaired blood flow may create various complications like brain swelling that causes a brain shift and cellular changes due to a lack of oxygen. This phase requires careful medical/surgical management to minimize permanent injury and prevent death. If a brain injury is severe enough death may not be prevented despite the healthcare provider’s best efforts to prevent it.
If the child survives the initial injury and the second phase of brain injury, the third injury phase of brain injury may arise from the second injury phase because of pressure on the brain stem and inflammatory mediators that are released from injured brain cells and the immune system. This phase has a profound effect on the respiratory center of the child’s brain. It also negatively impacts the vascular motor stability throughout the child’s body. So the child may have problems with breathing, blood pressure and heart rhythm which may result in low perfusion states. Low perfusion states interfere with the delivery of oxygen to cells and will adversely affect recovery from traumatic injuries.
If you have any questions or concerns about what can be done to help babies who have been shaken due to Shaken Baby Syndrome, Child Abuse, or families of babies who have died, please call Christopher Keane and The Keane Law Firm toll-free for free consultation at (888) 592-5437 (KIDS), click on contact us here, or use the web form provided at https://www.keanelaw.com
