P3A155: Growth Outcomes of Children with Abusive Head Trauma in West Virginia: 2011-2020

Background: Abusive head trauma (AHT) is a leading cause of morbidity and mortality in young children in the United States. Long-term growth data on children who are victims of AHT is not well-described. The purpose of this study was to analyze long-term growth measurements of children who were diagnosed with AHT prior to two years of age.

Methods: A retrospective chart review was performed of cases of AHT treated at one tertiary pediatric center in West Virginia from 2011-2020. Cases of AHT in children less than two years old were identified using ICD-9 and ICD-10 codes that were inclusive of injuries commonly associated with AHT. Medical records were reviewed to determine which of these cases met inclusion criteria for the study. Patient charts were reviewed and CDC growth charts analyzed for height (cm), weight (kg), and head circumference (cm) documented on the patient’s date of birth, date of admission, and at follow up visits. The main outcomes included z-scores for three growth parameters (height, weight, and head circumference (HC)). Linear mixed models were used to account for the longitudinal data. Time was rounded to weeks and treated continuously.

Results: There were 27 cases of AHT during the study period. Population characteristics are described in Table 1. Height, weight, and head circumference were measured at the time of admission in 85% of cases (n=23). Mean post-discharge follow up visits for 24 patients was 22.11 (SD = 20.95) and 3 patients did not have a documented follow up appointment. At admission (t = 0) the mean HC z-score appeared to be macrocephalic (mean = 1.70 (SE = 0.33), p < 0.0001) and significantly declined -0.016 (SE = 0.005, p = 0.0062) z-score per week (Figure 1). Measurements indicate normal linear growth and weight gain beyond index admission.

Conclusion: In our dataset, the downward trend from macrocephaly towards microcephaly was statistically significant, however; height and weight were noted to follow normal growth parameters. Microcephaly and impaired brain growth are noted to be associated with developmental delay, which optimally responds to interventions delivered during the first years of life. Therefore, pediatricians and other healthcare workers should monitor growth and development closely following AHT to help identify opportunities for early intervention.