Introduction

This project aims to increase our knowledge on abusive head trauma in children. Albeit rare, abusive head trauma is an important health issue with serious implications for the child, the carers and for the society. Currently, there is an ongoing debate as to whether shaking alone can cause subdural haemorrhages, retinal haemorrhages and encephalopathy, known as the “triad”. There is debate whether or not healthy new-borns have subdural hematomas, whether this is more prevalent in prematures/ex-prematures, and whether or not children with increasing head circumference and wide subarachnoid spaces have an increased risk of subdural hematomas. The results of this project will shed some light on these questions, and thus have great impact on clinical – and juridical practice in cases of suspected child abuse.

Hypotheses

The prevalence of intracerebral haemorrhage in new borns (both ex-prematures and healthy new borns), and in children with increasing head circumference (crossing 2 centiles) is low, and if present, differ in size and location from haemorrhages reported in abusive head trauma.

Research questions:

• What is the prevalence of intracerebral haemorrhage in ex-premature babies, at corrected term?
• What is the prevalence of intracerebral haemorrhages in healthy new-borns, and if present, what size and location do they have?
  • For both the above questions, we will examine associations between the occurrence of haemorrhage and a) sex, b) occipitofrontal head circumference, c) birth weight, d) gestational age
• Do otherwise healthy children examined for increasing head circumference (crossing 2 centiles) have prominent subarachnoid spaces (BESS), SDH or both? Are there associations between BESS, SDH and sex/age/head circumference?

Project partners

The project "On securing the diagnosis of abusive head trauma in children; a national, multicentre crossectional study" is founded on collaborative work between UNN/UiT, St. Olavs, Nordlandssykehuset, HUS, SUS and Ahus. The project is funded by HelseNord 2021.

This subproject is led by Professor Karen Rosendahl, MD, PhD, consultant paediatric radiologist at UNN/UiT. Prof. Rosendahl has a long track record in paediatric imaging and epidemiological research, and currently chairs the Medical Imaging Research group at UiT (www.medical-imaging.no), the European Society of Paediatric Radiology Task Force on musculo-skeletal imaging and the European Institute of Bio-Imaging Research (EIBIR), Paediatric initiative (www.espr.org).

Dr.Trond Bondevik, paediatric radiologist at the Department of Circulation and Medical Imaging (ISB), St. Olavs hospital, Trondheim), Professor Stein Magnus Aukland, consultant paediatric radiologist (Haukeland University Hospital, Bergen / University of Bergen), Dr. Gry Behzadi, MD, consultant neuroradiologist (Stavanger University Hospital, Stavanger) and Drs. Josephine Bomer-Skogstad / Anke Neukamm (Akershus University Hospital, Oslo) will be local PI’s in Trondheim, Bergen, Stavanger and Oslo, respectively. Drs. Nils Thomas Songstad, PhD and Lene Trulsen Nymo, neonatologists at UNN, together with Dr. Siren Rettedal, Dr.Tomas Sørbø and Dr. Moritz Schneider will be responsible for the recruitment of cases for the study on Children with increasing head circumference (cohort 3) at UNN, SUS, HUS and Ahus, respectively. The project group also includes John Are Jonassen from Stine Sofies Stiftelse, a leading, non-profit foundation established in 2000, addressing a variety of abuse issues (www.stinesofiestiftelse.no).

We have liaised with Professor Maria Argyropoulou at the University Hospital of Ionnina, Greece. Prof. Argyropoulou leads the ESPR task force group in paediatric neuro-radiology, representing the European “frontier” of imaging in NAI. She has published extensively on paediatric neuro-imaging, and will take active part in discussions / provide scientific advice.

The PhD candidate, Dr. Maria Olsen Fossmark, MD, is radiologist in training at the Radiology department, UNN. She will perform the MRIs and ultrasound examinations at UNN, and will be responsible for the study database, perform the analyses and draft the three papers supervised by her mentors in collaboration with experts from the rest of the project group.

SPKI will be involved on the estimation of volumes of cerebrospinal fluid (including volumes of subarachnoid spaces and volumes of the lateral ventricles) using AI in all three cohorts (ex-prematures, healthy new borns, children with increasing head circumference).