Baby ABA, born in Lebanon and arrived in Australia at 2 months old, died from head injury at 6.5 months of age on 10 June 2008. She had fallen from a couch on 7 June 2008 with no apparent serious injury. The following morning she displayed concerning signs including bruises, reduced responsiveness, and dry mouth. Parents did not seek medical attention immediately despite a previously witnessed episode of her becoming pale, cold and stiff. Later that morning she suffered cardiopulmonary arrest. Imaging revealed acute subdural haemorrhages and bilateral retinal haemorrhages consistent with head trauma. Autopsy showed multiple facial bruises in various healing stages and traumatic brain injury. The homicide investigation was unable to determine the cause of injuries. Clinical lessons: recognition of subtle signs of serious head injury in infants; low threshold for medical evaluation following significant falls or episodes of unconsciousness; importance of seeking immediate medical attention when infants display acute deterioration or concerning symptoms rather than watchful waiting.
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Specialties
paediatricsintensive careneurosurgeryophthalmologyforensic medicine
Error types
delay
Clinical conditions
head injurysubdural haemorrhagesubarachnoid haemorrhageretinal haemorrhageshypoxic-ischaemic encephalopathycerebral swelling
Procedures
CT scanophthalmological examinationautopsy
Contributing factors
Blunt head trauma with multiple bruises to face and head
Acute subdural haemorrhages
Bilateral retinal haemorrhages
Delay in seeking medical attention despite concerning symptoms
Failure to obtain medical evaluation following witnessed episode of apparent loss of consciousness and pallor days prior to fatal event
Inadequate parental recognition of severity of infant's condition
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