New York - Increased levels of certain proteins detectable in blood or cerebrospinal fluid may signal inflicted traumatic brain injury in well-appearing infants with vague, nonspecific symptoms, such as vomiting or fussiness, study findings suggest.
If confirmed in larger studies, determining levels of these potential biomarkers of abuse "would allow health care providers to limit medical complications as a result of delayed diagnosis, minimise re-injury to infants by preventing them from returning to an unsafe environment, and protect siblings who may be living in the same violent environment," study authors write in the journal Pediatrics.
Dr Rachel Pardes Berger and her associates previously found that the two proteins - NSE and MBP - were elevated in patients with inflicted traumatic brain injury who presented with a history of trauma or with severe symptoms.
Their current study looked to see if these biomarkers could be useful for screening well-appearing infants who present without a history of trauma and with nonspecific symptoms.
They included 98 patients younger than one year who presented to the Children's Hospital of Pittsburgh emergency department with one of the following symptoms: apparent life-threatening event, more than four episodes of vomiting without diarrhoea in the previous 24 hours, seizures, or nonspecific neurologic signs or symptoms.
NSE and MBP were measured in serum and/or cerebrospinal fluid, then infants who were not identified as having an inflicted brain injury at the time of enrollment were tracked to age one year to identify evidence of possible child abuse or exposure to domestic violence.
Inflicted brain injury was diagnosed in 14 children initially, based on bleeding on the brain, swelling of the brain, skull fracture, or retinal bleeding and abnormal mental status. Eleven of these children had increased levels of NSE or MBP. In one case the perpetrator confessed to inflicting the injury.
Five other children were classified as indeterminate, with evidence of possible abuse at 6 or 12-month follow-up, and four of these children had raised NSE or MBP levels.
The investigators call for further study of the potential value of determining levels of these two proteins in cases of suspected abuse.
SOURCE: Pediatrics, February 2006.