Stress and strain propagation on infant skull from impact loads during falls: a finite element analysis.

Background and Objective: To simulate infant skull trauma after low height falls when variable degrees of ossification of the sutures are present. Methods: A finite elements model of a four-week-old infant skull was developed for simulating low height impact from 30 cm and 50 cm falls. Two impacts were simulated: An occipito-parietal impact on the lambdoid suture and a lateral impact on the right parietal and six cases were considered: unossified and fully ossified sutures, and sagittal, metopic, right lambdoid and right coronal craniosynostosis. Results: 26 simulations were performed. Results showed a marked increase in strain magnitudes in skulls with unossified sutures and fontanels. Higher deformations and lower Von Mises stress in the brain were found in occipital impacts. Fully ossified skulls showed less overall deformation and lower Von Mises stress in the brain. Results suggest that neonate skull impact when falling backward has a higher probability of resulting in permanent damage. Conclusion: This work shows an initial approximation to the mechanisms underlying TBI in neonates when exposed to low height falls common in household environments, and could be used as a starting point in the design and development of cranial orthoses and protective devices for preventing or mitigating TBI.

Transfontanellar contrast enhanced ultrasound in infants: initial experience.

BACKGROUND AND PURPOSE: Transfontanellar contrast enhanced ultrasound (TCEUS) in infants with neurological diseases has not been previously reported. Thus, the objective of our study was to describe the imaging findings of transfontanellar contrast enhanced ultrasound (TCEUS) performed in various neurological conditions in infants and to compare the findings with non-enhanced transfontanellar ultrasound (TFUS) and MRI. METHODS: Local institutional review board approval was obtained and, because of the need to catheterize children for contrast media administration, written informed consent of parents was obtained prior to all performed TCEUS. Twelve infants who underwent 12 TCEUS were included in this study from June 2009 to June 2012. Second generation contrast material was used (Bracco). TCEUS imaging findings were compared with those of conventional transfontanellar ultrasound in each case and with MRI. RESULTS: In 10 out of the 12 performed examinations, TCEUS showed abnormalities which were not depicted on non-enhanced TFUS. Accurate diagnosis of TCEUS compared with MRI was found in 10 out of 12 initial TCEUS. No adverse events during or immediately after contrast media injection occurred. CONCLUSION: TCEUS appears to be a potential bedside accessible non-ionizing alternative imaging modality in the assessment of neonatal brain injury. It provides additional information when compared to non-enhanced transfontanellar US, especially in the field of brain perfusion assessment. Moreover, the information provided seems to be accurate when compared with those of MRI.

Accidental penetrating brain injury through anterior fontanelle: a rare phenomenon.

Penetrating injuries of the anterior fontanelle are exceedingly uncommon and are most often associated with inflictedinjury. This report of a 7-month-old male infant, whose father was working with a knife which accidentally slipped from his hand and penetrated the infants anterior fontanelle and frontal lobe, demonstrates that accidental injuries may also occur rarely.

Foreign body penetration of the fontanelle: mechanisms and manner of death.

Penetrating injuries of the anterior fontanelle are exceedingly uncommon and are most often associated with inflicted injury. This report of an 11-month-old boy, who fell backward onto a lamp-shade strut that penetrated his anterior fontanelle and left frontal lobe, demonstrates that accidental injuries may also rarely occur. Death was due to hypoxic-ischemic encephalopathy complicating raised intracranial pressure after a penetrating injury of the brain. Careful evaluation of the death scene with reconstruction incorporating the autopsy findings was required to establish the veracity of the history and the credibility of the proposed sequence of events. Mechanisms of death after penetrating injuries of the fontanelle include immediate effects from direct damage to cerebral vital structures or blood vessels with hemorrhage or delayed effects from either cerebral edema with hypoxic-ischemic encephalopathy or sepsis.