This technique
is similar to the grip on an infant’s thorax while shaking. Is it possible that posterior rib
fractures in newborns and infants could be caused by the “two-thumbs” technique? Using
computerized databases from three German children’s hospitals, we identified all infants
less than 12 months old who underwent professional CPR within a 10-year period. We
included all infants with anterior–posterior chest radiographs taken after CPR. Exclusion
criteria were sternotomy, osteopenia, various other bone diseases and NAT. The radiographs
were independently reviewed by the Chief of Pediatric Radiology (MB) and a Senior
Pediatrician, Head of the local Child Protection Team (IF). Eighty infants with 546 chest
radiographs were identified, and 50 of those infants underwent CPR immediately after
birth. Data concerning the length of CPR was available for 41 infants. The mean length of
CPR was 11 min (range: 1–180 min, median: 3 min). On average, there were seven radiographs
per infant. A total of 39 infants had a follow-up radiograph after at least 10 days.
No rib fracture was visible on any chest X-ray. The results of this study suggest rib fracture
after the use of the “two-thumbs” CPR technique is uncommon. Thus, there should be careful
consideration of abuse when these fractures are identified, regardless of whether CPR
was performed and what technique used. The discovery of rib fractures in an infant who
has undergone CPR without underlying bone disease or major trauma warrants a full child
protection investigation.