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Incidence, Distribution, and Duration of Birth-Related Retinal Hemorrhages: A Prospective Study

https://doi.org/10.1016/j.jaapos.2005.12.005Get rights and content

Background: Retinal hemorrhages secondary to birth trauma are part of the differential diagnosis of intraocular hemorrhages seen in the setting of Shaken baby syndrome in very young infants. This prospective study aimed to document the morphology, distribution and, most importantly, the natural history of these hemorrhages using digital imaging. Subjects and methods: Infants were recruited as soon after birth as possible and examined by indirect ophthalmoscopy. Retinal hemorrhages were photographed using the RetCam 120. Birth history was documented from the medical notes. Infants were reexamined and photographed until hemorrhages had resolved. Results: Data were analyzed for a total of 53 neonates. The number of infants with retinal hemorrhage was 18 (34%). The incidence in relation to mode of delivery was as follows: vacuum delivery, 77.8%; normal vaginal delivery, 30.4%; cesarean section, 8.3%; forceps delivery, 30.3%. All hemorrhages were intraretinal and in all but two infants hemorrhages had resolved by 16 days. In two subjects hemorrhages were still present at 31 and 58 days, respectively. Both these infants were delivered by vacuum delivery. Conclusions: The RetCam 120 provides excellent documentation of retinal hemorrhages and their natural history. We have demonstrated hemorrhages still present at 58 days in a child born by vacuum delivery and this may have important implications for consideration in the differential diagnosis of Shaken baby syndrome.

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Subjects and methods

Parents of neonates were asked to take part in the study in the maternity units of The Northern General Hospital and Jessop Hospital for Women in Sheffield during a 12-month period (from December 1999 to November 2000). The parents gave written informed consent to the examination of their child.

The first examination was performed at 1 day postdelivery or as close to this as possible (range 1 to 4 days). General external ophthalmic observations were made and documented. Pupils were dilated using

Results

Sixty infants were examined. Data for seven neonates either were incomplete or were examined in the Special Care Baby Unit (SCBU) and therefore excluded to ensure that the data analysis only included those neonates without systemic conditions. Data were analyzed for a total of 53 neonates.

The number of infants with retinal hemorrhage was 18 (33.96%); 14 were bilateral. Table 1 summarizes the demographic data for the cohort as a total and for those infants found to have retinal hemorrhage. The

Discussion

The RetCam 120 is a portable digital imaging system that provides high-resolution real-time images of retinal hemorrhages without the need for sedation or general anesthesia in young children and infants. Traditionally retinal hemorrhages are documented in a freehand drawing by the examining clinician and, while these drawings are useful, real-time digital photographs provide much better documentation. The RetCam 120 provides a 120-degree field-of-view and therefore peripheral hemorrhages can

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This study was carried out at The University of Sheffield, England, UK.

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