Article Text

Download PDFPDF
Higher prevalence of fundus haemorrhages in early-screened (NEST Study) as compared to late-screened (SUNDROP Study) newborn populations
  1. Cassie A. Ludwig1,2,
  2. Sayena Jabbehdari3,
  3. Marco Ji1,
  4. Daniel Vail1,
  5. Ahmad Al-Moujahed1,
  6. Tatiana Rosenblatt1,
  7. Amee D. Azad1,
  8. Malini Veerappan1,
  9. Natalia F. Callaway1,
  10. Darius M. Moshfeghi1
  1. 1 Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA
  2. 2 Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
  3. 3 Department of Ophthalmology, University of Illinois at Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr. Darius M. Moshfeghi, Department of Ophthalmology, Stanford University, Palo Alto, CA 94131, USA; dariusm{at}


Background/aims To determine whether timing of ophthalmic screening influences prevalence of neonatal fundus haemorrhages. We compared the prevalence of fundus haemorrhages in two populations: term newborns screened early (less than 72 hours) and preterm newborns screened late (4–11 weeks). Additionally, we reviewed the literature on timing and prevalence of newborn haemorrhages.

Methods Retrospective observational cohort study. Infants who underwent wide-angle ophthalmic digital imaging over one overlapping year in the Newborn Eye Screen Testing (NEST) or Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) programme were included. The PubMed database was filtered to include English-language articles dating back to 1950. Nine articles were selected for review based on inclusion of the prevalence of newborn fundus haemorrhages at multiple time points.

Results A total of 202 patients received early imaging in the NEST cohort and 73 patients received late imaging in the SUNDROP cohort. In the NEST cohort, 20.2% of newborns had haemorrhages. In contrast, we found haemorrhages in only one case or 1.4% of the SUNDROP cohort. Using prevalence data from nine additional studies, we developed a predicted probabilities model of newborn haemorrhages. Per this model, the probability of seeing a haemorrhage if you screen an infant at 1 hour is 18.8%, at 2 weeks is 2.9% and at 1 month is 0.28%.

Conclusion We found a significant difference in the prevalence of fundus haemorrhages between the early-screened NEST cohort and the late-screened, preterm SUNDROP cohort. Likely, this difference is due to the transient nature of most newborn haemorrhages.

  • retina
  • child health (paediatrics)
  • imaging
  • epidemiology
  • public health

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

View Full Text


  • Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.

  • Contributors CAL, SJ, DMM: conceptualisation and final approval of manuscript. CAL, SJ, MJ, DV, AA-M, TR, ADA, MV and NC: manuscript writing, collection and/or assembly of data, data analysis and data interpretation. CAL, SJ and DMM: writing—review and editing.

  • Funding This work was supported by the Heed Fellowship awarded through the Society of Heed Fellows to CAL, as well as by the Heed Ophthalmic Foundation and Michels Fellowship Foundation awarded to NFC.

  • Competing interests Darius M. Moshfeghi: 1-800 Contacts (Board of Directors, equity), Akceso Advisors AG (Evaluation of DME Market), Alcon (Consultant), Alexion (Senior consultant), Allegro (SAB), Apellis (Site PI), Bayer Pharma AG (ROP Imaging Committee), (CME consultant), dSentz, Inc. (Founder, Board of Directors, equity), Genentech (Proper Grant 2019). Iconic Therapeutics (Steering Committee), Irenix(SAB), Grand Legend Technology, LTD (Equity), Linc (Founder, Equity, Board of Directors), M3 GLOBAL RESEARCH (Consultant), NORTHWELL HEALTH (Grand Rounds), Novartis Pharmaceuticals (Data Safety Monitoring Boardx3 (Hawk/Harrier, Kite/Kestrel, China nAMD/DME), Pediatric Advisory Board, Safety Review Committee), Ocular Surgery News (Consultant), Placid0 (Founder, equity, Board of Directors), Pr3vent (Founder, Board of Directors, equity), Praxis UNS (Consultant), Prime Medical Education (CME consultant), Promisight (Founder, Board of Directors, equity), Pykus (SAB, equity), Regeneron (CME consultant, ROP Steering Committee, OI for ROP Trial), Retina Today/Pentavision (Consultant), Shapiro Law (ROP expert witness), SLACK (CME consultant), University of Miami (CME consultant), Versl (Founder, equity), Vindico (CME consultant), Visunex (SAB, equity), RESEARCH TO PREVENT BLINDNESS (Dept. Support) and NEI P30-EY026877 (Dept. Support).

  • Provenance and peer review Not commissioned; externally peer reviewed.

Linked Articles

  • At a glance
    Frank Larkin