Elsevier

Ophthalmology

Volume 108, Issue 1, January 2001, Pages 36-39
Ophthalmology

Incidence and rate of disappearance of retinal hemorrhage in newborns

https://doi.org/10.1016/S0161-6420(00)00474-7Get rights and content

Abstract

Objective

To determine the prevalance, associated biometric factors, and rate of disappearance of neonatal retinal hemorrhage.

Design

Cross-sectional and natural history study.

Methods

Healthy newborns (n = 149) at an urban hospital were examined using indirect ophthalmoscopy within 30 hours of birth. Newborns with retinal hemorrhage were reexamined biweekly until hemorrhage resolved.

Main outcome measures

Neonatal and maternal biometric factors, and incidence and rate of resolution of retinal hemorrhage.

Results

Intraretinal hemorrhage was present in 34% of newborns and varied from a single dot hemorrhage in one eye to bilateral widespread hemorrhages, occasionally with white centers. The incidence of hemorrhage was higher for vacuum-assisted (75%) than for spontaneous vaginal deliveries (33%) and was least for infants delivered by cesarean section (7%). The mean maternal age was greater for infants with retinal hemorrhage. By 2 weeks after birth, retinal hemorrhage resolved in 86% of eyes, and at 4 weeks no intraretinal hemorrhage was detected, although a single subretinal hemorrhage persisted until 6 weeks after birth.

Conclusions

Intraretinal hemorrhages are common in the immediate postnatal period and resolve by 1 month of age. Retinal hemorrhage in infants older than 1 month should heighten suspicion that the hemorrhage is associated with factors other than birth.

Section snippets

Patients and methods

This study was conducted with institutional approval for human investigations. Babies admitted to the newborn special care unit or with known or suspected systemic or ocular disease or congenital malformation were excluded. Infants considered for enrollment were a cohort of 402 consecutive births over a period of 65 weekdays admitted to the Well-Baby Nursery at the Children’s Hospital of Yale-New Haven Medical Center determined by the pediatrics service to be free of any medical problems. One

Results

Of 402 consecutive newborns eligible for enrollment, parental consent was obtained for the 149 infants who were enrolled in this study, and each underwent an initial retinal examination. Demographic features of the infant population are given in Table 1.

Retinal hemorrhage was found in 34% (50/149) of newborns. Of the 50 newborns with hemorrhage, 26 (52%) had hemorrhage in both eyes, so that 26% (76/298) of eyes examined contained hemorrhage. Hemorrhages were dot blot or flame shaped; larger

Discussion

The incidence of retinal hemorrhage in newborns in this study (34%) is comparable with several reported values (30%,4 34%,14 35%,3 37.5%,5 40%,8 42.1%,11 and 50%7), but greater than values given in several studies (2.6%,6 10.2%,10 14.5%,12 15%,2 18.2%,9 18.9%,15 and 19.2%13). Variation in reported values may be the result of different patient demographics, variable time periods between birth and initial examination, inclusion of children with systemic diseases, and use of pupillary dilation,

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    The authors have no financial interests in the products or devices mentioned herein.

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