Journal of American Association for Pediatric Ophthalmology and Strabismus
Review ArticleNewborn retinal hemorrhages: A systematic review
Section snippets
Methods
Ten databases were systematically searched by the use of extensive keywords/phrases and without language restrictions for the period 1970-2011 (Figure 1; Appendices 1-3, e-Supplement 1, available at jaapos.org); “snowballing” techniques enhanced the identification of additional relevant articles. Of 935 abstracts identified, 45 studies were subjected to standardized critical appraisal by 2 independent trained reviewers, with a third review for disagreements.
Results
Of 45 fully reviewed studies, 13 were included, representing a total of 1,777 infants: 4 were prospective cohorts,10, 17, 18, 19 and 9 were case series.20, 21, 22, 23, 24, 25, 26, 27, 28 Some oft-cited studies were excluded because they failed to meet our quality standards.29, 30, 31 The commonest reasons for exclusion were “direct” retinal examinations,29, 30, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42 insufficient retinal examination detail,32, 43, 44, 45, 46 ocular trauma or other neonatal
Discussion
While one is examining young infants with suspected abusive head trauma, birth-related RH may form part of the differential diagnosis. This rigorous review, in which we used strict quality standards, highlights that RH in the newborn are strongly correlated with the mode of delivery: whereas RH occur in 25.6% of SVD, they occur in 52% infants born of double instrumental delivery (OR 3.27) and 42.6% of vacuum extraction births (OR 2.75). When present, RHs are more commonly bilateral,
Acknowledgments
The authors thank Laura Wain for editorial assistance.
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