Elsevier

Ophthalmology

Volume 123, Issue 5, May 2016, Pages 1043-1052
Ophthalmology

Original article
Retinal and Optic Nerve Hemorrhages in the Newborn Infant: One-Year Results of the Newborn Eye Screen Test Study

Presented at: Association for Research in Vision and Ophthalmology Annual Meeting, May 2015, Denver, Colorado.
https://doi.org/10.1016/j.ophtha.2016.01.004Get rights and content

Purpose

To report the birth prevalence, risk factors, characteristics, and location of fundus hemorrhages (FHs) of the retina and optic nerve present in newborns at birth.

Design

Prospective cohort study at Stanford University School of Medicine.

Participants

All infants who were 37 weeks postmenstrual age or older and stable were eligible for screening. Infants with known or suspected infectious conjunctivitis were excluded.

Methods

Infants born at Lucile Packard Children's Hospital (LPCH) from July 25, 2013, through July 25, 2014, were offered universal newborn screening via wide-angle digital retinal photography in the Newborn Eye Screen Test study. Maternal, obstetric, and neonatal factors were obtained from hospital records. The location, retinal layer, and laterality of FH were recorded by 1 pediatric vitreoretinal specialist.

Main Outcome Measures

Birth prevalence of FH. Secondary outcomes included rate of adverse events, risk factors for FH, hemorrhage characteristics, and adverse events.

Results

The birth prevalence of FH in this study was 20.3% (41/202 infants). Ninety-five percent of FHs involved the periphery, 83% involved the macula, and 71% involved multiple layers of the retina. The fovea was involved in 15% of FH cases (birth prevalence, 3.0%). No cases of bilateral foveal hemorrhage were found. Fundus hemorrhages were more common in the left eye than the right. Fundus hemorrhages were most commonly optic nerve flame hemorrhages (48%) and white-centered retinal hemorrhages (30%). Retinal hemorrhages were found most frequently in all 4 quadrants (35%) and more often were multiple than solitary. Macular hemorrhages most often were intraretinal (40%). Among the risk factors examined in this study, vaginal delivery compared with cesarean section (odds ratio [OR], 9.34; 95% confidence interval [CI], 2.57–33.97) showed the greatest level of association with FH. Self-identified ethnicity as Hispanic or Latino showed a protective effect (OR, 0.43; 95% CI, 0.20–0.94). Other study factors were not significant.

Conclusions

Fundus hemorrhages are common among newborns. They often involve multiple areas and layers of the retina. Vaginal delivery was associated with a significantly increased risk of FH, whereas self-identified Hispanic or Latino ethnicity was protective against FH in this study. The long-term consequences of FH on visual development remain unknown.

Section snippets

Study Design

The Newborn Eye Screen Testing (NEST) study was a prospective institutional cohort study conducted at Lucile Packard Children's Hospital (LPCH) at Stanford University School of Medicine. It was designed to determine the birth prevalence of ophthalmic disease and the long-term vision outcomes of newborns with ocular abnormalities identified at birth. Universal newborn screening with retinal image photography was offered to all infants born at LPCH who do not undergo retinopathy of prematurity

Eligible Study Population

During the 1-year study period, 830 newborns who met inclusion criteria for NEST study participation were approached. The approached study population was 53.7% male and included 33 sets of twins and 3 sets of triplets. Thirty-one percent of approached mothers self-identified as Hispanic or Latino, and self-identified race was reported as 52.2% white or Caucasian, 41.0% Asian, 4.3% Native Hawaiian or other Pacific Islander, and 2.6% African American or black. Study recruitment was performed in

Discussion

This article presents the 1-year results of the first universal retinal image screening performed in healthy term infants in the United States. The birth prevalence of FH among the newborns screened during the first year of enrollment in the NEST study at LPCH at Stanford University was 20.3% (41/202). The birth prevalence of multilaminar hemorrhages was 14.4% (29/202), and the birth prevalence of foveal hemorrhages was 3.0% (6/202). The rate of FH reported in this study is similar to that

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    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    Supported by the Giannini Foundation (San Francisco, CA); and the Spectrum TL1 Clinical Research Training Program at Stanford University (Palo Alto, CA); supported by the National Institutes of Health (Bethesda, MD) (grant no.: TL1 TR 001084 [N.F.C., C.A.L.]). The sponsor or funding organization had no role in the design or conduct of this research. The database for the project described was supported by the National Center for Research Resources and the National Center for Advancing Translation Sciences, National Institutes of Health (grant no.: UL1 RR025744). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

    Author Contributions:

    Conception and design: Callaway, Ludwig, Blumenkranz, Jones, Fredrick, Moshfeghi

    Analysis and interpretation: Callaway, Ludwig, Blumenkranz, Jones, Fredrick, Moshfeghi

    Data collection: Callaway, Ludwig, Blumenkranz, Jones, Fredrick, Moshfeghi

    Obtained funding: Moshfeghi, Blumenkranz, Fredrick

    Overall responsibility: Callaway, Ludwig, Blumenkranz, Jones, Fredrick, Moshfeghi

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