Birth-related retinal hemorrhages in healthy full-term newborns and their relationship to maternal, obstetric, and neonatal risk factors

Zhao, Qi; Zhang, Yanli; Yang, Yu; Li, Zijing; Lin, Yan; Liu, Ran; Wei, C. Y.; Ding, Xiaoyan

doi:10.1007/s00417-015-3052-9

Cited by 39 publications

(37 citation statements)

References 10 publications

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“…2, 7 The studies that have examined FH at birth report that FH are not uncommon at birth, are more frequent among infants delivered via vaginal delivery, and at times can take up to 58 days to resolve completely. 8 No study has performed universal retinal examination on a diverse group of infants such as the United States population.…”

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confidence: 99%

Retinal and Optic Nerve Hemorrhages in the Newborn Infant

et al. 2016

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Purpose To report the birth prevalence, risk factors, characteristics and location of fundus hemorrhages (FH) 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 were deemed stable by their pediatrician were eligible for screening. Infants who were anophthalmic or had 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 (NEST) study. Maternal, obstetric, and neonatal factors were obtained by reviewing hospital records prior to discharge. The location, retinal layer, and laterality of FH were recorded by one 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.

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Retinal and Optic Nerve Hemorrhages in the Newborn Infant

et al. 2016

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“…Retinal haemorrhages (RHs) in term newborns were discovered with a binocular indirect ophthalmoscope by Jaeger in 1861 . Later, with improvement in retinal examination techniques, RHs was found to be one of the most commonly identified eye abnormalities in term newborns . The incidence of RH varies in different reports, but is generally in the range of 2.6% to 50% .…”

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confidence: 99%

“…Choi et al suggested that newborns with a history of perinatal distress were more likely to have retinal haemorrhage than healthy babies. Zhao et al found that spontaneous vaginal delivery and cephalohematoma were potential risk factors for the development of newborn RH in full‐term infants. Foetal hypoxia may cause retinal vein congestion, increased blood viscosity, leading to postnatal retinal haemorrhage…”

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confidence: 99%

“…examination techniques, RHs was found to be one of the most commonly identified eye abnormalities in term newborns. 2,3 The incidence of RH varies in different reports, but is generally in the range of 2.6% to 50%. 4,5 Most RH resolves without visual consequence.…”

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“…Though the direct cause is not clear, many factors have been related to RHs in term newborns, for example, the mode of delivery, hypoxia, the presence of cephalohematoma, foetal distress and higher maternal age. 2,11,12 Choi et al 7 suggested that newborns with a history of perinatal distress were more likely to have retinal haemorrhage than healthy babies. Zhao et al 2 found that spontaneous vaginal delivery and cephalohematoma were potential risk factors for the development of newborn RH in full-term infants.…”

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New grading criterion for retinal haemorrhages in term newborns based on deep convolutional neural networks

Mao

Luo

Lao

et al. 2019

Clinical Exper Ophthalmology

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Background To define a new quantitative grading criterion for retinal haemorrhages in term newborns based on the segmentation results of a deep convolutional neural network. Methods We constructed a dataset of 1543 retina images acquired from 847 term newborns, and developed a deep convolutional neural network to segment retinal haemorrhages, blood vessels and optic discs and locate the macular region. Based on the ratio of areas of retinal haemorrhage to optic disc, and the location of retinal haemorrhages relative to the macular region, we defined a new criterion to grade the degree of retinal haemorrhages in term newborns. Results The F1 scores of the proposed network for segmenting retinal haemorrhages, blood vessels and optic discs were 0.84, 0.73 and 0.94, respectively. Compared with two commonly used retinal haemorrhage grading criteria, this new method is more accurate, objective and quantitative, with the relative location of the retinal haemorrhages to the macula as an important factor. Conclusions Based on a deep convolutional neural network, we can segment retinal haemorrhages, blood vessels and optic disc with high accuracy. The proposed grading criterion considers not only the area of the haemorrhages but also the locations relative to the macular region. It provides a more objective and comprehensive evaluation criterion. The developed deep convolutional neural network offers an end‐to‐end solution that can assist doctors to grade retinal haemorrhages in term newborns.

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