Factors related to retinal haemorrhage in infants born at high risk

Pu, Qinglan; Li, Ping; Jiang, Huiqin; Wang, Hong; Zhou, Qiaozhi; Liu, Jia; Zhong, Wenhua; Huang, Haiming

doi:10.1111/aos.13515

Cited by 9 publications

(9 citation statements)

References 12 publications

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“…In this study, vaginal delivery was a risk factor for neonatal retinal hemorrhage. Previous studies have also reported that vaginal delivery is significantly associated with neonatal retinal hemorrhage [ 1 , 4 , 6 , 8 , 12 , 26 , 29 , 30 , 31 , 34 ]. Callaway et al found that 29.6% of babies delivered vaginally exhibited retinal hemorrhage, compared to 5.2% of babies delivered by cesarean section [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, China, which has a large population with an annual birth rate of 12% [ 28 ], has limited data on neonatal retinal hemorrhage [ 29 , 30 , 31 , 32 , 33 ], and the few existing studies have not fully evaluated the risk factors associated with mothers and newborns. Moreover, the descriptions of the characteristics of retinal hemorrhage are not sufficiently detailed, which limits our knowledge of the condition and the development of prevention and treatment strategies.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence, Characteristics, and Risk Factors of Retinal Hemorrhage among Full-Term Neonates in Southern China

Yang

Chen

et al. 2022

IJERPH

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Neonatal retinal hemorrhage (RH) is the most common ocular fundus disease among newborns. Early detection and timely intervention are vital for reducing the risk of visual impairment caused by RH. However, little is known about the prevalence, characteristics, and risk factors of RH in southern China. Full-term infants born in Qingyuan City during the first 10 days of each month in 2021 were included in this study. All infants underwent RetCam III retinal examinations. Detailed information on retinal hemorrhage, including involved eyes, bleeding severity, and affected area (extrafoveal macula, fovea, or optic disc), and clinical information on the neonates and their mothers was collected. The results showed that among the 1072 eligible neonates, 266 (24.8%) had neonatal retinal hemorrhage. Consistent bilateral retinal hemorrhage severity was observed in 83.2% of the cases. The prevalence of optic disc involved RH, extrafoveal macular involved RH and foveal involved RH were 23.7%, 81.2% and 2.63%, respectively. Multivariate logistic regression analysis showed that lower birth weight (OR, 0.63; 95% CI, 0.40–0.99; p < 0.05) and vaginal delivery (OR, 20.6; 95% CI, 9.10–46.5; p < 0.001) were risk factors of neonatal RH. The area under the ROC curve of vaginal delivery, combined with birth weight, as predictors of neonatal RH was 0.73, with 85.3% sensitivity and 23.9% specificity. The birth weight cutoff was 3460 g. Our results suggested that neonatal RH is common in full-term neonates in southern China. It usually has the same severity in both eyes and mostly involves the extrafoveal macular region. Vaginal delivery and low birth weight are risk factors for neonatal RH.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence, Characteristics, and Risk Factors of Retinal Hemorrhage among Full-Term Neonates in Southern China

Yang

Chen

et al. 2022

IJERPH

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“…Bilateral, extensive bleeding in several retinal layers has been regarded as a key feature of abusive head trauma [ 6 , 7 , 36 , 41 , 42 , 53 , 56 ]. However, RH may not be pathognomonic for abusive head traumas; they can also be seen in infants not related to abuse, e.g., in a large number of healthy newborns [ 37 , 50 , 70 ], in infants with “macrocephaly” [ 55 , 64 ], after “high-risk” deliveries [ 58 ], following acute life-threatening events [ 5 ], and after cardiopulmonary resuscitation [ 33 , 54 , 57 ]. RHs have also been documented in premature infants; contrary to the rapid resolution of the bleeding one usually sees in most newborns, the bleeding in preterms tend to be long lasting [ 18 ].…”

Section: Clinical and Radiological Findingsmentioning

confidence: 99%

Is external hydrocephalus a possible differential diagnosis when child abuse is suspected?

Scheller¹,

Wester

2021

Acta Neurochir

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Background Criteria for diagnosing abusive head trauma (AHT) or “shaken baby syndrome” are not well defined; consequently, these conditions might be diagnosed on failing premises. Methods The authors have collected a total of 28 infants, from the US (20) and Norway (8), suspected of having been violently shaken, and their caregivers had been suspected, investigated, prosecuted or convicted of having performed this action. Among 26 symptomatic infants, there were 18 boys (69%) and 8 girls (31%)—mean age 5.1 month, without age difference between genders. Results Twenty-one of 26 symptomatic children (81%) had a head circumference at or above the 90 percentile, and 18 had a head circumference at or above the 97 percentile. After macrocephaly, seizure was the most frequent initial symptom in 13 (50%) of the symptomatic infants. Seventeen (65%) of the symptomatic infants had bilateral retinal haemorrhages, and two had unilateral retinal haemorrhages. All infants had neuroimaging compatible with chronic subdural haematomas/hygromas as well as radiological characteristics compatible with benign external hydrocephalus (BEH). Conclusions BEH with subdural haematomas/hygromas in infants may sometimes be misdiagnosed as abusive head trauma. Based on the authors’ experience and findings of the study, the following measures are suggested to avoid this diagnostic pitfall: medical experts in infant abuse cases should be trained in recognising clinical and radiological BEH features, clinicians with neuro-paediatric experience should always be included in the expert teams and reliable information about the head circumference development from birth should always be available.

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“…There are also reports showing RH was higher for younger mothers < 22 years old, which may possibly be the result of greater birth canal resistance due to primiparity, uterine inertia and insufficient force of labour, longer stages of labour, and an external force (obstetric forceps or vacuum) but in contrary to these studies, in our study there showed no clinically significant association between maternal age and neonatal RH. 12 In regards to birth weight, our study showed that larger birth weight had clinically significant association with retinal haemorrhage. This could be due to the fact that there is greater birth canal resistance during birth.…”

Section: Discussionmentioning

confidence: 52%

“…9 Though, in a survey of high-risk factors affecting retinopathy in full-terms infants in China showed a lower incidence of 18%. 1,6,12 Nevertheless, the incidence rate of neonatal retinal haemorrhage has shown to vary from 2.6 to 50%. 3,4 In our study majority of the retinal haemorrhage were of grade 1 according to Classification Degree of Neonatal Retinal Haemorrhage based in Egge et al 8 This contradicted to study by Qinglan et al where they had almost equal distribution of all grades of retinal haemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Retinal Haemorrhage in Newborns in Tertiary Care Hospital

Shrestha

Sharma

et al. 2022

Kathmandu Univ. Med. J.

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Background Retinal haemorrhage in new-born is a clinically common neonatal fundus condition. Although, it usually does not affect the development of visual function, entities like macular haemorrhages may lead to amblyopia causing deterioration of visual function. Such scenario leads to downgrade in quality of life of the affected child. Objective To explore the underlying clinical factors associated with retinal haemorrhage in term new-borns. Method A cross sectional study was conducted involving 136 term neonates admitted in the neonatal intensive care unit of Dhulikhel Hospital. Fundus examination was performed within 2 weeks of delivery. Retinal haemorrhage was graded according to their location in three retinal zones. Result Out of 136 cases examined, 44 (32.35%) of the cases had one of the eyes with retinal haemorrhage. Where grade 1 retinal haemorrhage was accounted in majority of the cases. Birth weight, gestational age, mode of delivery, poor Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) Score in 1 and 5 minutes, birth asphyxia, neonatal sepsis and heavy work in antenatal period had statistically significant correlation with occurrence of retinal haemorrhage. Conclusion Our results suggest that spontaneous vaginal delivery, larger birth weight, higher gestational age, birth asphyxia, low Appearance, Pulse, Grimace, Activity, and Respiration score, are risk factors for occurrence of neonatal retinal haemorrhage. It is recommended that in neonates with above high-risk factors should undergo targeted fundus screening for early identification and needful interventions.

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Factors related to retinal haemorrhage in infants born at high risk

Abstract: The incidence of RH in high-risk infants was 18%, and delivery mode, and neonatal asphyxia were major risk factors for RH in high-risk infants.

Cited by 9 publications

References 12 publications

Prevalence, Characteristics, and Risk Factors of Retinal Hemorrhage among Full-Term Neonates in Southern China

Prevalence, Characteristics, and Risk Factors of Retinal Hemorrhage among Full-Term Neonates in Southern China

Is external hydrocephalus a possible differential diagnosis when child abuse is suspected?

Retinal Haemorrhage in Newborns in Tertiary Care Hospital

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