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Retinal and Optic Nerve Hemorrhages in the Newborn Infant

One-Year Results of the Newborn Eye Screen Test Study
Published:February 11, 2016DOI:https://doi.org/10.1016/j.ophtha.2016.01.004

      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.

      Abbreviations and Acronyms:

      CI (confidence interval), FH (fundus hemorrhage), HIPAA (Health Insurance Portability and Accountability Act), LPCH (Lucile Packard Children's Hospital), NEST (Newborn Eye Screen Testing), OR (odds ratio), ROP (retinopathy of prematurity)
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      References

        • Kaur B.
        • Taylor D.
        Fundus hemorrhages in infancy.
        Surv Ophthalmol. 1992; 37: 1-17
        • Zhao Q.
        • Zhang Y.
        • Yang Y.
        • et al.
        Birth-related retinal hemorrhages in healthy full-term newborns and their relationship to maternal, obstetric, and neonatal risk factors.
        Graefes Arch Clin Exp Ophthalmol. 2015; 253: 1021-1025
        • Luo R.
        • Liu J.
        • Hu P.
        • et al.
        Results of 779 cases of neonatal fundus screening and risk factors for neonatal fundus diseases.
        Zhongguo Dang Dai Er Ke Za Zhi. 2014; 16: 1197-1201
        • Li L.H.
        • Li N.
        • Zhao J.Y.
        • et al.
        Findings of perinatal ocular examination performed on 3573, healthy full-term newborns.
        Br J Ophthalmol. 2013; 97: 588-591
        • Choi Y.J.
        • Jung M.S.
        • Kim S.Y.
        Retinal hemorrhage associated with perinatal distress in newborns.
        Korean J Ophthalmol. 2011; 25: 311-316
        • Lashutka M.K.
        • Chandra A.
        • Murray H.N.
        • et al.
        The relationship of intraocular pressure to intracranial pressure.
        Ann Emerg Med. 2004; 43: 585-591
        • Vinekar A.
        • Govindaraj I.
        • Jayadev C.
        • et al.
        Universal ocular screening of 1021 term infants using wide-field digital imaging in a single public hospital in India—a pilot study.
        Acta Ophthalmol. 2015; 93: e372-e376
        • Hughes L.A.
        • May K.
        • Talbot J.F.
        • Parsons M.A.
        Incidence, distribution, and duration of birth-related retinal hemorrhages: a prospective study.
        J AAPOS. 2006; 10: 102-106
        • Grabska J.
        • Walden P.
        • Lerer T.
        • et al.
        Can oral sucrose reduce the pain and distress associated with screening for retinopathy of prematurity?.
        J Perinatol. 2005; 25: 33-35
        • Slevin M.
        • Murphy J.F.
        • Daly L.
        • O’Keefe M.
        Retinopathy of prematurity screening, stress related responses, the role of nesting.
        Br J Ophthalmol. 1997; 81: 762-764
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • et al.
        Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Zhang J.
        • Yu K.F.
        What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes.
        JAMA. 1998; 280: 1690-1691
        • Emerson M.V.
        • Pieramici D.J.
        • Stoessel K.M.
        • et al.
        Incidence and rate of disappearance of retinal hemorrhage in newborns.
        Ophthalmology. 2001; 108: 36-39
        • Watts P.
        • Maguire S.
        • Kwok T.
        • et al.
        Newborn retinal hemorrhages: a systematic review.
        J AAPOS. 2013; 17: 70-78
        • Gonzalez Viejo I.
        • Ferrer Novella C.
        • Pueyo Subias M.
        • et al.
        Hemorrhagic retinopathy in newborns: frequency, form of presentation, associated factors and significance.
        Eur J Ophthalmol. 1995; 5: 247-250
        • Svenningsen L.
        • Eidal K.
        Lack of correlation between umbilical artery pH, retinal hemorrhages and Apgar score in the newborn.
        Acta Obstet Gynecol Scand. 1987; 66: 639-642
        • Williams M.C.
        • Knuppel R.A.
        • O’Brien W.F.
        • et al.
        Obstetric correlates of neonatal retinal hemorrhage.
        Obstet Gynecol. 1993; 81: 688-694
        • Bergen R.
        • Margolis S.
        Retinal hemorrhages in the newborn.
        Ann Ophthalmol. 1976; 8: 53-56
        • Airiani S.
        • Fine H.F.
        • Walrath J.D.
        • et al.
        Bilateral circumferential macular folds in inflicted childhood neurotrauma.
        Retin Cases Brief Rep. 2010; 4: 23-24
        • Binenbaum G.
        • Rogers D.L.
        • Forbes B.J.
        • et al.
        Patterns of retinal hemorrhage associated with increased intracranial pressure in children.
        Pediatrics. 2013; 132: e430-e434
        • Levin A.V.
        Retinal hemorrhage in abusive head trauma.
        Pediatrics. 2010; 126: 961-970
        • Togioka B.M.
        • Arnold M.A.
        • Bathurst M.A.
        • et al.
        Retinal hemorrhages and shaken baby syndrome: an evidence-based review.
        J Emerg Med. 2009; 37: 98-106
        • Morad Y.
        • Kim Y.M.
        • Armstrong D.C.
        • et al.
        Correlation between retinal abnormalities and intracranial abnormalities in the shaken baby syndrome.
        Am J Ophthalmol. 2002; 134: 354-359
        • Roth M.
        Ueber Netzhautaffectionen bei Wundfiebern.
        Deutsche Zeitschrift für Chirurgie. 1872; 1: 471-484
        • Ling R.
        • James B.
        White-centred retinal haemorrhages (Roth spots).
        Postgrad Med J. 1998; 74: 581-582
        • Kapoor S.
        • Schiffman J.
        • Tang R.
        • et al.
        The significance of white-centered retinal hemorrhages in the shaken baby syndrome.
        Pediatr Emerg Care. 1997; 13: 183-185
        • Attebo K.
        • Mitchell P.
        • Cumming R.
        • et al.
        Prevalence and causes of amblyopia in an adult population.
        Ophthalmology. 1998; 105: 154-159
        • Tarczy-Hornoch K.
        • Cotter S.A.
        • Borchert M.
        • et al.
        Prevalence and causes of visual impairment in Asian and non-Hispanic white preschool children: Multi-ethnic Pediatric Eye Disease Study.
        Ophthalmology. 2013; 120: 1220-1226
        • Robaei D.
        • Rose K.
        • Ojaimi E.
        • et al.
        Visual acuity and the causes of visual loss in a population-based sample of 6-year-old Australian children.
        Ophthalmology. 2005; 112: 1275-1282
        • Thompson J.R.
        • Woodruff G.
        • Hiscox F.A.
        • et al.
        The incidence and prevalence of amblyopia detected in childhood.
        Public Health. 1991; 105: 455-462
        • Choong Y.F.
        • Lukman H.
        • Martin S.
        • Laws D.E.
        Childhood amblyopia treatment: psychosocial implications for patients and primary carers.
        Eye (Lond). 2004; 18: 369-375
        • Chua B.
        • Mitchell P.
        Consequences of amblyopia on education, occupation, and long term vision loss.
        Br J Ophthalmol. 2004; 88: 1119-1121
        • Horwood J.
        • Waylen A.
        • Herrick D.
        • et al.
        Common visual defects and peer victimization in children.
        Invest Ophthalmol Vis Sci. 2005; 46: 1177-1181
        • Webber A.L.
        • Wood J.M.
        • Gole G.A.
        • Brown B.
        The effect of amblyopia on fine motor skills in children.
        Invest Ophthalmol Vis Sci. 2008; 49: 594-603
        • Rahi J.S.
        • Cumberland P.M.
        • Peckham C.S.
        Does amblyopia affect educational, health, and social outcomes? Findings from 1958 British birth cohort.
        BMJ. 2006; 332: 820-825
        • Katz L.C.
        • Shatz C.J.
        Synaptic activity and the construction of cortical circuits.
        Science. 1996; 274: 1133-1138
        • Shotton K.
        • Powell C.
        • Voros G.
        • Hatt S.R.
        Interventions for unilateral refractive amblyopia.
        Cochrane Database Syst Rev. 2008; (October 8;(4):CD005137)
        • Taylor K.
        • Powell C.
        • Hatt S.R.
        • Stewart C.
        Interventions for unilateral and bilateral refractive amblyopia.
        Cochrane Database of Systematic Reviews. 2012; (CD005137:1-44)
        • Pescosolido N.
        • Stefanucci A.
        • Buomprisco G.
        • Fazio S.
        Amblyopia treatment strategies and new drug therapies.
        J Pediatr Ophthalmol Strabismus. 2014; 51: 78-86