Am J Ophthalmol. 1979 Jan;87(1):74-6. Related Articles, Links
Neonatal retinal hemorrhages and influence of perinatal factors.
Besio R, Caballero C, Meerhoff E, Schwarcz R.
We studied fundus oculi in 234 newborns, divided into two groups of mothers and neonates with or without disease. The overall frequency or retinal hemorrhages was 30.3% (71 neonates). In each group, we studied the association between retinal hemorrhage and several variables of labor and the newborn infant. Statistically significant differences were found in the incidence of hemorrhage in one (2.6%) neonate born by cesarean section, as compared with 61 (38%) spontaneous or 9 (25%) forceps delivery.
PMID: 434055 [PubMed - indexed for MEDLINE]
Yan Ke Xue Bao. 1993 Dec;9(4):200-2. Related Articles, Links
[Retinal hemorrhage in newborn infants]
[Article in Chinese]
Liu X, Cheng G, Yang S, Ling Y, Ke P.
Zhongshan Ophthalmic Center, Sun Yat-Sen University of Medical Sciences, Guangzhou, China.
The fundi of the 527 infants born within one week were investigated. The results showed that 54 cases (78 eyes) had retinal hemorrhage. Among them, 23 cases (28 eyes) accompanied macular hemorrhage. The retinal hemorrhage in newborn infants was higher in vaginal delivery than in cesarean section, and the incidence of the fetal distress was higher in the newborn infants with macular hemorrhage. The essential causes of the retinal hemorrhage in newborn infants, development of infant macular and the mechanism of amblyopia induced by macular hemorrhage were discussed.
J Pediatr Ophthalmol Strabismus. 1997 Sep-Oct;34(5):286-8.
Long-term outcome of neonatal macular hemorrhage.
Zwaan J, Cardenas R, O'Connor PS.
Department of Ophthalmology, University of Texas Health Science Center at San Antonio, USA.
BACKGROUND: We studied long-term visual acuity in children who had macular hemorrhages at birth. METHODS: Of 11 involved children, seven had eye examinations at about age 10. Two were contacted by telephone; two were lost to follow up. RESULTS: Of the seven examined children, six had normal visual acuities. One had reduced vision in the eye with the macular hemorrhage, possibly related to deprivation amblyopia secondary to slow resorption of the hemorrhage. The two patients contacted by telephone reported normal vision. CONCLUSION: Although macular hemorrhages generally resolve without any lasting damage, the outcome may be less favorable in some patients.
PMID: 9310916 [PubMed - indexed for MEDLINE]
Surv Ophthalmol. 1992 Jul-Aug;37(1):1-17. Related Articles, Links
Fundus hemorrhages in infancy.
Kaur B, Taylor D.
Hospitals for Sick Children, London, England.
The anatomical location and appearance of retinal hemorrhages in the infant provide important clues in the diagnosis of underlying disorders. While neonatal retinal hemorrhages related to birth trauma are common, benign, and self-limited, other retinal hemorrhages in infancy may signify intracranial aneurysms, accidental or non-accidental injury, and a variety of ocular (e.g., Coats' disease, PHPV, ROP, retinal dysplasia, hypertension, myopia) or systemic disease (e.g., hematologic or cardiovascular disorders, infection, protein C deficiency). In this review, retinal hemorrhages are illustrated and classified according to location, appearance, and etiology. Prompt diagnosis of retinal hemorrhages in infants is crucial, because treatment may be required to prevent early deprivation amblyopia and blindness. Ophthalmological findings may also be a valuable contribution to the overall medical evaluation of the infant.
PMID: 1509354 [PubMed - indexed for MEDLINE]
Hemorrhagic retinopathy in newborns: frequency, form of presentation, associated factors and significance.
Gonzalez Viejo I, Ferrer Novella C, Pueyo Subias M, Ronchera Oms JM, Bueno Lozano J, Ferrer Novella E, Vicente Aznar E, Honrubia Lopez FM.
Service of Ophthalmology, Hospital Miguel Servet, Zaragoza, Spain.
During the first 72 hours of their lives, 420 neonates were checked for retinal hemorrhages and macular affection. The neonate's gestational age, birth weight, and Apgar scores and maternal data (nulliparty, fetal presentation, duration of labor and delivery, induction of labor and obstetric technique) were all recorded. In 81 cases (19.2%), retinal hemorrhages were found. No significant relation was established with any of the associated factors, except for a significantly lower frequency of hemorrhages in cases of cesarean delivery (p < 0.01) and a significantly longer expulsive phase in the group with hemorrhages (p < 0.05). In follow-up examination 3 to 4 months later, neither the infants with hemorrhages nor the control group presented alterations.
PMID: 8963162 [PubMed - indexed for MEDLINE]
Retinal and intraventricular cerebral hemorrhages in the preterm infant born at or before 30 weeks' gestation.
Anteby II, Anteby EY, Chen B, Hamvas A, McAlister W, Tychsen L.
Department of Ophthalmology and Visual Sciences, St Louis Children's Hospital at Washington University School of Medicine, St Louis, Missouri 63110, USA.
PURPOSE: To determine the prevalence of retinal hemorrhages and their association with cerebral intraventricular hemorrhages (IVH) in low-birth-weight preterm neonates born at or before 32 weeks' gestation. METHODS: We prospectively studied a consecutive series of 22 neonates (24-30 weeks' gestation; mean gestational age, 27 weeks; mean weight, 1065 g) admitted to the neonatal intensive care unit. Anterior segment and indirect ophthalmoscopic examination, as well as cranial ultrasonographic examination, were performed on day 1 and day 10 of life. The prevalence of retinal and intraventricular hemorrhage was tested statistically for association with obstetric and neonatal clinical variables. RESULTS: The prevalence of retinal hemorrhage was 9% (2/22; 95% CI, 3%-21%) on day 1 and 2% (1/22) on day 10. The prevalence of IVH was 27% (6/22; 95% CI, 9%-46%): 14% (3/22) on day 1 and 23% (5/22) on day 10. Retinal hemorrhages occurred with greater frequency in neonates born to women who had intrauterine infection (chorioamnionitis, P =.043) and low umbilical cord pH levels (P =.027). No association was found between the presence of retinal hemorrhage and IVH (P = 1.000), mode of delivery (ie, vaginal vs cesarean section, P = 1.000), birth weight (P =.476), or gestational age (P = 1.000). The presence of subconjunctival hemorrhage was associated with IVH (P =.046). CONCLUSIONS: Retinal hemorrhages occur in less than 10% of low-birth-weight neonates, ie, a prevalence one half that observed in term neonates (22%). The hemorrhages tend to resolve without sequelae in the first 10 days of life and occur more commonly in infants born to women with uterine infection. Retinal hemorrhages in very premature neonates are not predictive of IVH-related brain damage.
PMID: 11304816 [PubMed - indexed for MEDLINE]
Perinatal events and intraventricular/subependymal hemorrhage in the very low-birth weight infant.
Strauss A, Kirz D, Modanlou HD, Freeman RK.
One hundred nineteen very low-birth weight infants were studied to see whether intrapartum fetal distress with or without acidosis correlated with the development of intraventricular and subependymal hemorrhage. Of 112 infants studied prospectively, 24% (27/112) had intraventricular/subependymal hemorrhage documented by real-time ultrasound studies shortly after birth; only 4.4 (5/112) had severe hemorrhage (grade 3/4). Ominous fetal heart rate patterns occurred in 50% of monitored infants with severe intraventricular/subependymal hemorrhage compared to 8% of matched controls (p less than 0.01). Reassuring fetal heart rate patterns were more predominant in infants without intraventricular/subependymal hemorrhage (p less than 0.05). Neonatal depression and the need for assisted ventilation beyond the immediate delivery period were more frequent in infants who developed intraventricular/subependymal hemorrhage. Antepartum and intrapartum complications, fetal presentation, cesarean section, duration of labor, hyaline membrane disease, and volume expansion appeared to play no role in the incidence of intraventricular/subependymal hemorrhage. Preliminary data presented here suggest that intrapartum fetal distress and acidosis may be significant factors in predicting which very low-birth weight infant will develop intraventricular/subependymal hemorrhage. The condition of the infant at birth may be more significant with respect to the extent of intraventricular/subependymal hemorrhage than a variety of obstetric variables. Aggressive management of appropriately selected patients and judicious resuscitation of the very low-birth weight infant may keep the incidence of severe intraventricular/subependymal hemorrhage at a minimum, thereby optimizing neurological outcome for this high-risk group.
PMID: 3985063 [PubMed - indexed for MEDLINE]
Obstet Gynecol. 1993 May;81(5 ( Pt 1)):688-94. Related Articles, Links
Obstetric correlates of neonatal retinal hemorrhage.
Williams MC, Knuppel RA, O'Brien WF, Weiss A, Spellacy WN, Pietrantoni M.
Department of Obstetrics and Gynecology, University of South Florida, Tampa.
OBJECTIVE: To determine whether maternal or fetal factors, other than vacuum-assisted delivery, play a role in neonatal retinal hemorrhage, and whether correlates are similar in retinal hemorrhage after spontaneous vaginal delivery. METHODS: A cross-section of assisted deliveries at an urban hospital (n = 156) over 7 months were compared with contemporaneous spontaneous vaginal deliveries (n = 122). A subset of assisted deliveries (n = 87) was prospectively randomized to forceps or vacuum-assisted delivery by sealed envelope. Maternal and neonatal biometric data were collected, and Apgar scores, umbilical artery blood gas analysis, and neonatal ophthalmologic evaluations were performed. RESULTS: Moderate to severe retinal hemorrhage was found in 18% of spontaneous, 13% of forceps, 28% of vacuum-assisted, and 50% of sequential vacuum and forceps-assisted deliveries. Fetal distress (P < .008), vacuum-assisted delivery (P < .02), decreased birth weight for gestation (P < .004), umbilical artery pH less than 7.20 (P < .004), and second stage of labor less than 30 minutes (P < .05) were most closely associated with increased degrees of retinal hemorrhage. Maternal parity, preeclampsia, length of labor, and head circumference were not correlated with retinal hemorrhage. Vacuum-assisted delivery among low birth weight infants (P < .0001), short second stage of labor (P < .006), fetal acidosis (P < .045), and sequential use of vacuum and forceps for assisted delivery (P < .005) formed a logistic model that correctly predicted 81% of moderate to severe retinal hemorrhage cases. Logistic analysis of the randomized assisted deliveries gave similar results. CONCLUSIONS: Maternal and fetal factors other than vacuum-assisted delivery are significant correlates of moderate to severe retinal hemorrhage. Vacuum-assisted delivery among small for gestational age infants is closely correlated with moderate to severe retinal hemorrhage.
Randomized Controlled Trial
PMID: 8469455 [PubMed - indexed for MEDLINE]