Retinal Bleeding from birth and beyond
Incidence, Distribution, and Duration of
Birth-Related Retinal Hemorrhages:
A Prospective Study
Lindsey A. Hughes, B. Med Sci (Orthoptics),a Kristina May, MB, ChB, FRCOphth,b
John F. Talbot, FRCOphth, FRCS,b and Michael Andrew Parsons, MB, ChB, FRCPatha
Background: Retinal hemorrhages secondary to birth trauma are part of the differential diagnosis of intraocular
hemorrhages seen in the setting of Shaken baby syndrome in very young infants. This prospective study aimed to
document the morphology, distribution and, most importantly, the natural history of these hemorrhages using
digital imaging. Subjects and methods: Infants were recruited as soon after birth as possible and examined by
indirect ophthalmoscopy. Retinal hemorrhages were photographed using the RetCam 120. Birth history was
documented from the medical notes. Infants were reexamined and photographed until hemorrhages had resolved.
Results: Data were analyzed for a total of 53 neonates. The number of infants with retinal hemorrhage was 18
(34%). The incidence in relation to mode of delivery was as follows: vacuum delivery, 77.8%; normal vaginal
delivery, 30.4%; cesarean section, 8.3%; forceps delivery, 30.3%. All hemorrhages were intraretinal and in all but
two infants hemorrhages had resolved by 16 days. In two subjects hemorrhages were still present at 31 and 58
days, respectively. Both these infants were delivered by vacuum delivery. Conclusions: The RetCam 120 provides
excellent documentation of retinal hemorrhages and their natural history. We have demonstrated hemorrhages
still present at 58 days in a child born by vacuum delivery and this may have important implications for
consideration in the differential diagnosis of Shaken baby syndrome. (J AAPOS 2006;10:102-106)
I t is well known that retinal hemorrhages occur in
newborn infants during delivery. The reported incidence
varies from 2.6 to 50%.1,2 This variation appears
to be primarily due to when infants are examined
after birth. Giles3 demonstrated that the incidence was
reduced from 40% at 1 hour postdelivery to 20% at 72
hours. Sezen4 found the incidence was only 2.6% after 3 to
5 days. Experience of the examiner, mode of examination
(direct versus indirect ophthalmoscopy), and use of a
speculum are also thought to contribute to this variation.
1,2,5 The incidence varies with mode of delivery. They
occur most frequently in those delivered by vacuum extraction
(75%); 33% in those delivered by spontaneous
vaginal delivery; and 6.7% by cesarean section.2 These
figures concur with those of other authors.6,7
The severity of the hemorrhages varies considerably.This is an extract from the report, there is more to it and will post links up.
Iain