Birth-related retinal hemorrhages: The Soonchunhyang University Cheonan Hospital universal newborn eye screening (SUCH-NES) study

Abstract

Purpose To report the prevalence, related factors, and characteristics of birth-related retinal hemorrhages (RHs) according to their severity in healthy newborns using a telemedicine network and wide-field digital retinal imaging (WFDRI). Methods Newborns who underwent WFDRI at 61 obstetrics/gynecology hospitals between January 2017 and December 2019 were enrolled. Demographics and related factors were compared among newborns with and without RHs. The newborns’ eyes were divided into the minimal, mild, moderate, and severe groups according to the number of RHs, and characteristics like bilaterality, laterality, involved retinal layer, involved zone, macular and/or optic nerve (ON) involvement were compared. Results Among 56247 newborns, 13026 had birth-related RHs (23.2%). Normal spontaneous vaginal delivery (NSVD) showed the highest association with RHs (odds ratio, 19.774; 95% confidence interval, 18.277–21.393; P < 0.001) on multivariate analysis. Bilateral RHs (8414/13026; 64.59%) were more common than unilateral RHs (4612/13026; 35.41%); however, unilateral RHs (2383/4217; 56.51%) were more common than bilateral RHs (1834/4217; 43.49%) in the minimal group. RHs showed no laterality differences between the two eyes (P = 0.493). Most RHs were intraretinal (18678/21440; 87.12%), and 2328 (31.65%) eyes with preretinal hemorrhage were observed in the severe group. Zone I RHs were common in the minimal (7072/7090; 99.75%), mild (4953/4960; 99.86%), and moderate (2013/2035; 98.92%) groups; zone I and II RHs were common in the severe group (4843/7355; 65.85%); and RHs in zone III were rare (7/21440; 0.03%). Most RHs showed no macular and/or ON involvement in the minimal and mild group; however, this was common in the severe group (7111/7355; 96.68%). Conclusions Birth-related RHs were common in healthy newborns and were significantly associated with NSVD. RHs were usually bilateral, intraretinal, and distributed posterior to the retina, but severe RHs had unique characteristics. Future long-term and longitudinal studies are required to elucidate the prognosis of severe RHs.

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

“…The prevalence of neonatal retinal hemorrhage in this study was 24.8%. This is comparable to the rates reported by some previous studies (20.2–24.5%) [ 8 , 22 , 30 , 32 , 34 ], but significantly higher than those reported by other studies (2.4–14.5%) [ 9 , 26 , 27 , 35 , 36 , 37 ], and lower than those reported by others (34–39.4%) [ 4 , 6 , 20 , 25 , 31 ]. Despite attempts to explain the reasons for these significant differences, no statistically proven explanation has been provided.…”

“…We found that the severity of neonatal retinal hemorrhage was generally consistent (83.2%) between the two eyes. This is comparable to the 71.4% consistency reported by Cho et al [ 8 ]. Conversely, Emerson et al [ 6 ] found no consistency.…”

“…We also found that in the severe hemorrhage group, almost all patients exhibited extrafoveal macular involvement. Cho et al found that in neonates with severe retinal hemorrhage, the proportion of simultaneous macula and optic disc involvement was 96.68% [ 8 ]. The reason neonatal retinal hemorrhage mostly involves the macular area may be that the retinal blood vessels in this area are more sensitive to ischemia and hypoxia.…”

“…Its reported prevalence ranges from 2.6% to 50%, which makes it the most common ocular fundus disease among newborns [ 1 , 2 , 3 , 4 ]. Although neonatal retinal hemorrhage is generally considered benign and is mostly spontaneously absorbed within one month [ 3 , 5 , 6 ], severe hemorrhage, or hemorrhage involving the fovea, can lead to prolonged hemorrhage absorption time and retinal toxicity, resulting in visual disorders, such as ametropia, strabismus, and amblyopia [ 7 , 8 , 9 , 10 ]. Early detection and timely follow-up and intervention strategies are vital for reducing the risk of visual impairment.…”

“…Vinekar used RetCam to screen 1021 full-term infants and reported that the prevalence of neonatal retinal hemorrhage was only 2.4% [ 27 ]. Cho used wide-field digital retinal imaging and reported a prevalence of 23.2% among 56,247 healthy neonates [ 8 ]. Moreover, they found that neonatal retinal hemorrhage was significantly associated with natural vaginal delivery and that severe hemorrhage showed common macular and/or optic disc involvement.…”