Retinal and Conjunctival Haemorrhage in the Newborn

Abstract

. (1970). Archives of Disease in Childhood, 45, 344. Retinal and conjunctival haemorrhage in the newborn. Two hundred and thirty newborn infants were examined for retinal and conjunctival haemorrhages. Retinal photographs were taken in selected cases to record the morphological varieties and the different rates of disappearance of the retinal haemorrhages.The incidence of retinal and conjunctival haemorrhages was studied in relation to a number of possible aetiological factors. In the case of retinal haemorrhages we did not identify the critical factor or factors that determine their occurrence. Neither cephalic venous congestion, nor a coagulation defect, nor birth asphyxia was associated with retinal haemorrhages. It is likely that they are of multifactorial origin, and it is suggested that blood viscosity may be an important contributory factor.In contrast, conjunctival haemorrhages occurred in association with multiparity, rapid second stage of labour, Negro race, high Apgar score, and relatively high birthweight, head circumference, and gestational age. In addition the occurrence of conjunctival haemorrhage as part of the picture of 'traumatic cyanosis' suggests that these lesions do result from changes in cephalic venous pressure.The first practical ophthalmoscope was introduced by Helmholtz in 1850. Eleven years later Jaeger first described retinal haemorrhages in newborn infants (Jaeger,1861). Many studies have since been made concerning the incidence, morphology, aetiology, and significance of these haemorrhages

Retinal Haemorrhages in the Newborn

“…Surprisingly, the incidence of retinal haemorrhages in babies with a smaller head circumference was greater than those with weight where heavier babies showed a greater frequency of found a greater frequency of haemorrhages in males because of their greater cephalic measurements and the same result was highlighted by Critchley (1968) who obtained a marked difference, the male-female ratio being 21:8. However, the findings were in keeping with the results obtained by Edgerton (1934), McKeown (1941) and Baum and Bulpitt (1970) who noted no difference in the incidence with regard to sex of the baby. As regards birth weight, the greater frequency in larger birth weight babies was in conformity with the findings of Edgerton (1934) and Critchley (1968).…”

“…The haemorrhages found were mainly located at the posterior pole, to the findings of Coburn (1904) who found them mainly in the equatorial region, the classification of the four types of haemorrhages was the same as adopted by Baum and Bulpitt (1970) and if splinter haemorrhages are excluded as a group it is identical with the classification of Richman (1936) and McKeown (1941). The fourth group of subhyaloid haemorrhages as described by Kauffman (1958) was not found in the present study.…”

Ocular pathology in shaken baby syndrome and other forms of infantile non-accidental head injury

“…Usually, most RH in newborns are completely resolved without any sequelae by 8 days after birth [29,57,113], whereas NAHI-associated RH will persist usually for months [79]. Association to mode of birth delivery has been reported with the highest frequency for vacuum delivery, followed by vaginal delivery with or without forceps and least often in cesarean section [25,29,57,71,97,107] although this still remains controversial [7]. One study found a higher frequency of RH in neonates following dinoprostone-induced labor when compared with oxytocin [106].…”

“…Retinal hemorrhages, which can be bilateral, can occur in up to more than 30% of newborns, albeit their incidence declines substantially within the first days [7,29,107] and even within the first hour [40]. Usually, most RH in newborns are completely resolved without any sequelae by 8 days after birth [29,57,113], whereas NAHI-associated RH will persist usually for months [79].…”

Retinal hemorrhage and pediatric brain injury: etiology and review of the literature

“…Large preretinal hemorrhages take a little longer to clear. 6,13,[20][21][22] Among premature newborns, retinal hemorrhages are frequent. Retinal hemorrhages tend to occur in the acute phases of the retinopathy of prematurity.…”