M Laghmari1, H Skiker1, H Handor2, B Mansouri1, K Ouazzani Chahdi1, R Lachkar1, Y Salhi1, O Cherkaoui1, B Ouazzani Tnacheri1, W Ibrahimy1, H Alami3, R Bezad3, S Ahid4, R Abouqal4, R Daoudi1. 1. Service d'ophtalmologie, hôpital des spécialités, centre hospitalier Ibn Sina (CHIS), rue Lamfadel Cherkaoui, BP 6527, Rabat, Maroc. 2. Service d'ophtalmologie, hôpital des spécialités, centre hospitalier Ibn Sina (CHIS), rue Lamfadel Cherkaoui, BP 6527, Rabat, Maroc. Electronic address: hhandor@yahoo.fr. 3. Centre national de santé de reproduction, maternité des Orangers, avenue du Président Soekarno, Rabat, Maroc. 4. Laboratoire de biostatiques et de recherche clinique et épidémiologiques (LBRCE), faculté de médecine et de pharmacie de Rabat, université Mohammed V-Souissi, Angle avenue Allal El Fassi et Mfadel Cherkaoui, Al Irfane 8007 NU, Rabat, Maroc.
Abstract
PURPOSE: To assess the prevalence, morphology and distribution of retinal hemorrhages in healthy newborns and their relationship to neonatal, maternal and obstetrical factors, and to determine their natural history. PATIENTS AND METHODS: The present study prospectively included 2,031 consecutive healthy newborns. Indirect ophthalmoscopy was performed within 24 hours after birth in all newborns. Infants with retinal hemorrhages were reexamined weekly until the hemorrhage resolved. Annual ophthalmologic follow-up was also scheduled in these children. Neonatal, maternal and obstetric parameters were analyzed in all newborns and compared between newborns with retinal hemorrhages and those without retinal hemorrhages. RESULTS: 31.8 % of newborns exhibited retinal hemorrhages. 72.6 % of hemorrhages were bilateral. They tended to be localized around the optic discs and in the posterior pole, but their distribution was variable. Retinal hemorrhages were of variable shapes. The prevalence of retinal hemorrhages was higher in newborns delivered with vacuum-assisted extraction (38 %, P<0.001), intermediate during normal vaginal delivery (32.6 %, P<0.001) and lower with cesarean section (20.8 %). Comparative analysis between elective cesarean section and emergency cesarean showed a higher incidence of retinal hemorrhages in the emergency cesarean group (P=0.006). On multivariate analysis, vacuum-assisted delivery was the only factor associated with a higher prevalence of retinal hemorrhages in newborns (P=0.045). Two thirds of hemorrhages had disappeared by one week after birth. Retinal hemorrhages had resolved in all newborns within four weeks. CONCLUSION: Birth-related retinal hemorrhages are common (1/3 of our newborns). Vacuum-assisted delivery is the main risk factor in this study. All hemorrhages resolved by one month of age. These findings may help in differential diagnosis with shaken baby syndrome.
PURPOSE: To assess the prevalence, morphology and distribution of retinal hemorrhages in healthy newborns and their relationship to neonatal, maternal and obstetrical factors, and to determine their natural history. PATIENTS AND METHODS: The present study prospectively included 2,031 consecutive healthy newborns. Indirect ophthalmoscopy was performed within 24 hours after birth in all newborns. Infants with retinal hemorrhages were reexamined weekly until the hemorrhage resolved. Annual ophthalmologic follow-up was also scheduled in these children. Neonatal, maternal and obstetric parameters were analyzed in all newborns and compared between newborns with retinal hemorrhages and those without retinal hemorrhages. RESULTS: 31.8 % of newborns exhibited retinal hemorrhages. 72.6 % of hemorrhages were bilateral. They tended to be localized around the optic discs and in the posterior pole, but their distribution was variable. Retinal hemorrhages were of variable shapes. The prevalence of retinal hemorrhages was higher in newborns delivered with vacuum-assisted extraction (38 %, P<0.001), intermediate during normal vaginal delivery (32.6 %, P<0.001) and lower with cesarean section (20.8 %). Comparative analysis between elective cesarean section and emergency cesarean showed a higher incidence of retinal hemorrhages in the emergency cesarean group (P=0.006). On multivariate analysis, vacuum-assisted delivery was the only factor associated with a higher prevalence of retinal hemorrhages in newborns (P=0.045). Two thirds of hemorrhages had disappeared by one week after birth. Retinal hemorrhages had resolved in all newborns within four weeks. CONCLUSION: Birth-related retinal hemorrhages are common (1/3 of our newborns). Vacuum-assisted delivery is the main risk factor in this study. All hemorrhages resolved by one month of age. These findings may help in differential diagnosis with shaken baby syndrome.
Authors: Shwetha Mangalesh; Du Tran-Viet; Carolyn Pizoli; Vincent Tai; Mays Antoine El-Dairi; Xi Chen; Christian Viehland; Laura Edwards; Joanne Finkle; Sharon F Freedman; Cynthia Ann Toth Journal: Graefes Arch Clin Exp Ophthalmol Date: 2020-05-29 Impact factor: 3.117