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Published on: September 11, 2013
Retinal haemorrhages in premature infants: a pathogenetic alternative diagnosis to child abuse
1Rigshospitalet, Eye Department, Copenhagen University, Copenhagen, Denmark. rh03217@fh.dk
Insights
Retinal hemorrhages in premature infants are not always due to abuse. Prematurity itself is a potential cause, distinct from shaken baby syndrome, requiring careful diagnosis.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatrics
Background:
- Retinal hemorrhages in newborns are often associated with abusive head trauma, commonly known as shaken baby syndrome.
- Differentiating the cause of retinal hemorrhages is critical for accurate diagnosis and appropriate management in infants.
Observation:
- This study observed 11 infants with retinal and/or vitreous hemorrhages.
- Ten infants were premature and under surveillance for retinopathy of prematurity (ROP).
- Other cases included Zellweger's syndrome, coagulation factor deficiency, and a term infant with fatal brain edema.
Findings:
- Four premature infants showed signs of ROP, with two requiring laser therapy.
- Ocular bleeding in premature infants was generally long-standing, unlike the rapid absorption in term infants.
- Some hemorrhages appeared to be postnatal, developing during observation.
Implications:
- Prematurity should be considered a potential cause of retinal hemorrhages, alongside other conditions like coagulopathies.
- This finding helps distinguish non-abusive causes from shaken baby syndrome in neonates.
- Accurate etiological diagnosis is essential for appropriate clinical intervention and parental guidance.
Purpose:
To present the occasional observation of retinal haemorrhages in premature babies, as a diagnostic alternative to those observed as part of shaken baby syndrome.
Methods:
We carried out an observational study on 11 infants in whom retinal and/or vitreous haemorrhages had been observed within their first months of life. Ten infants were under surveillance for retinopathy of prematurity (ROP), with gestational ages and birth weights in the ranges of 27--34 weeks and 790--1665 g, respectively. One infant was diagnosed with Zellweger's syndrome and one received substitution therapy for coagulation factor II deficiency. The last child had been delivered at 38 weeks, weighing 2070 g; he died on day 5 from severe brain oedema with incarceration and extensive bilateral fundus bleeding.
Results:
Four of the 11 infants had some evidence of ROP, and two later received retinal ablation therapy. Contrary to the quick absorption (<1-2 weeks only) usually seen in most newborn term infants, the ocular bleeding in preterms was generally longstanding. A quick increase in intracranial pressure probably played a role in the lethal case with delivery near term, and one infant received lung physiotherapy for pneumonia at the age of 6 months. Some bleeding appeared to be truly postnatal (i.e. it was observed as a new occurrence during the course of surveillance).
Conclusions:
In the series under study there was no suspicion of child abuse. In term infants, retinal haemorrhages are extremely rare except when due to shaking, but other diseases should be ruled out, coagulopathies in particular. We suggest that prematurity as such is added to the list of possibly underlying causes when retinal bleedings are evaluated in very small infants and shaken baby mechanisms are suspected.
