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Ophthalmologic findings in infants after an apparent life-threatening event
R L Altman1, S Forman, D A Brand
1Department of Pediatrics, New York Medical College and Westchester Medical Center, Valhalla, NJ 10595, USA. robin_altman@nymc.edu
Insights
Retinal hemorrhages in infants experiencing apparent life-threatening events (ALTE) can indicate shaken baby syndrome. Ophthalmologic findings are crucial for diagnosing child abuse in these critical cases.
Area of Science:
- Pediatric ophthalmology
- Child abuse diagnosis
- Infant emergency medicine
Background:
- Apparent life-threatening events (ALTE) in infants involve breathing, color, muscle tone, or mental status changes.
- Retinal hemorrhages in ALTE infants suggest shaken baby syndrome.
- Previous studies focused on retinal hemorrhages, neglecting other ocular findings' diagnostic value.
Purpose of the Study:
- To review ophthalmologic findings in infants with ALTE.
- To determine the diagnostic significance of ocular findings in ALTE.
- To assess the role of ophthalmology in identifying child abuse as a cause of ALTE.
Main Methods:
- Retrospective review of ophthalmologic findings in 120 ALTE patients.
- Analysis of inpatient medical records, including history, physical exams, and diagnostic tests.
- Correlation of ocular findings with discharge diagnoses.
Main Results:
- Ten patients (8.3%) presented with positive ophthalmologic findings.
- Retinal hemorrhages were found in 4 of 6 patients diagnosed with shaken baby syndrome.
- Retinal hemorrhages were the sole ocular finding aiding in the diagnosis of ALTE causation.
Conclusions:
- Ophthalmologic examinations are vital for diagnosing the cause of ALTE.
- Funduscopic examination can identify child abuse in infants with ALTE.
- Ophthalmologists play a key role in the early evaluation of infants experiencing ALTE.
Purpose:
An apparent life-threatening event (ALTE) refers to the sudden occurrence in an infant of a breathing abnormality, color change, or alteration in muscle tone or mental status. The finding of retinal hemorrhage in an infant who has experienced an ALTE strongly suggests the possibility of shaken baby syndrome. Previous ALTE studies have reported the frequency of this specific ocular abnormality but have not reported other ocular findings and their possible diagnostic significance.
Methods:
This study reviews ophthalmologic findings from a series of 120 patients with ALTE who underwent eye examinations as part of their inpatient evaluation. Details of the history, physical examination, diagnostic testing, and discharge diagnosis were abstracted from the medical record while the patient was in the hospital.
Results:
Ten patients (8.3%) had positive findings, including retinal hemorrhages in four of the six patients with shaken baby syndrome, the only ophthalmologic finding that helped establish the cause of an ALTE.
Conclusions:
Since the funduscopic examination can help identify child abuse as the cause of an apparent life-threatening event, ophthalmologists play a critical role in the early evaluation of infants who have experienced such an event.
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