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Prevalence of retinal hemorrhages in critically ill children

Shruti Agrawal1, Mark J Peters, Gillian G W Adams

  • 1Paediatric and Neonatal Intensive Care Units, Great Ormond Street Hospital for Children, London, United Kingdom. shragrawal@gmail.com

Pediatrics
|May 23, 2012
PubMed

Insights

Retinal hemorrhages (RHs) occurred in 15.1% of critically ill children, mostly mild. Severe multilayered RHs, often linked to abusive head trauma (AHT), were rare and associated with severe medical conditions, not AHT.

Area of Science:

  • Ophthalmology
  • Pediatric Critical Care
  • Medical Research

Background:

  • Retinal hemorrhages (RHs) are often associated with abusive head trauma (AHT).
  • Previous studies on RHs have potential selection bias due to their focus on AHT.
  • There is a need to understand RH prevalence in critically ill children beyond AHT.

Purpose of the Study:

  • To determine the prevalence, distribution, and extent of retinal hemorrhages (RHs) in critically ill children.
  • To differentiate RHs in critically ill children from those typically seen in abusive head trauma (AHT).

Main Methods:

  • A prospective observational study was conducted from February 2008 to December 2009.
  • Critically ill children (≥ 6 weeks old) underwent dilated retinal examinations or RetCam imaging.
  • Exclusions included suspected/proven AHT, penetrating eye trauma, and elective admissions.

Main Results:

  • The prevalence of RHs was 15.1% (24/159), with most cases being mild.
  • Severe multilayered RHs were rare (3.7%), observed in 6 patients with conditions like myeloid leukemia, sepsis, accidental head injury, or coagulopathy.
  • Sepsis and coagulopathy were significantly associated with any RH, while only admission diagnosis independently predicted severe multilayered RH.

Conclusions:

  • Retinal hemorrhages (RHs) are present in 15.1% of critically ill children, predominantly mild.
  • Severe multilayered RHs, similar to those in AHT, are uncommon in this population.
  • These severe RHs were linked to severe underlying medical conditions, not AHT.
Abstract

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