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Retinal haemorrhage in infants with pertussis
Naz Raoof1, Susana Pereira2, Shuan Dai1,3
1Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Insights
Severe coughing in infants with pertussis (whooping cough) does not cause the retinal hemorrhages associated with abusive head trauma. This study found no evidence to support this hypothesis in infants with pertussis.
Area of Science:
- Ophthalmology
- Pediatrics
- Infectious Diseases
Background:
- Infantile pertussis (whooping cough) involves severe paroxysmal coughing.
- Retinal hemorrhages are a key indicator in diagnosing abusive head trauma in infants.
- A hypothesis suggested pertussis coughing could mimic abusive head trauma retinal findings.
Purpose of the Study:
- To investigate if paroxysmal coughing in infantile pertussis can cause retinal hemorrhages.
- To determine if pertussis-related retinal hemorrhages resemble those seen in abusive head trauma.
Main Methods:
- Prospective study of 48 infants hospitalized with pertussis (2009-2014).
- Infants aged 3 weeks to 7 months underwent retinal examinations by pediatric ophthalmology.
- Clinical severity of pertussis was categorized; all infants had ongoing paroxysmal cough.
Main Results:
- No retinal hemorrhages were observed in any of the 48 infants examined.
- The study included infants with both severe (39) and mild (9) pertussis.
- Examinations occurred after a mean of 18 days of coughing.
Conclusions:
- The study found no evidence to support the hypothesis that pertussis causes retinal hemorrhages similar to those in abusive head trauma.
- Findings suggest pertussis is unlikely to be the cause of retinal hemorrhages typically associated with abusive head trauma.
Aims:
It has been hypothesised that paroxysmal coughing in infantile pertussis (whooping cough) could produce retinal haemorrhages identical to those seen in abusive head trauma. We aimed to test this hypothesis.
Methods:
This is a prospective study of infants hospitalised with pertussis in Auckland, New Zealand, from 2009 to 2014. The clinical severity of pertussis was categorised. All infants recruited had retinal examination through dilated pupils by the paediatric ophthalmology service using an indirect ophthalmoscope.
Results:
Forty-eight infants with pertussis, aged 3 weeks to 7 months, were examined after a mean of 18 days of coughing. Thirty-nine had severe pertussis and nine had mild pertussis. All had paroxysmal cough, and all were still coughing at the time of examination. No retinal haemorrhages were seen.
Conclusions:
We found no evidence to support the hypothesis that pertussis may cause the pattern of retinal haemorrhages seen in abusive head trauma in infants.
