Bilateral Hemorrhages in a Premature Infant With Subarachnoid Hemorrhage: An Underrecognized Etiology

The authors describe an 8-day-old male infant born premature at 31 weeks and 6 days (corrected gestational age: 33 weeks) with cholestatic jaundice and cytomegalovirus (CMV) viremia found to have bilateral multilaminar hemorrhages that represented a diagnostic challenge. Fluorescein angiography (FA) ruled out vasculitis, retinitis, and neovascular process. An extensive laboratory work-up for infectious and coagulopathic etiologies was negative other than a positive systemic viral titer for CMV, but there was no retinitis based on serial exams and FA. Magnetic resonance imaging showed a right-sided subarachnoid hemorrhage, which was felt to be parturitional and confirmed the unifying diagnosis of delivery-associated retinopathy and intracranial hemorrhages in a preterm infant, a term that has been previously described. Simultaneous subarachnoid hemorrhage and vitreoretinal hemorrhage may represent an underrecognized cause of neonatal hemorrhage in preterm infants. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:596-600.].