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Retinopathy of prematurity screening and retinal hemorrhages - Our experience among Indian babies
B C Hemalatha1, B N Kalpana1, Y D Shilpa1
1Minto Regional Institute of Ophthalmology, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India.
Insights
Neonatal retinal hemorrhages, often linked to maternal and fetal factors, can indicate a risk for retinopathy of prematurity (ROP). Early detection and monitoring in preterm and low birth weight infants are crucial for timely ROP treatment.
Area of Science:
- Ophthalmology
- Neonatology
- Perinatal Medicine
Background:
- Retinal hemorrhages are observed in neonates screened for retinopathy of prematurity (ROP).
- Understanding the clinical characteristics and risk factors associated with these hemorrhages is essential for managing potential ROP progression.
Purpose of the Study:
- To evaluate the clinical characteristics of intraocular hemorrhages in neonates screened for ROP.
- To determine the additional risk these hemorrhages pose for ROP progression.
Main Methods:
- A descriptive study of 108 eyes from 60 neonates with retinal hemorrhages, identified during ROP screening of 540 at-risk infants.
- Assessment of maternal, obstetric, and neonatal risk factors, alongside hemorrhage type, area, and retinal zone involvement.
Main Results:
- Retinal hemorrhages occurred in 11.2% of screened neonates.
- Maternal factors included elderly primigravida and prolonged labor; fetal factors included low birth weight and prematurity.
- Flame-shaped hemorrhages were most common; 7.4% of affected eyes progressed to ROP requiring laser treatment.
Conclusions:
- Neonatal retinal hemorrhages are associated with prolonged labor, advanced maternal age, and anemia.
- Identifying hemorrhages in preterm and low birth weight infants is critical for timely ROP treatment.
- Regular follow-up and systemic monitoring are necessary for affected infants.
Purpose:
To evaluate the clinical characteristics of intraocular hemorrhages among babies screened for retinopathy of prematurity (ROP) and thereby their additional risk to the progression of ROP.
Methods:
A descriptive study was conducted at a tertiary referral hospital, which included 108 eyes of 60 neonates who were discovered to have retinal hemorrhages on retinal screening of 540 babies at risk for ROP. Maternal, obstetric, and neonatal risk factors were assessed in neonates with retinal hemorrhages. Retinal hemorrhages were assessed in terms of type, area, and relation to different retinal zones.
Results:
Among 540 neonates who were screened, retinal hemorrhages were found in 11.2% (n = 60 babies). Elderly primigravida mothers and spontaneous vaginal deliveries with prolonged second stage of labor were a common maternal risk factors for retinal hemorrhages. Low birth weight and preterm were fetal risk factors with neonatal retinal hemorrhages. These hemorrhages were more often bilateral (no. of babies = 48, 80%). Flame-shaped hemorrhages were more common than dot and blot ones. The majority of cases (no. of eyes = 74, 65%) resolved within 4 weeks, whereas four babies (8 eyes, 7.4%) progressed to ROP were treated with laser.
Conclusion:
Retinal hemorrhages in neonates are commonly associated with prolonged duration of second stage of labor, advanced maternal age, and anemia. Although not all progress to ROP, recognizing preterm and low birth weight babies with junctional hemorrhages is crucial not to delay the treatment. Regular follow-up until the clearance of hemorrhages and monitoring systemic conditions in these babies of amblyogenic age-group are required.
