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Can convulsions alone cause retinal haemorrhages in infants?
A K Tyagi1, S Scotcher, N Kozeis
1Birmingham and Midland Eye Centre.
Insights
In children under 2 years old, convulsions alone rarely cause retinal hemorrhages. This suggests other causes should be investigated if hemorrhages are found after a convulsion.
Area of Science:
- Pediatric Ophthalmology
- Neurology
Background:
- Retinal hemorrhages in young children are often associated with abusive head trauma.
- The role of seizures as a sole cause of retinal hemorrhages in infants is debated.
Purpose of the Study:
- To determine the incidence of retinal hemorrhages in children under 2 years old following convulsions.
- To assess if convulsions alone can cause retinal hemorrhages in this age group.
Main Methods:
- Prospective examination of 32 children under 2 years admitted with convulsions.
- Ophthalmological evaluation including indirect ophthalmoscopy within 48 hours of admission.
- Classification of convulsions by a pediatric neurologist; statistical analysis using Hanley's rule of three.
Main Results:
- None of the 32 children examined had retinal hemorrhages.
- The upper limit of the 95% confidence interval for retinal hemorrhages following convulsions in children under 2 years is less than 10/100.
- Combined data suggest the upper limit for children under 14 years is less than 5/100.
Conclusions:
- Convulsions alone are unlikely to cause retinal hemorrhages in children under 2 years old.
- The presence of retinal hemorrhages in a child with a history of convulsions warrants a thorough investigation for other causes, such as non-accidental injury.
Aim:
To evaluate the likelihood that, in children under the age of 2 years, convulsions alone may cause retinal haemorrhages.
Methods:
Children under the age of 2 years admitted to hospital following convulsions, were examined within 48 hours of admission. The convulsions were classified by a paediatric neurologist and detailed ocular examination, including indirect ophthalmoscopy, was performed by an ophthalmologist. Statistical analysis was undertaken using Hanley's rule of three.
Results:
32 consecutive children admitted with convulsions were examined; 10 of them were admitted following epileptic seizures and 22 following febrile convulsions. Two of the children with febrile convulsions were admitted in status epilepticus. None of these children had retinal haemorrhages. Therefore, using Hanley's rule of three, the upper limit of 95% confidence interval of retinal haemorrhages following convulsions in children under the age of 2 years, is less than 10/100.
Conclusions:
In children under the age of 2 years convulsions alone are unlikely to cause retinal haemorrhages. By combining the results of this study with those previously reported from this unit in older children, the upper limit of 95% confidence interval of retinal haemorrhages, following convulsions in children under the age of 14 years, is less than 5/100. Therefore, the finding of retinal haemorrhages in a child admitted with a history of convulsion should trigger a meticulous search for other causes of these haemorrhages, particularly non-accidental injury.