Causes
The blood vessels of the retina begin to develop about 3 months into pregnancy. They complete development at the time of normal birth. The eyes may not develop properly if a baby is born very early. The vessels may stop growing or grow abnormally from the retina into the back of the eye. The vessels are fragile. They can leak and cause bleeding in the eye. Scar tissue may develop and pull the retina loose from the inner surface of the eye. In severe cases, this can result in vision loss. In the past, the use of too much oxygen in treating premature babies caused vessels to grow abnormally. Better methods are now available for monitoring oxygen, so this problem is rare. Today, the risk of developing ROP depends on the degree of prematurity. Smaller babies with more medical problems are at higher risk. Almost all babies who are born before 30 weeks or weigh fewer than 3 pounds at birth are screened for the condition. Some high-risk babies who weigh 3 - 4.5 pounds or who are born after 30 weeks should also be screened. See link for full article: https://www.nlm.nih.gov/medlineplus/ency/article/001618.htm Retinal haemorrhages in premature infants: a pathogenetic alternative diagnosis to child abuse.11/6/2015 Abstract
PURPOSE:To present the occasional observation of retinal haemorrhages in premature babies, as a diagnostic alternative to those observed as part of shaken baby syndrome. METHODS: We carried out an observational study on 11 infants in whom retinal and/or vitreous haemorrhages had been observed within their first months of life. Ten infants were under surveillance for retinopathy of prematurity (ROP), with gestational ages and birth weights in the ranges of 27--34 weeks and 790--1665 g, respectively. One infant was diagnosed with Zellweger's syndrome and one received substitution therapy for coagulation factor II deficiency. The last child had been delivered at 38 weeks, weighing 2070 g; he died on day 5 from severe brain oedema with incarceration and extensive bilateral fundus bleeding. RESULTS:Four of the 11 infants had some evidence of ROP, and two later received retinal ablation therapy. Contrary to the quick absorption (<1-2 weeks only) usually seen in most newborn term infants, the ocular bleeding in preterms was generally longstanding. A quick increase in intracranial pressure probably played a role in the lethal case with delivery near term, and one infant received lung physiotherapy for pneumonia at the age of 6 months. Some bleeding appeared to be truly postnatal (i.e. it was observed as a new occurrence during the course of surveillance). CONCLUSIONS:In the series under study there was no suspicion of child abuse. In term infants, retinal haemorrhages are extremely rare except when due to shaking, but other diseases should be ruled out, coagulopathies in particular. We suggest that prematurity as such is added to the list of possibly underlying causes when retinal bleedings are evaluated in very small infants and shaken baby mechanisms are suspected. For article link see: http://www.ncbi.nlm.nih.gov/pubmed/16029264 Examination induced retinal haemorrhage in preterm infants is uncommon. It may occur independently of retinopathy of prematurity (ROP) associated neovascularisation. Retinal haemorrhages due to ROP tend to occur on the surface of the neovascular ridge, which represents an arteriovenous shunt formed by the anastomosis of primitive retinal vessels.1 However, ROP related retinal haemorrhages occurring posteriorly,2 as well as vitreous haemorrhage,3 have also been described in advanced disease. Other common causes of retinal haemorrhage in infancy such as birth4 and shaken baby syndrome should be excluded. Retinal haemorrhage in a premature infant after RetCam photography has been reported.5 We report retinal haemorrhages in a premature infant immediately following examination for ROP.
Please see link for full article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860199/ A Witnessed Short Fall MimickingPresumed Shaken Baby Syndrome(Inflicted Childhood Neurotrauma)7/3/2015 Incidence, distribution, and duration of birth-related retinal hemorrhages: a prospective study6/30/2015 BACKGROUND:
Retinal hemorrhages secondary to birth trauma are part of the differential diagnosis of intraocular hemorrhages seen in the setting of Shaken baby syndrome in very young infants. This prospective study aimed to document the morphology, distribution and, most importantly, the natural history of these hemorrhages using digital imaging. SUBJECTS AND METHODS: Infants were recruited as soon after birth as possible and examined by indirect ophthalmoscopy. Retinal hemorrhages were photographed using the RetCam 120. Birth history was documented from the medical notes. Infants were reexamined and photographed until hemorrhages had resolved. RESULTS: Data were analyzed for a total of 53 neonates. The number of infants with retinal hemorrhage was 18 (34%). The incidence in relation to mode of delivery was as follows: vacuum delivery, 77.8%; normal vaginal delivery, 30.4%; cesarean section, 8.3%; forceps delivery, 30.3%. All hemorrhages were intraretinal and in all but two infants hemorrhages had resolved by 16 days. In two subjects hemorrhages were still present at 31 and 58 days, respectively. Both these infants were delivered by vacuum delivery. CONCLUSIONS: The RetCam 120 provides excellent documentation of retinal hemorrhages and their natural history. We have demonstrated hemorrhages still present at 58 days in a child born by vacuum delivery and this may have important implications for consideration in the differential diagnosis of Shaken baby syndrome. http://www.biomedsearch.com/nih/Incidence-distribution-duration-birth-related/16678742.html Abstract
Traumatic retinal hemorrhages in young children are considered pathognomonic of child abuse. We identified 3 children with unilateral retinal hemorrhages caused by accidental household trauma. The hemorrhages were ipsilateral to intracranial hemorrhage and isolated to the posterior retinal pole. (J Pediatr 1999;135:125-7) http://www.ncbi.nlm.nih.gov/pubmed/10393620 Retinal Hemorrhage After Cardiopulmonary Resuscitation in Children: An Etiologic Reevaluation6/30/2015 ABSTRACT
Retinal hemorrhage detected after cardiopulmonary resuscitation has important medical, social, and legal implications. When a child is brought to the hospital in circulatory arrest, these hemorrhages raise the question of preceding trauma, frequently child abuse.1 Several authors have suggested that retinal hemorrhage may be virtually pathognomonic of child abuse.2,3 We have questioned this belief because our experience, as well as that of others,4,5suggests that retinal hemorrhage may result from resuscitative efforts. We therefore undertook a prospective study to evaluate whether cardiopulmonary resuscitation can cause retinal hemorrhage. MATERIALS AND METHODS During a 4-month period, all children admitted to the Pediatric Critical Care Medicine Service who underwent cardiopulmonary resuscitation were considered for inclusion in the study. http://pediatrics.aappublications.org/content/85/4/585.abstract?ijkey=017d5ce3cd2decaa1be1b5f7e0bae03e8f6f00f4&keytype2=tf_ipsecsha The concept that certain eye injuries are diagnostic of shaken baby syndrome is scientifically questionable and needs to be re-examined, argue researchers in this week's BMJ.Shaken baby syndrome is a term used to describe the consequences of the forceful shaking of infants. It is usually recognised by a triad of injuries - bleeding into the eye and around the brain (subdural and retinal haemorrhages) and brain damage. Patrick Lantz and colleagues report the case of a healthy 14 month old child who was brought to hospital with a severe head injury after a television fell on him at home.... http://news.bio-medicine.org/medicine-news-2/Evidence-for-shaken-baby-syndrome-is-uncertain-3654-1/ Retinal haemorrhages in premature infants: a pathogenetic alternative diagnosis to child abuse6/30/2015 Abstract.Purpose: To present the occasional observation of retinal haemorrhages in premature babies, as a diagnostic alternative to those observed as part of shaken baby syndrome.
Methods: We carried out an observational study on 11 infants in whom retinal and/or vitreous haemorrhages had been observed within their first months of life. Ten infants were under surveillance for retinopathy of prematurity (ROP), with gestational ages and birth weights in the ranges of 27–34 weeks and 790–1665 g, respectively. One infant was diagnosed with Zellweger's syndrome and one received substitution therapy for coagulation factor II deficiency. The last child had been delivered at 38 weeks, weighing 2070 g; he died on day 5 from severe brain oedema with incarceration and extensive bilateral fundus bleeding. Results: Four of the 11 infants had some evidence of ROP, and two later received retinal ablation therapy. Contrary to the quick absorption (< 1–2 weeks only) usually seen in most newborn term infants, the ocular bleeding in preterms was generally longstanding. A quick increase in intracranial pressure probably played a role in the lethal case with delivery near term, and one infant received lung physiotherapy for pneumonia at the age of 6 months. Some bleeding appeared to be truly postnatal (i.e. it was observed as a new occurrence during the course of surveillance). Conclusions: In the series under study there was no suspicion of child abuse. In term infants, retinal haemorrhages are extremely rare except when due to shaking, but other diseases should be ruled out, coagulopathies in particular. We suggest that prematurity as such is added to the list of possibly underlying causes when retinal bleedings are evaluated in very small infants and shaken baby mechanisms are suspected. http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0420.2005.00471.x/abstract |