Document Detail

Retinal haemorrhages in premature infants: a pathogenetic alternative diagnosis to child abuse.
MedLine Citation:
PMID:  16029264     Owner:  NLM     Status:  MEDLINE    
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.
Hans C Fledelius
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Acta ophthalmologica Scandinavica     Volume:  83     ISSN:  1395-3907     ISO Abbreviation:  Acta Ophthalmol Scand     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-07-20     Completed Date:  2005-09-01     Revised Date:  2008-03-17    
Medline Journal Info:
Nlm Unique ID:  9507578     Medline TA:  Acta Ophthalmol Scand     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  424-7     Citation Subset:  IM    
Rigshospitalet, Eye Department, Copenhagen University, Copenhagen, Denmark.
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MeSH Terms
Birth Weight
Gestational Age
Infant, Newborn
Infant, Premature
Retinal Hemorrhage / diagnosis*,  etiology*
Retinopathy of Prematurity / complications,  diagnosis*
Shaken Baby Syndrome / complications,  diagnosis*
Vitreous Hemorrhage / diagnosis,  etiology

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