This large prospective study conducted in China found that a significant number of healthy newborns exhibit ocular abnormalities on digital ocular examination, with more than one-fifth of them showing retinal hemorrhage.
With such a large cohort of otherwise normal newborns showing retinal hemorrhages from birth trauma, perhaps traditional thinking on the significance will shift.
To the authors' knowledge, this is the first published report on data from a large neonatal eye examination program. China's Ministry of Health encourages newborn examination in detail as part of its National Children's Health Standard.
Of 3,573 healthy full-term newborns enrolled in the program and examined at the Maternal and Child Healthcare Hospital in China between May 2010 and June 2011, there were 871 cases with ocular abnormalities (24.4 percent). The majority of abnormal exams were retinal hemorrhage (22 percent of all newborns examined). Of these, there were 215 cases of significant retinal hemorrhage that were possibly sight threatening or amblyogenic, representing 6 percent of the total. In addition, 67 cases involved macular hemorrhage.
The other 107 cases with abnormal ocular findings included subconjunctival hemorrhage, congenital microphthalmos, congenital corneal leukoma, posterior synechia, persistent pupillary membrane, congenital cataract, enlarged C/D ratio, retinal hamartoma, optic nerve defects, macular pigment disorder and nonspecific peripheral retinopathy.
They write that it is an unsupported assumption that disorders of the neonatal fundus, particularly retinal hemorrhages due to birth trauma, are at best very rare and at worst transient and benign. This is, however, speculation and these data point to the need for further study in this area. Is it possible that some visual disturbances seen later in childhood (i.e., anisometropia, amblyopia) have their genesis or are manifest during the neonatal period? There are several theories being postulated that retinal blur may have a profound impact on normal optical development and emmetropization of the eye.
They conclude that it remains to be seen if early discovery of pathological findings can indeed lead to a decrease in visual morbidity. A protocol is currently being developed for the prospective examination of the newborn fundus along with sustained follow-up in order to track resolution and the possible sequelae of abnormalities discovered on digital examination.