Differing characteristics of retinal hemorrhage due to abuse versus vaginal delivery

This study retrospectively compared retinal hemorrhages (RHs) in infants who experienced abusive head trauma (AHT) versus infants who had normal vaginal deliveries (NVD).

Study design

RetCam images of 20 patients with AHT were obtained at the University of Nebraska Medical Center while images of 200 infants with NVD were obtained from a universal newborn eye screening program in South Korea.

Outcomes

Hemorrhages in the AHT group were significantly larger (3.1 vs 0.96 disk diameters), more likely to involve all 3 retinal layers (60% vs 0.6%), more likely to have associated vitreous hemorrhages (54.3% vs 1.5%) and had higher RH grading scale scores (7.2 vs 3.6) than in the NVD group.

Resolution of NVD retinal hemorrhages occurred within 4 weeks of birth in 95% of the patients (1 case associated with vitreous hemorrhage took 12 weeks to resolve). All infants in the AHT group had at least one accompanying neurological finding, including subdural hematoma (95%), loss of consciousness (65%) and seizure (65%).

Limitations

The AHT group was relatively small and the NVD infants were seen within 7 days of birth. Small intraretinal hemorrhages may have resolved prior to the exam.

Clinical significance

While RH associated with NVD is very common, severe RH seen 1 month after birth—particularly, hemorrhages involving all 3 retinal layers or associated with vitreous hemorrhages—should be evaluated for AHT. When severe RHs occur in very young newborns, neurologic findings should be carefully considered when making a diagnosis of AHT.