title: Does valsalva retinopathy occur in infants? An initial investigation in infants with vomiting caused by pyloric stenosis.
abstract: OBJECTIVE
  Retinal hemorrhages (RHs) are 1 manifestation of child abuse, and although they often are considered to be diagnostic of abuse in a young child, there are other potential causes. RHs have been described in association with valsalva maneuver, such as forceful vomiting or coughing. Our aim was to describe the incidence of RH in infants with vomiting caused by pyloric stenosis.
  
  
  METHODS
  A prospective, descriptive study was conducted of infants who underwent pyloromyotomy for hypertrophic pyloric stenosis (HPS). Dilated retinal examinations were performed, and the findings were documented.
  
  
  RESULTS
  A total of 100 infants with HPS were evaluated. Eighty-four infants were male, 92 were white, and 21 had a family history of pyloric stenosis. Thirty-seven examinations were performed in the operating room. Eighteen examinations were confirmed by a second investigator, and 3 children had dilated eye examinations documented independently by a pediatric ophthalmologist. No RHs were identified (0 of 100; 95% confidence interval: 0%-3%). One patient had facial petechiae, and 2 had subconjunctival hemorrhage. Electrolyte levels were abnormal in 63 patients. In 89 cases, the emesis was described as projectile. Patients varied in the number of episodes of emesis, with 30% of patients having >100 episodes of emesis before diagnosis. One patient had a respiratory arrest associated with vomiting in the emergency department and required bag-valve mask ventilation.
  
  
  CONCLUSIONS
  No RHs were identified in 100 infants with vomiting caused by HPS. These results suggest that RHs do not result from forceful vomiting in infants.
authors.affiliation: Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. sandra.herr@louisville.com
authors.forename: Sandra
authors.initials: S
authors.lastname: Herr
authors.forename: Mary C
authors.initials: MC
authors.lastname: Pierce
authors.forename: Rachel P
authors.initials: RP
authors.lastname: Berger
authors.forename: Henri
authors.initials: H
authors.lastname: Ford
authors.forename: Raymond D
authors.initials: RD
authors.lastname: Pitetti
mesh_terms: D002649:Child Abuse / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006984:Hypertrophy; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D011707:Pyloric Stenosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D012166:Retinal Hemorrhage / Q000209:etiology*; D014839:Vomiting / Q000150:complications*