Newborn retinal hemorrhages: a systematic review.
OBJECTIVE
To systematically review the characteristics, prevalence, evolution, and obstetric associations of retinal hemorrhages (RH) in newborns.


METHODS
A systematic review, searching 10 databases (1970-2011), identified 45 studies, which underwent two independent reviews via the use of standardized critical appraisal. Studies meeting the following criteria were included: examination by an ophthalmologist, use indirect ophthalmoscopy, and first examination conducted within 96 hours of birth and before hospital discharge.


RESULTS
Thirteen studies were included, representing 1,777 infants. The studies revealed that 25.6% of newborns born via spontaneous vaginal deliveries had RH. In contrast, infants delivered by vacuum extraction had a 42.6% rate of RH (OR, 2.75; 95% CI, 1.32-5.70), and infants delivered by double-instrument deliveries (forceps and vacuum) had a 52% rate of RH (OR, 3.27; 95% CI, 1.68-6.36). The hemorrhages are commonly bilateral (59%), of varying severity, from "mild" (22%-56%) to "severe" (18%-37%), and predominantly intraretinal and in the posterior pole. The majority of RH (83%) resolved within 10 days; isolated cases persisted to 58 days.


CONCLUSIONS
Birth-related RH in infants occurs in one-quarter of normal deliveries and are far more common after instrumental deliveries. Commonly bilateral, they were predominantly intraretinal, posterior, resolved rapidly, and very rarely persisted beyond 6 weeks.
Department of Ophthalmology, University Hospital of Wales, Heath Park, Cardiff, United Kingdom. patrickowatts@yahoo.co.uk
Patrick
P
Watts
Sabine
S
Maguire
Thomas
T
Kwok
Bnar
B
Talabani
Mala
M
Mann
Jarmila
J
Wiener
Zoe
Z
Lawson
Alison
A
Kemp
D001720:Birth Injuries / Q000453:epidemiology*; D016208:Databases, Factual; D036861:Delivery, Obstetric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015995:Prevalence; D012166:Retinal Hemorrhage / Q000453:epidemiology*; D012307:Risk Factors