title: Retinal haemorrhages associated with fatal paediatric infections.
abstract: For many physicians, retinal haemorrhages (RHs) in infants and young children remain highly diagnostic of non-accidental (abusive) head trauma. Because clinicians have applied indirect ophthalmoscopy selectively to cases of suspected child abuse, the association between RH and other conditions such as infection, coagulopathy and accidental trauma has encountered habitual bias, creating the potential for iatrogenic misdiagnosis of child abuse. We present an autopsy case series of four children, aged three years old or younger, in whom RHs were detected by post-mortem monocular indirect ophthalmoscopy after the patients had died from infections. We discuss the laterality, number, type and location of RHs in these cases, and summarize proposed mechanisms of RH formation in fatalities from paediatric infection. We demonstrate that many of the ophthalmological findings that have been considered diagnostic of abusive head trauma can also occur in association with infective processes.
authors.affiliation: Oxford University Hospitals NHS Trust, UK.
authors.forename: Marcus C
authors.initials: MC
authors.lastname: Salvatori
authors.affiliation: Department of Pathology, Wake Forest University School of Medicine, USA plantz@wakehealth.edu.
authors.forename: Patrick E
authors.initials: PE
authors.lastname: Lantz
mesh_terms: D002675:Child, Preschool; D004751:Enteritis / Q000150:complications*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008589:Meningococcal Infections / Q000150:complications*; D008590:Meningoencephalitis / Q000150:complications*; D009887:Ophthalmoscopy; D053120:Respiratory Aspiration / Q000209:etiology; D012166:Retinal Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D018805:Sepsis / Q000150:complications*; D013345:Subarachnoid Hemorrhage / Q000473:pathology
keywords: Forensic science; abusive head trauma; encephalitis; infection; intraocular haemorrhage; meningitis; non-accidental head injury; retinal haemorrhage; sepsis; shaken baby syndrome