Retinal hemorrhages in intubated pediatric intensive care patients.
OBJECTIVE
To define the diagnoses associated with the presence of retinal hemorrhages, to clarify the association between retinal hemorrhages, cardiopulmonary resuscitation (CPR), and coagulopathy, and to describe the type of retinal hemorrhages found in intubated critically ill patients <4 years of age.


METHODS
This was a prospective observational study of intubated patients <4 years of age admitted to the pediatric intensive care unit of a tertiary care center from March 2010 to May 2012. The presence and description of retinal hemorrhages was recorded along with diagnoses, international normalized ratio (INR), CPR (in minutes), and mortality.


RESULTS
A total of 85 intubated, critically ill patients (37 females) were included; average patient age was 8.2 months (range, 0.1-46.8 months). Of the 85 patients, 6 (7%) had retinal hemorrhages (95% CI, 0.029-0.153). Of the 6 patients with RH, abusive head trauma (AHT) was diagnosed in 4 patients, 1 patient had direct head trauma, and 1 had CPR. There were 8 patients with CPR out of the 85. AHT was highly associated with severe multilayered retinal hemorrhages (P = 0.0001) but coagulopathy (P = 0.2671) and CPR (P = 0.5342) were not.


CONCLUSIONS
Severe multilayered retinal hemorrhages were associated with AHT in this cohort of patients. Without a history of trauma, retinal hemorrhages occurred in only 1 of 85 patients; in this case the hemorrhages were mild, confined to the posterior pole, and found only in the retinal layer.
Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa; Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa. Electronic address: Susannah-longmuir@uiowa.edu.
Susannah Q
SQ
Longmuir
Carver College of Medicine, Iowa City, Iowa.
Lindsay
L
McConnell
Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Resmiye
R
Oral
Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Alina
A
Dumitrescu
Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Sameer
S
Kamath
Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Gwen
G
Erkonen
D002649:Child Abuse / Q000175:diagnosis; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis; D016638:Critical Illness / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D007440:Intubation / Q000706:statistics & numerical data; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012166:Retinal Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology