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Retinal haemorrhages in newborn infants.

1971; BMJ; Volume: 55; Issue: 4 Linguagem: Inglês

10.1136/bjo.55.4.248

1468-2079

Fazil Sezen,

Homicide, Infanticide, and Child Abuse

Although neonatal retinal haemorrhage is a common pathological finding in about 20 per cent. of newborn infants, the cause of this condition is still not well understood.Jager (i86i) is generally accepted as the first author to have reported the condition.Estimates of its incidence have varied from 2 -6 to 50 per cent. (Duke-Elder and Dobree, I967).Chace, Mlerritt, and Bellows (1950), in a study of more than i,ooo newborn in- fants, found retinal haemorrhages in 2 -6 per cent.;Belmonte Gonzalez (I 947) in 27-4 per cent. of I24; Cavrot (1956) in 20 per cent. of 42I; Kauffman (I958) in I8-2 per cent. of 7,727; Giles (I960) in 40 per cent. of IOO infants.The types of retinal haemorrhage have been described by many authors, including Mezey (1952) and Schenker and Gombos (I966).They were classified by Richman (1938) into four groups:(a) Flame-shaped; (b) More or less circular in the deeper layers of the retina; (c) Sharply circumscribed, perfectly round, and deep red; (d) Subhyaloid.Many possible causes have been suggested.Schleich (I884) thought they were due to increased venous pressure within the cavernous sinus with congestion of the ophthalmic veins.Naumoff (i890) found retinal haemorrhage in a patient with compression of the central retinal vein.Ehrenfest (1922) stated that a haemorrhagic diathesis was present in infants who manifested retinal haemorrhages at birth.Pietrowa (1956) attributed them to vitamin K deficiency.Chace and others (1950), Musini and Grassi (1950), and Singer, Sgallova and Kudrnovsky (1956) thought that prothrombin deficiency was the cause.On the other hand, most investigators (Schleich, I884; Paul, I900; Lemmingson and Stark, 1957; Sanchez Ibafiez, Belmonte Gonzalez, and Navarro Martinez, I963) suggested that they resulted from obstetric trauma.Krauer-Mayer (i966) found 50 per cent.and Neuweiler and Onwudiwe (I966) 72 per cent. in cases of forceps delivery in which ophthalmoscopic examination had been performed within 24 hours after birth. Material and methodsIn this study, I,238 newborn infants were examined in the Department of Gynaecology and Obstetrics of the Faculty of Medicine at Istanbul University.One hour after the instillation of 5 per cent.homatropine solution, Sauer's speculum was inserted for the examination of the infant's eye and the Jena ophthalmoscope was used for fundus examination, the head being held by a nurse.709 were seen within the first 24 hours after birth, 304 within 25 to 48 hours, and 225 between the 3rd and 5th day.All infants with retinal haemorrhages were examined at approximately 24-hr intervals and were followed until the haemorrhages disappeared.