The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.
Review last updated in June 2012
The finding of retinal haemorrhages in a child aged less than three years with an intracranial injury has a positive predictive value of 71% (odds ratio 3.504) for abusive head trauma 1. However, retinal haemorrhages have also been described in non-abusive injury 2, other disease states 3 and newborn infants 4-7. Increasing emphasis has been placed on the detailed pattern of retinal findings and whether these characteristics may aid in distinguishing abusive head trauma from other aetiologies 8.
Recent studies have highlighted retinal findings in conditions that may mimic abuse. There are still no studies to date which set out to determine the evolution of retinal haemorrhages to enable dating of these injuries.
The review seeks to answer the following review questions:
-
What differences are found between abusive head trauma retinal findings versus non-abusive head trauma retinal findings? (only include children < 11 years)
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What are the differential diagnoses of retinal haemorrhages in children with clinical features associated with child abuse? (only include children < 11 years)
- Retinal haemorrhages in newborn infants:
a) What are the retinal findings in newborn infants?
b) What are the obstetric correlates to retinal haemorrhages in the newborn?
c) What is the evolution of newborn retinal haemorrhages?
4. Can you date retinal findings in children? (only include children < 11 years)*
*To date, there have been no studies that specifically set out to address this question
References
- Maguire SM, Pickerd N, Farewell D, Mann MK, Tempest V, Kemp AM. Which clinical features distinguish inflicted from non-inflicted brain injury? A systematic review. Archives of Disease in Childhood. 2009;94(11):860-867 [Pubmed]
- Vinchon M, Defoort-Dhellemmes S, Noulé N, Duhem R, Dhellemmes P. Accidental or non-accidental brain injury in infants. Prospective study of 88 cases [French]. Presse Médicale. 2004;33(17):1174-1179 [Pubmed]
- Kafil-Hussain NA, Monavari A, Bowell R, Thornton P, Naughten E, O'Keefe M. Ocular findings in glutaric aciduria type 1. Journal of Pediatric Ophthalmology and Strabismus. 2000;37(5):289-293 [Pubmed]
- Svenningsen L, Eidal K. Lack of correlation between umbilical artery pH, retinal hemorrhages and Apgar score in the newborn. Acta Obstetricia et Gynecologica Scandinavica. 1987;66(7):639-642 [Pubmed]
- Svenningsen L, Lindemann R, Eidal K, Jensen O. Neonatal retinal hemorrhages and neurobehavior related to tractive force in vacuum extraction. Acta Obstetricia et Gynecologica Scandinavica. 1987;66(2):165-169 [Pubmed]
- Svenningsen L, Eidal K. Retinal hemorrhages and traction forces in vacuum extraction. Early Human Development. 1988;16(2-3):263-269 [Pubmed]
- Svenningsen L, Lindemann R, Eidal K. Measurements of fetal head compression pressure during bearing down and their relationship to the condition of the newborn. Acta Obstetricia et Gynecologica Scandinavica. 1988;67(2):129-133 [Pubmed]
- Levin AV. Ophthalmology of shaken baby syndrome. Neurosurgery Clinics of North America. 2002;13(2)201-11 [Pubmed]