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Retinal haemorrhages of children in the intensive care unit

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.


Two studies have examined children admitted to the intensive care unit for the prevalence of retinal haemorrhages 1,2


One study included children aged six weeks to six years, excluding penetrating eye trauma and abusive head trauma 1. 24 out of 159 children (15.1%) had retinal haemorrhages and 12 out of the 24 had unilateral retinal haemorrhages, with 11 having the haemorrhages restricted to Zone 1. Severity of bleeding was mild to moderate in 75% of children. There were seven cases of trauma, of which two were road traffic accidents and one was a crush injury. The remaining cases had leukaemia, sepsis, or intra-cerebral abnormalities.


The second study 2 examined all children who were intubated in the intensive care unit, aged 0-4 years. Those with retinopathy of prematurity, retinoblastoma, retinal trauma, or previous retinal haemorrhages were excluded. Excluding four cases with abusive head trauma, 2 out of 81 children had retinal haemorrhages, one of whom had sustained a crush injury and one cardiac arrest and CPR.  Both of theses cases had bi-lateral mild to moderate retinal haemorrhages. The child with a crush injury had multi-layered retinal haemorrhages. The infant undergoing cardiopulmonary resuscitation who died of hypoxic ischemic encephalopathy had mild haemorrhages in the retinal layer, exclusively in the posterior pole. Correspondence with the author confirmed that abuse had been excluded by the child abuse team in this case.


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  1. Adams GG, Agrawal S, Sekhri R, Peters MJ, Pierce CM. Appearance and location of retinal haemorrhages in critically ill children. British Journal of Ophthalmology. 2013;97(9):1138-1142 [Pubmed]

  2. Longmuir SQ, McConnell L, Oral R, Dumitrescu A, Kamath S, Erkonen G. Retinal hemorrhages in intubated pediatric intensive care patients. Journal of AAPOS. 2014;18(2):129-133 [Pubmed]


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