Yale study clarifies when bleeding in newborns' eyes is due to hemorrhaging at birth or possible child abuse

January 03, 2001

New Haven, Conn. - A new Yale study may help to clarify whether hemorrhaging in a baby's eyes is due to child abuse or simply a lingering effect of birth.

The researchers found that retinal hemorrhaging caused by the pressure of moving through the birth canal cleared up within two to four weeks in all but one of 149 infants who were examined. The one infant who had hemorrhaging beyond four weeks showed no signs of retinal bleeding by six weeks of age.

"The conclusion is if you see retinal hemorrhages in a baby beyond two to four weeks of age, you have to be much more concerned that abuse has occurred," said Ray Gariano, M.D., assistant professor of ophthalmology at Yale School of Medicine and senior author of the study published in the January issue of the journal Ophthalmology.

The finding has implications in evaluation of suspected cases of child abuse, particularly in instances of so-called "shaken baby syndrome," where hemorrhaging in a baby's eyes could be blamed on residual effects of birth trauma.

Gariano said he and his fellow researchers hope their results might assist legal teams to prepare a more precise defense or prosecution in a case of child abuse. The other researchers are M. Vaughn Emerson, a medical student; Dante Piemamici, M.D., at the time assistant professor of ophthalmology; Kathleen Stoessel, M.D., associate clinical professor of ophthalmology, and John Berreen, M.D., at the time a clinical instructor in ophthalmology.

"There has always been this concern in babies the first month, or two, or three, that if you see retinal hemorrhages, are they from birth trauma that hasn't cleared yet, or are they actually from abuse?" Gariano said.

He said that retinal hemorrhaging in newborns is common and does not by itself cause subsequent visual or neurological problems, although it may be associated with systemic and other ocular pathology.

"Intraretinal hemorrhages are a key feature of the shaken baby syndrome, but also are seen in certain diseases," Gariano said. "Characteristics that distinguish between hemorrhages due to birth or to trauma may be critical in assessment of possible child abuse. The time course for spontaneous clearing of birth-related hemorrhage may facilitate differentiation of traumatic hemorrhage from birth-related retinal hemorrhage, but this has not been systematically evaluated, until this study."

The researchers examined 149 infants within 30 hours of birth. They found that one in three newborns had intraretinal hemorrhages. The bleeding varied from a single dot hemorrhage in one eye to bilateral widespread hemorrhages.

The researchers then examined the babies at two week intervals until evidence of the hemorrhaging had disappeared.

"At two weeks of age, 86 percent of the babies that had hemorrhages no longer showed any evidence of intraretinal bleeding," Gariano said. "By four weeks there was only one. And the eyes of that single child showed no evidence of retinal hemorrhaging six weeks after birth."
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Yale University

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