Should Ocular Hemorrhage Screening be Conducted in Newborns with Acidosis?

Sezin Unal; Caner Kara; Nihal Demirel; Seza Petriçli; Sumru Kavurt; Elif Uzlu; Mehtap Durukan; Ahmet Yagmur Bas

doi:10.1055/s-0044-1780512

Should Ocular Hemorrhage Screening be Conducted in Newborns with Acidosis?

Am J Perinatol. 2024 Feb 16. doi: 10.1055/s-0044-1780512. Online ahead of print.

Authors

Sezin Unal¹, Caner Kara², Nihal Demirel³, Seza Petriçli², Sumru Kavurt¹, Elif Uzlu¹, Mehtap Durukan¹, Ahmet Yagmur Bas³

Affiliations

¹ Department of Neonatology/Pediatrics, University of Health Sciences, Etlik Zubeyde Hanim Maternity Teaching and Research Hospital, Ankara, Turkey.
² Department of Ophtalmology, University of Health Sciences, Etlik Zubeyde Hanim Maternity Teaching and Research Hospital, Ankara, Turkey.
³ Division of Neonatology, Department of Pediatrics, Ankara Yıldırım Beyazıt University, Ankara, Turkey.

PMID: 38365214
DOI: 10.1055/s-0044-1780512

Abstract

Objective: Ocular hemorrhages (OHs) may cause visual disturbances and incidence vary from 18 to 39% in newborns. Precipitated/instrumental delivery and perinatal asphyxia were predefined risk factors. Acidosis can interfere with coagulation and disrupt the pressure of ocular capillaries and put infants with moderate acidosis with or without hypoxic-ischemic encephalopathy at risk for OH. We aimed to evaluate the OH in neonates with fetal acidosis.

Study design: Neonates >34 weeks are included if pH < 7.10 and BE < -12 mmol/L within the first hour. Ophthalmologic examinations for retinal (RH), vitreous, and anterior chamber (hyphema) hemorrhage were done within the third day. RH was staged according to Egge's classification. Follow-up of the patients was continued until the age of 2. Clinical characteristics of newborns were analyzed.

Results: Sixty-two neonates (38 ± 2.3 weeks, 2,971 ± 612 g) were included. pH = 6.91 ± 0.16, BE = - 17.2 ± 5.3 mmol/L. OH was found in 22 (36.7%) neonates (hyphema n = 2, vitreous n = 2, RH n = 21). Thirty-eight eyes with RH were staged (Stage 3: n = 15 [39.5%]; Stage 2: n =11 [28.9%]; Stage 1: n = 12 [31.6%]). Vaginal delivery (OR: 4.9, 95% CI [1.4-17.8]) and advanced resuscitation at the delivery room (OR: 8.8; 95% CI [1.9-41.7]) were found to increase the risk of RH.

Conclusion: Approximately one-third of neonates with moderate to severe acidosis exhibited RH when examined on the third day. Contrary to previous studies that reported mild RH in otherwise healthy neonates, our findings revealed that neonates with moderate to severe acidosis predominantly presented with Stage 3 RH. While the higher incidence of RH in vaginally delivered infants is consistent with previous studies, the identification of advanced resuscitation as a risk factor is a new addition to the literature. The findings in our study highlight the importance of retinal examination in neonates with acidosis in the presence of intubation during resuscitation.

Key points: · One-third of neonates with moderate to severe acidosis exhibited RH.. · Stage 3 RH was identified as the most prevalent.. · Advanced resuscitation was identified as an independent risk factor for RH..