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Am J Perinatol 2024; 41(13): 1755-1760
DOI: 10.1055/s-0044-1780512
Original Article

Should Ocular Hemorrhage Screening Be Conducted in Newborns with Acidosis?

Sezin Unal 
1   Department of Neonatology/Pediatrics, University of Health Sciences, Etlik Zubeyde Hanim Maternity Teaching and Research Hospital, Ankara, Türkiye
,
Caner Kara
2   Department of Ophtalmology, University of Health Sciences, Etlik Zubeyde Hanim Maternity Teaching and Research Hospital, Ankara, Türkiye
,
Nihal Demirel
3   Division of Neonatology, Department of Pediatrics, Ankara Yıldırım Beyazıt University, Ankara, Türkiye
,
Seza Petriçli
2   Department of Ophtalmology, University of Health Sciences, Etlik Zubeyde Hanim Maternity Teaching and Research Hospital, Ankara, Türkiye
,
Sumru Kavurt
1   Department of Neonatology/Pediatrics, University of Health Sciences, Etlik Zubeyde Hanim Maternity Teaching and Research Hospital, Ankara, Türkiye
,
Elif Uzlu
1   Department of Neonatology/Pediatrics, University of Health Sciences, Etlik Zubeyde Hanim Maternity Teaching and Research Hospital, Ankara, Türkiye
,
Mehtap Durukan
1   Department of Neonatology/Pediatrics, University of Health Sciences, Etlik Zubeyde Hanim Maternity Teaching and Research Hospital, Ankara, Türkiye
,
Ahmet Yagmur Bas
3   Division of Neonatology, Department of Pediatrics, Ankara Yıldırım Beyazıt University, Ankara, Türkiye
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Funding None.
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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.

Keywords

retinal hemorrhages - newborn infants - metabolic acidosis - advanced resuscitation

Ethical Approval

This study was approved by the University of Health Sciences, Etlik Zubeyde Hanım Hospital Ethics Committee (approval number: EZH/2020:01).


Authors' Contributions

S.Ü. and C.K. conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. S.P. and S.K. designed the data collection instruments, collected data, performed the initial analyses, and reviewed and revised the manuscript. N.D., M.D., and E.U. collected data, performed the initial analyses, and reviewed the manuscript. S.Ü., N.D., and A.Y.B. conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.




Publication History

Received: 03 October 2023

Accepted: 19 January 2024

Article published online:
16 February 2024

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