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Darius M Moshfeghi, Cassie A. Ludwig, Natalia Fijalkowski Callaway; Fundus Hemorrhages in a Term Newborn and Preterm Population: Does Examination Timing Influence Findings?. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):963.
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© ARVO (1962-2015); The Authors (2016-present)
The influence of timing of ophthalmic screening of newborns with digital imaging on findings of fundus hemorrhages is yet to be determined. In this retrospective cohort study, we aimed to compare the incidence of retinal hemorrhages to determine if the timing of screening influenced the rate of hemorrhagic fundus findings in two populations: 1) a consecutive series of term newborns prospectively enrolled in the Newborn Eye Screen Testing Study (NEST) at Stanford University and 2) preterm infants in the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) program.
202 newborns were prospectively enrolled in the NEST trial and 73 premature newborns in the SUNDROP program from 7/18/13-7/17/14. Newborns in the NEST trial were imaged within the first 72 hours of life to evaluate ophthalmic pathology present in normal term newborns. Newborns in the SUNDROP trial were imaged beginning at 31 weeks post-menstrual age or 4 weeks chronological age, whichever was greater. In both trials, a standardized form was filled out that included tracking of the incidence of fundus hemorrhage. We compared the incidence of hemorrhages in both populations over the same time period and evaluated the impact of age, birth weight, weight at exam, gender, and retinopathy of prematurity to determine their relationship to fundus hemorrhages.
The incidence of fundus hemorrhages in the NEST trial was 20.3% and in the SUNDROP trial was 1.4%, affecting 16.1% and 0.8% of eyes in the NEST and SUNDROP trials, respectively. In the SUNDROP trial, 1 eye of 1 patient had fundus hemorrhage, and this occurred in the presence of Stage 1 ROP. The mean gestational age at birth was 39.1 and 28.6 weeks, in the NEST and SUNDROP trials, respectively. The mean chronological age at first exam was 0.3 weeks in the NEST trial and 4.6 weeks in the SUNDROP trial. Mean birth weight was 1144.8 grams in SUNDROP and the daily weight at first exam was 1697.8 grams. A total of 10 patients in the SUNDROP trial had ROP at first exam during the time period, affecting 16 eyes.
There was a significant difference in the rate of fundus hemorrhages between the NEST population imaged within 72 hours of birth and the preterm SUNDROP population imaged 4.6 weeks later. Likely, this difference is due to the transient nature of the hemorrhages themselves.
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