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Natalia Fijalkowski Callaway, Cassie Ludwig, Darius M Moshfeghi; Newborn Retinal Hemorrhages: One-year Results of the Newborn Eye Screening Test (NEST) Study. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2031.
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Retinal hemorrhages at birth may interfere with the visual axis early in life and and go undetected in current screening paradigms. The purpose of this study is to determine the birth prevalnce of retinal hemorrhages among universally screened newborns and further describe the risk factors and characteristiscs of retinal hemorrhages.
This study was approved by the IRB at Stanford University (#25098). The newborn eye screening test (NEST) study is a prospective cohort study evaluating universal newborn screening with RetCam III wide-angle digital photography. Screening was offered to all infants born from 07/25/2013 to 07/25/2014 who did not receive retinopathy of prematurity (ROP) screening. A trained NICU-nurse obtained a standardized series of six telemedicine images per eye. A pediatric vitreoretinal specialist reviewed the images and recorded ophthalmic examination findings. The birth prevalence, characteristics and potential risk factors for retinal hemorrhage were collected. SAS 5.1 was used for all statistical analyses including appropriate crude bivariate comparisons and logistic regression modeling for adjusted risk factor determination.
203 subjects (24% participation rate) were screened during the study period with 39 subjects (19% of those screened) demonstrating retinal hemorrhages (Figure 1). The retinal hemorrhages involved the macula in 34 subjects (87%). The baseline characteristics of the screened cohort are shown in Table 1. Vaginal delivery was signficicantly more frequent among infants with retinal hemorrhage (92% vs. 55%, p < 0.001). Retinal hemorrhages were most commonly 360 degrees (29%), white-centered (57%), and multiple (64%). The odds ratio for retinal hemorrhage was 10.5 (CI: 3.1 - 36.0) with vaginal birth. There was no statisical difference in retinal hemorrhage by gender, race, advanced maternal age, low birth weight, or mom's first delivery.
Retinal hemorrhages are present in a significant number of full-term newborns and the long-term significance of these findings remains unknown. Vaginal delivery increases the odds of retinal hemorrhage.
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