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D. M. Esposito, T. L. Nguyen, R. G. Josephberg; The Medical-Legal Implications of Rapid Clearance of Retinal Hemorrhaging in Shaken Baby Syndrome (SBS). Invest. Ophthalmol. Vis. Sci. 2009;50(13):3181.
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Previously, it was thought that the extensive hemorrhages seen in Shaken Baby Syndrome (SBS) last several months, however there are few studies that support this concept. This study set out to document how quickly retinal hemorrhages disappear in infants with SBS. Since the presence of retinal hemorrhages in infants upon dilated fundus examination is an essential component to making the diagnosis of SBS, this study also set out to determine the optimal time-frame for retinal examination of infants with the suspected diagnosis of SBS.
An observational case series. Over a period of four consecutive months, dilated fundus examinations were performed for all infants that presented to Westchester Medical Center with the suspected diagnosis of SBS. The initial examinations were performed within two days of admission. All infants identified with retinal hemorrhages were examined by the same investigator (RGJ). Subsequently, all infants with retinal hemorrhages were then followed with periodic dilated fundus examinations until the hemorrhages had resolved by indirect ophthalmoscopy.
Five infants with bilateral retinal hemorrhages, a total of ten eyes, were identified. All infants had more significant hemorrhaging in one eye versus the other and all were found to have bleeding in the brain. A few eyes with minimal amounts of retinal hemorrhage cleared entirely within the first 72 hours. The vast majority of the eyes with more extensive retinal hemorrhages had cleared by 2 weeks and 100% had disappeared entirely by 2 ½ weeks.
Extensive retinal hemorrhages, comparable to those seen in central retinal vein occlusions, have been shown to rapidly disappear within 2 to 2 ½ weeks time in infants with SBS. Minimal amounts of retinal hemorrhage have been shown to disappear entirely within 72 hours. Since retinal hemorrhages in infants with SBS have been shown to rapidly clear, delay in retinal examination may result in a failure to accurately diagnose SBS. Thus for medical-legal purposes, initial ophthalmologic examination for infants with the suspected diagnosis of SBS should ideally be performed within 72 hours of admission to the hospital.
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