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Yang T, Hu R, Chen J, Lu Y, Guo Y, Liu Y, Yu R, Jin G. Prevalence, Characteristics, and Risk Factors of Retinal Hemorrhage among Full-Term Neonates in Southern China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13927. [PMID: 36360805 PMCID: PMC9654104 DOI: 10.3390/ijerph192113927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
Neonatal retinal hemorrhage (RH) is the most common ocular fundus disease among newborns. Early detection and timely intervention are vital for reducing the risk of visual impairment caused by RH. However, little is known about the prevalence, characteristics, and risk factors of RH in southern China. Full-term infants born in Qingyuan City during the first 10 days of each month in 2021 were included in this study. All infants underwent RetCam III retinal examinations. Detailed information on retinal hemorrhage, including involved eyes, bleeding severity, and affected area (extrafoveal macula, fovea, or optic disc), and clinical information on the neonates and their mothers was collected. The results showed that among the 1072 eligible neonates, 266 (24.8%) had neonatal retinal hemorrhage. Consistent bilateral retinal hemorrhage severity was observed in 83.2% of the cases. The prevalence of optic disc involved RH, extrafoveal macular involved RH and foveal involved RH were 23.7%, 81.2% and 2.63%, respectively. Multivariate logistic regression analysis showed that lower birth weight (OR, 0.63; 95% CI, 0.40-0.99; p < 0.05) and vaginal delivery (OR, 20.6; 95% CI, 9.10-46.5; p < 0.001) were risk factors of neonatal RH. The area under the ROC curve of vaginal delivery, combined with birth weight, as predictors of neonatal RH was 0.73, with 85.3% sensitivity and 23.9% specificity. The birth weight cutoff was 3460 g. Our results suggested that neonatal RH is common in full-term neonates in southern China. It usually has the same severity in both eyes and mostly involves the extrafoveal macular region. Vaginal delivery and low birth weight are risk factors for neonatal RH.
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Affiliation(s)
- Tingting Yang
- Department of Ophthalmology, First Affiliated Hospital of Jinan University, Jinan University, Guangzhou 510632, China
- Department of Ophthalmology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People’s Hospital, Qingyuan 511518, China
| | - Rongsheng Hu
- Department of Urology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People’s Hospital, Qingyuan 511518, China
| | - Jiansu Chen
- Institute of Ophthalmology, Medical College, Jinan University, Guangzhou 510632, China
| | - Yamei Lu
- Department of Ophthalmology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People’s Hospital, Qingyuan 511518, China
| | - Yonglong Guo
- Department of Ophthalmology, First Affiliated Hospital of Jinan University, Jinan University, Guangzhou 510632, China
| | - Yao Liu
- Department of Ophthalmology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People’s Hospital, Qingyuan 511518, China
| | - Ruixia Yu
- Department of Ophthalmology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People’s Hospital, Qingyuan 511518, China
| | - Guangming Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Sun Yat-sen University, Guangzhou 510060, China
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Yaoyao S, Kaixin D, Xiaoxin L, Min Z, Yanrong J, Hong Y, Huijun Q, Tong Q, Dandan L, Wenzhen Y, Mingwei Z, Jianhong L. Analysis of non-retinopathy of prematurity (ROP)-related fundus hemorrhage in preterm infants in China. Front Pediatr 2022; 10:985268. [PMID: 36225339 PMCID: PMC9548691 DOI: 10.3389/fped.2022.985268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine the incidence of fundus hemorrhage (FH) not associated with retinopathy of prematurity (ROP) during ocular screening and report their clinical features, risk factors, therapies, and prognosis in a large population of premature newborns. METHODS The medical records of all preterm newborns admitted to the Department of Ophthalmology, Peking University People's Hospital, Beijing, from January 1, 2016 through August 31, 2021 were retrospectively reviewed. Fundus examinations were carried out by experienced retinal experts. Examination under anesthesia was carried out in newborns with abnormal fundus including vitreous hemorrhage (VH) or retinal hemorrhage (RH) >2 disks' diameter by a Retcam 2 system. A lens-preserving vitrectomy was performed in infants requiring a vitrectomy. A comprehensive medical history was also recorded and analyzed. RESULTS During the 5-year period, a total of 7,260 preterm babies were screened. There were 82 (1.13%) newborns and 104 (0.72) eyes with FH, including VH or RH.Twelve (14.63%) newborns (16 eyes, 15.38%) had VH; 56 (68.29%) (74 eyes, 71.15%) had flame-shaped, superficial hemorrhages; six (7.31%) (6 eyes, 5.77%) had small, round, deep hemorrhages (<2 disk diameters in size); and eight (9.76%) (8 eyes, 7.69%) had large, round hemorrhages (>2 disk diameters). In all, there were 10 (12.20%) cases of intracranial hemorrhage. The mode of delivery was not found to be a significant factor in the occurrence of birth-related retinal hemorrhage (P = 0.22).Six newborns (eyes) with large, round retinal hemorrhage at the posterior pole while the macular was not impacted and 11 cases (15 eyes) with vitreous hemorrhage were required to receive close follow-up with average follow-up time of 105 days. A lens-sparing vitreous surgery was conducted in three patients without any complications. CONCLUSION Preterm newborns with FH that are not caused by ROP are more likely to have superficial, peripheral hemorrhages. Vaginal delivery compression and forceps may be associated with hemorrhage. A lens-preserving vitrectomy is required and considered safe for dense FH involving the refractive media.
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Affiliation(s)
- Sun Yaoyao
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Deng Kaixin
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China.,Department of Ophthalmology, Beijing Jishuitan Hospital, Beijing, China
| | - Li Xiaoxin
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Zhao Min
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Jiang Yanrong
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Yin Hong
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Qi Huijun
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Qian Tong
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Linghu Dandan
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Yu Wenzhen
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Zhao Mingwei
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
| | - Liang Jianhong
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Diseases and Optometry Institute, Beijing, China.,Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,College of Optometry, Peking University Health Science Center, Beijing, China
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Wood EH, Capone A, Drenser KA, Berrocal A, Hubbard GB, Callaway NF, Kychenthal A, Ells A, Harper CA, Besirli CG, Baumal CR, Vavvas DG, Chang EY, Nudleman ED, Tsui I, Sears J, Vajzovic L, Hartnett ME, Shapiro MJ, Quiram PA, Ozdek S, Kusaka S, Wu WC, Trese MT. Referable Macular Hemorrhage-A Clinically Meaningful Screening Target in Newborn Infants. Position Statement of the Association of Pediatric Retina Surgeons. Ophthalmic Surg Lasers Imaging Retina 2022; 53:3-6. [PMID: 34981999 DOI: 10.3928/23258160-20211214-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Universal newborn eye screening facilitates early diagnosis of ocular abnormalities and mitigates vision loss. "Referral warranted" eye disease is present at birth in about 5.5% of term infants, with "macular hemorrhage impinging on the fovea" representing about 50% of referral warranted disease. The Association of Pediatric Retina Surgeons held a symposium on February 9, 2021 that culminated in a position statement on "referable macular hemorrhage" (RMH) in newborn infants. RMH is meaningful in that in can cause amblyopia through deprivation, can be readily captured with wide-angle photography in a safe and efficient manner, and may lead to early intervention with mitigation of vision loss. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:3-6.].
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Kumm J. Newborn Eye Screening as an Application of AI. Ophthalmic Surg Lasers Imaging Retina 2021; 52:S17-S22. [PMID: 34908492 DOI: 10.3928/23258160-20211115-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Artificial intelligence (AI) applications are diverse and serve varied functions in clinical practice. The most successful products today are clinical decision tools used by physicians, but autonomous AI is gaining traction. Widespread use of AI is limited in part because of concerns about bias, fault-tolerance, and specificity. Adoption of AI often depends on removing cost and complexity in clinical workflow integration, providing clear incentives for use, and providing clear demonstration of clinical outcome. Existing wide-angle photographic screening could be integrated into the clinical workflow based on prior implementations for premature babies and linked with AI interpretation with existing technology. Incidence of retinal abnormality, clinical considerations, AI performance, grading variation for AI-augmented human grading, and cost and policy aspects play a significant role. Improved outcomes for newborns and a relatively high estimated incidence of abnormality have been named as benefits to counterweigh costs in the long term. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:S17-S22.].
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Azad AD, Al-Moujahed A, Ludwig CA, Vail D, Callaway NF, Rosenblatt TR, Kumm J, Moshfeghi DM. The Utility of Universal Newborn Eye Screening: A Review. Ophthalmic Surg Lasers Imaging Retina 2021; 52:S6-S16. [PMID: 34908491 DOI: 10.3928/23258160-20211115-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Universal newborn eye screening can identify ocular abnormalities early and help mitigate long-term visual impairment. Traditional neonatal and infant eye screening is administered by neonatologists and pediatricians using the red reflex test. If this test identifies an ocular abnormality, then the patient is examined by an ophthalmologist. Notably, the red reflex test may be unable to detect amblyogenic posterior segment pathology. Recent studies using fundus imaging and telemedicine show reduced cost of human resources and increased sensitivity compared with traditional approaches. In this review, the authors discuss universal newborn eye screening pilot programs with regard to disease prevalence, referral-warranted disease, and cost-effectiveness. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:S6-S16.].
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Cho IH, Kim MS, Heo NH, Kim SY. Birth-related retinal hemorrhages: The Soonchunhyang University Cheonan Hospital universal newborn eye screening (SUCH-NES) study. PLoS One 2021; 16:e0259378. [PMID: 34752467 PMCID: PMC8577753 DOI: 10.1371/journal.pone.0259378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/19/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To report the prevalence, related factors, and characteristics of birth-related retinal hemorrhages (RHs) according to their severity in healthy newborns using a telemedicine network and wide-field digital retinal imaging (WFDRI). Methods Newborns who underwent WFDRI at 61 obstetrics/gynecology hospitals between January 2017 and December 2019 were enrolled. Demographics and related factors were compared among newborns with and without RHs. The newborns’ eyes were divided into the minimal, mild, moderate, and severe groups according to the number of RHs, and characteristics like bilaterality, laterality, involved retinal layer, involved zone, macular and/or optic nerve (ON) involvement were compared. Results Among 56247 newborns, 13026 had birth-related RHs (23.2%). Normal spontaneous vaginal delivery (NSVD) showed the highest association with RHs (odds ratio, 19.774; 95% confidence interval, 18.277–21.393; P < 0.001) on multivariate analysis. Bilateral RHs (8414/13026; 64.59%) were more common than unilateral RHs (4612/13026; 35.41%); however, unilateral RHs (2383/4217; 56.51%) were more common than bilateral RHs (1834/4217; 43.49%) in the minimal group. RHs showed no laterality differences between the two eyes (P = 0.493). Most RHs were intraretinal (18678/21440; 87.12%), and 2328 (31.65%) eyes with preretinal hemorrhage were observed in the severe group. Zone I RHs were common in the minimal (7072/7090; 99.75%), mild (4953/4960; 99.86%), and moderate (2013/2035; 98.92%) groups; zone I and II RHs were common in the severe group (4843/7355; 65.85%); and RHs in zone III were rare (7/21440; 0.03%). Most RHs showed no macular and/or ON involvement in the minimal and mild group; however, this was common in the severe group (7111/7355; 96.68%). Conclusions Birth-related RHs were common in healthy newborns and were significantly associated with NSVD. RHs were usually bilateral, intraretinal, and distributed posterior to the retina, but severe RHs had unique characteristics. Future long-term and longitudinal studies are required to elucidate the prognosis of severe RHs.
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Affiliation(s)
- In Hwan Cho
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Cheonan, Korea
| | - Min Seong Kim
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Cheonan, Korea
| | - Nam Hun Heo
- Clinical Trial Center, Soonchunhyang University, Cheonan, Korea
| | - So Young Kim
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Cheonan, Korea
- * E-mail:
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Cunha LP, Cavalcante Costa MAA, Miranda HA, Reis Guimarães J, Aihara T, Ludwig CA, Rosenblatt T, Callaway NF, Pasricha M, Al‐Moujahed A, Vail D, Ji MH, Kumm J, Moshfeghi DM. Comparison between wide-field digital imaging system and the red reflex test for universal newborn eye screening in Brazil. Acta Ophthalmol 2021; 99:e1198-e1205. [PMID: 34032022 DOI: 10.1111/aos.14759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/27/2020] [Accepted: 12/16/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare neonatal eye screening using the red reflex test (RRT) versus the wide-field digital imaging (WFDI) system. METHODS Prospective cohort study. Newborns (n = 380, 760 eyes) in the Maternity Ward of Irmandade Santa Casa de Misericórdia de São Paulo hospital from May to July 2014 underwent RRT by a paediatrician and WFDI performed by the authors. Wide-field digital imaging (WFDI) images were analysed by the authors. Validity of the paediatrician's RRT was assessed by unweighted kappa [κ] statistic, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS While WFDI showed abnormalities in 130 eyes (17.1%), RRT was only abnormal in 13 eyes (1.7%). Wide-field digital imaging (WFDI) detected treatable retina pathology that RRT missed including hyphema, CMV retinitis, FEVR and a vitreous haemorrhage. The sensitivity of the paediatrician's RRT to detect abnormalities was poor at 0.77% (95% confidence interval, CI, 0.02%-4.21%) with a PPV of only 7.69% (95% CI, 1.08%-38.85%). Overall, there was no agreement between screening modalities (κ = -0.02, 95% CI, -0.05 to 0.01). The number needed to screen to detect ocular abnormalities using WFDI was 5.9 newborns and to detect treatable abnormalities was 76 newborns. CONCLUSION While RRT detects gross abnormalities that preclude visualization of the retina (i.e. media opacities and very large tumours), only WFDI consistently detects subtle treatable retina and optic nerve pathology. With a higher sensitivity than the current gold standard, universal WFDI allows for early detection and management of potentially blinding ophthalmic disease missed by RRT.
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Affiliation(s)
| | | | | | | | - Teruo Aihara
- Irmandade Santa Casa de Misericórdia de São Paulo São Paulo Brazil
| | - Cassie A. Ludwig
- Stanford University Byers Eye Institute Palo Alto CA USA
- Retina Service Department of Ophthalmology Massachusetts Eye and Ear Harvard Medical School Boston MA USA
| | | | | | | | | | - Daniel Vail
- Stanford University Byers Eye Institute Palo Alto CA USA
| | - Marco H. Ji
- Stanford University Byers Eye Institute Palo Alto CA USA
| | - Jochen Kumm
- Stanford University Byers Eye Institute Palo Alto CA USA
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Fei P, Liu Z, He L, Li N, Xu L, Zhang M, Zhou Y, Li F, Wang H, Zhang Q, Huang Q, Li Y, Chen S, Guo W, Li Y, Liu Y, Lu J, Wang Y, Zhu X, Wang L, Wang Y, Xian J, Xu Y, Ji X, Liang T, Ren J, Zhang X, Li J, Zhao P. Early detection of ocular abnormalities in a Chinese multicentre neonatal eye screening programme-1-year result. Acta Ophthalmol 2021; 99:e415-e422. [PMID: 32930484 PMCID: PMC8246721 DOI: 10.1111/aos.14586] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/24/2020] [Accepted: 07/21/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Early detection of ocular abnormalities in newborns is essential for timely diagnosis and treatment. This study aimed to assess the 1-year result of a multicentre prospective neonatal eye examination programme with wide-field digital imaging system in China. METHODS A multicentre collaborative prospective study group for neonatal eye screening was established in nine hospitals, including eight Maternal and Children's Hospitals, and one general hospital across China from July 2016 to June 2017. Ocular examinations were performed on newborns within 28 days after birth using a wide-field digital imaging system. Data were reviewed and analysed. The primary outcome was the prevalence of ocular abnormalities in neonates. RESULTS We detected 13 514 (20.91%) abnormal cases in 64 632 newborns. The most frequent abnormality was retinal haemorrhage (RH; 11.83%). Most of mild RH resolved spontaneously. Among those who were beyond retinopathy of prematurity (ROP) screening criteria of China (gestational age ≥32 w and birthweight ≥2000 g), the total number of neonates with ocular abnormality was 12 218/62 799(19.45%). 59.44% of neonatal ocular abnormalities detected (accounting for 11.56% of all the screened population) needed further interference or observation. Among them, 258 patients (0.41% of all the screened population) needed immediate or timely intervention, including congenital cataract, retinal detachment, retinoblastoma and other ocular abnormalities. One thousand and ninety-eight patients (1.75% of all the screened neonates) should be followed up closely and needed further diagnosis or intervention if necessary, such as ROP or ROP-like retinopathy, familial exudative vitreoretinopathy and persistent hyperplasia of primary vitreous. Five thousand nine hundred and six patients (9.4%) with minor clinical significance needed short-term follow-up. CONCLUSIONS This prospective multicentre study of newborn ocular examination showed a relatively high prevalence of ocular abnormalities. There are a relatively high percentage of congenital eye pathology that required further referral and treatment in those neonates who were not screened routinely. According to the benefits and risks associated with neonatal eye examinations, neonatal ocular screening programme can detect ocular abnormalities at the very early stage and may play a positive role in promoting paediatric eye health.
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Affiliation(s)
- Ping Fei
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Zijiang Liu
- Department of Ophthalmology Urumqi Maternal and Child Health Hospital Xinjiang China
| | - Liying He
- Department of Ophthalmology Chongqing Health Center for Women and Children Chongqing China
| | - Na Li
- Department of Ophthalmology Kunming Maternity and Child Care Hospital Kunming city China
| | - Lihua Xu
- Department of Ophthalmology Dezhou Women's and Children's Hospital Shandong China
| | - Meiju Zhang
- Department of Ophthalmology Women and Children’s Health Care Hospital of Linyi Shandong China
| | - Yu Zhou
- Department of Ophthalmology Maternity and Child Health Care of Guangxi Zhuang Autonomous Region Giangxi China
| | - Fuxin Li
- Department of Ophthalmology Jilin Women and Children Health Hospital Jilin China
| | - Hong Wang
- Department of Ophthalmology Maanshan Wemen and children's Hospital Anhui China
| | - Qi Zhang
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Qiujing Huang
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Yi'an Li
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Shuangshuang Chen
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Wei Guo
- Department of Ophthalmology Jilin Women and Children Health Hospital Jilin China
| | - Yun Li
- Department of Ophthalmology Kunming Maternity and Child Care Hospital Kunming city China
| | - Ya Liu
- Department of Ophthalmology Chongqing Health Center for Women and Children Chongqing China
| | - Jun Lu
- Department of Ophthalmology Kunming Maternity and Child Care Hospital Kunming city China
| | - Ying Wang
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
- Department of Ophthalmology Dezhou Women's and Children's Hospital Shandong China
| | - Xiuyu Zhu
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Lei Wang
- Department of Ophthalmology Urumqi Maternal and Child Health Hospital Xinjiang China
| | - Yanhong Wang
- Department of Ophthalmology Women and Children’s Health Care Hospital of Linyi Shandong China
| | - Jianying Xian
- Department of Ophthalmology Maternity and Child Health Care of Guangxi Zhuang Autonomous Region Giangxi China
| | - Yu Xu
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Xunda Ji
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Tingyi Liang
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Jianing Ren
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Xi Zhang
- Clinical Research Unit Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Jing Li
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
| | - Peiquan Zhao
- Department of Ophthalmology Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine Shanghai China
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Teow Kheng Leong K, Abu Kassim SNA, Sidhu JK, Zohari Z, Sivalingam T, Ramasamy S, Mohd Khialdin S, Mohd Nordin N, Rahmat J. Neonatal eye screening for 203 healthy term new-borns using a wide-field digital retinal imaging system. BMC Ophthalmol 2021; 21:128. [PMID: 33750348 PMCID: PMC7941744 DOI: 10.1186/s12886-021-01882-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/25/2021] [Indexed: 12/28/2022] Open
Abstract
Background The current practice for new-born eye examination by an Ophthalmologist in Malaysian hospitals is limited to only preterm new-borns, syndromic or ill infants. Healthy term new-borns are usually discharged without a thorough eye examination. This study is aimed at determining the proportion and types of ocular abnormalities detected in purportedly healthy term new-borns. Method This cross-sectional study is comprised of 203 participants, all purportedly healthy term new-born infants from the Obstetrics and Gynaecology ward at Hospital Kuala Lumpur over a 6 months period. The examination list includes external eye examination, red reflex test, and fundus imaging using a wide-field digital retinal imaging system (Phoenix Clinical ICON Paediatric Retinal Camera) by a trained Investigator. The pathologies detected were documented. The results were compared and correlated with similar studies published in the literature previously. Results Total ocular abnormalities were detected in 34% of the infants. The most common finding was retinal haemorrhage in 29.6% of the infants, of which 53.3% occurred bilaterally. Spontaneous vaginal delivery (SVD) remained the greatest risk factor which has nearly 3.5 times higher risk of new-borns developing retinal haemorrhage compared to Lower Segment Caesarean Section (LSCS). There was a 6% increased likelihood of developing retinal haemorrhage for every 1-min increment in the duration of 2nd stage of labour. Conclusion Universal eye screening for all new-borns using a wide-field digital imaging system is realistically possible, safe, and useful in detecting posterior segment disorders. The most common abnormality detected is retinal haemorrhage.
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Affiliation(s)
- Kenneth Teow Kheng Leong
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia. .,Department of Ophthalmology, Hospital Kuala Lumpur, 50586, Jalan Pahang, Kuala Lumpur, Malaysia.
| | | | - Jasvinjeet Kaur Sidhu
- Department of Ophthalmology, Hospital Kuala Lumpur, 50586, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Zayani Zohari
- Department of Ophthalmology, Hospital Kuala Lumpur, 50586, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Thivakar Sivalingam
- Department of Ophthalmology, Hospital Kuala Lumpur, 50586, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Sunder Ramasamy
- Department of Ophthalmology, Hospital Kuala Lumpur, 50586, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Safinaz Mohd Khialdin
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Noraihan Mohd Nordin
- Department of Obstetrics & Gynaecology, Hospital Kuala Lumpur, 50586, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Jamalia Rahmat
- Department of Ophthalmology, Hospital Kuala Lumpur, 50586, Jalan Pahang, Kuala Lumpur, Malaysia
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Ludwig CA, Jabbehdari S, Ji M, Vail D, Al-Moujahed A, Rosenblatt T, Azad AD, Veerappan M, Callaway NF, Moshfeghi DM. Higher prevalence of fundus haemorrhages in early-screened (NEST Study) as compared to late-screened (SUNDROP Study) newborn populations. Br J Ophthalmol 2021; 106:676-680. [PMID: 33514529 DOI: 10.1136/bjophthalmol-2020-317908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/30/2020] [Accepted: 12/21/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To determine whether timing of ophthalmic screening influences prevalence of neonatal fundus haemorrhages. We compared the prevalence of fundus haemorrhages in two populations: term newborns screened early (less than 72 hours) and preterm newborns screened late (4-11 weeks). Additionally, we reviewed the literature on timing and prevalence of newborn haemorrhages. METHODS Retrospective observational cohort study. Infants who underwent wide-angle ophthalmic digital imaging over one overlapping year in the Newborn Eye Screen Testing (NEST) or Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) programme were included. The PubMed database was filtered to include English-language articles dating back to 1950. Nine articles were selected for review based on inclusion of the prevalence of newborn fundus haemorrhages at multiple time points. RESULTS A total of 202 patients received early imaging in the NEST cohort and 73 patients received late imaging in the SUNDROP cohort. In the NEST cohort, 20.2% of newborns had haemorrhages. In contrast, we found haemorrhages in only one case or 1.4% of the SUNDROP cohort. Using prevalence data from nine additional studies, we developed a predicted probabilities model of newborn haemorrhages. Per this model, the probability of seeing a haemorrhage if you screen an infant at 1 hour is 18.8%, at 2 weeks is 2.9% and at 1 month is 0.28%. CONCLUSION We found a significant difference in the prevalence of fundus haemorrhages between the early-screened NEST cohort and the late-screened, preterm SUNDROP cohort. Likely, this difference is due to the transient nature of most newborn haemorrhages.
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Affiliation(s)
- Cassie A Ludwig
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA.,Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Sayena Jabbehdari
- Department of Ophthalmology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Marco Ji
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Daniel Vail
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Ahmad Al-Moujahed
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Tatiana Rosenblatt
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Amee D Azad
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Malini Veerappan
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Natalia F Callaway
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Darius M Moshfeghi
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, USA
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Ali SMA, Ossuetta I, Dahlmann-Noor A, Jayaram H, Kozak I. Comprehensive Ocular Examination of Healthy Newborns in the Middle East. Ophthalmic Epidemiol 2020; 28:306-311. [PMID: 33213247 DOI: 10.1080/09286586.2020.1849740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Purpose: To report the prevalence of the perinatal ocular disease in healthy infants referred to a referral eye centre in the Middle East region for comprehensive ocular examinations.Methods: All healthy full-term babies born at a tertiary care women's and children hospital were referred to Moorfields Eye Hospital Centre in Abu Dhabi (MEHCAD), the United Arab Emirates for comprehensive ocular examination between January 2018 and April 2019. The examination included red-reflex testing, external, anterior and dilated posterior segment examination, and refraction.Results: Out of 6836 newborns, 4719 (69%) were not referred due to lack of national insurance (n = 3089), out of network referral (n = 1405), required ROP screening (n = 220) and identification of systemic diagnosis (n = 5). Of 2117 eligible referrals 897 (42%) babies were not examined because they either did not attend (890) or had a double booking for ROP screening (7); hence, 1220 babies (56%) were examined. Their mean age was 39 ± 16 days, and 48.8% were male, 51.2% were female. One hundred and sixty-four (13.4%) babies had an ocular abnormality in 249 (10.2%) eyes. The commonest abnormalities were nasolacrimal duct obstruction (36%) and refractive errors in 53 patients (32.3%). Congenital cataract and ptosis were present in four (0.3%) and three (0.2%) babies, respectively. The commonest retinal findings were intra-retinal haemorrhages (1.4%). Other posterior pole abnormalities included optic disc pit (0.08%) and myelinated nerve fibers (0.08%). One eye (0.08%) had a congenital macular hole.Conclusion: Comprehensive ocular examinations of healthy infants identifies a number of ocular abnormalities that would not be detected using red-reflex testing by a paediatrician or nurse.
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Affiliation(s)
- Syed M A Ali
- Moorfields Eye Hospital Centre, Abu Dhabi, United Arab Emirates.,Department of Neonatology, Danat Al Emarat Hospital, Abu Dhabi, United Arab Emirates.,Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Iviano Ossuetta
- Department of Neonatology, Danat Al Emarat Hospital, Abu Dhabi, United Arab Emirates
| | | | | | - Igor Kozak
- Moorfields Eye Hospital Centre, Abu Dhabi, United Arab Emirates.,Department of Neonatology, Danat Al Emarat Hospital, Abu Dhabi, United Arab Emirates.,Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Baldino VMCL, Eckert GU, Rossatto J, Wagner MB. Red reflex test at the maternity hospital: results from a tertiary hospital and variables associated with inconclusive test results. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Baldino VMCL, Eckert GU, Rossatto J, Wagner MB. Red reflex test at the maternity hospital: results from a tertiary hospital and variables associated with inconclusive test results. J Pediatr (Rio J) 2020; 96:748-754. [PMID: 31622568 PMCID: PMC9432304 DOI: 10.1016/j.jped.2019.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 08/15/2019] [Accepted: 08/15/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Describe the results of the red reflex test in full-term newborns, as well as identify factors associated with red reflex test outcome and compare hospital length of stay between patients with inconclusive and normal red reflex test results. METHODS Descriptive cross-sectional study of the results of the red reflex test performed in a tertiary hospital maternity unit between 2014 and 2018. A nested case-control study was also performed to search for anthropometric, gestational, and neonatal variables associated with the outcome of the red reflex test. RESULTS There were121 identified cases of inconclusive red reflex test in 11,833 newborns. Sixteen alterations were confirmed, four considered severe: two cases of congenital glaucoma, one of cataract, and one of coloboma. Mean birth weight (p=0.04), length (p=0.03), and head circumference (p=0.02) were lower in patients with inconclusive red reflex test; however without a relevant effect size (d=-0.21, -0.22, and -0.25, respectively).The proportion of white, mixed-race, and black patients was significantly different between the groups (p<0.001), with a higher chance of inconclusive results in mixed-race (OR=2.22) and black (OR=3.37) patients when compared to whites. An inconclusive red reflex test led to an increase in hospital length of stay from 62 to 82hours (p<0.001). CONCLUSIONS The red reflex test was able to identify four severe alterations in 11,833 newborns (0.03%). In the 121 newborns in which the red reflex test was classified as inconclusive, there was a 20-hour increase in the hospital length of stay, but a severe alteration was confirmed in only 3.3% of them. Differences in red reflex between white, mixed-race, and black patients should be considered.
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Affiliation(s)
- Vinicius Mac Cord Lanes Baldino
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil.
| | - Gabriela Unchalo Eckert
- Hospital de Clínicas de Porto Alegre (HCPA), Departamento de Oftalmologia e Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Juliana Rossatto
- Hospital de Clínicas de Porto Alegre (HCPA), Departamento de Oftalmologia e Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Mário Bernardes Wagner
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Departamento de Medicina Social, Porto Alegre, RS, Brazil
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Moshfeghi DM. Terson Syndrome in a Healthy Term Infant: Delivery-Associated Retinopathy and Intracranial Hemorrhage. Ophthalmic Surg Lasers Imaging Retina 2018; 49:e154-e156. [PMID: 30395678 DOI: 10.3928/23258160-20181002-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/28/2018] [Indexed: 11/20/2022]
Abstract
A term healthy infant was noted to have cephalohematoma following normal spontaneous vaginal delivery (NSVD). At 9 days of age, the attending team performed wide-angle remote digital fundus imaging and the left eye was noted to have scattered multi-laminar hemorrhages. Magnetic resonance imaging was performed which revealed occipital infarct and subarachnoid hemorrhage. A diagnosis of neonatal Terson syndrome was made. The child remained asymptomatic and the fundus hemorrhages resolved without sequelae. This case represents the first documented instance of Terson syndrome following NSVD and may represent a possible etiology of the common newborn retinal hemorrhage. Alternative terminology - delivery-associated retinopathy and intracranial hemorrhages - is proposed to describe these findings. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e154-e156.].
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