Prevalence of Retinal Hemorrhages in Critically Ill Children

Agrawal S et al. – Retinal hemorrhages (RHs) were seen in critically ill children with a prevalence of 15.1% (24/159); however, most were mild. Severe multilayered RH resembling those described in AHT were rare (6/24) and were only seen in patients with fatal accidental trauma, severe coagulopathy, sepsis with myeloid leukemia, or a combination of these factors.

Methods

• From February 2008 to December 2009, emergency intensive care admissions >6 weeks of age underwent dilated retinal examination by either a pediatric ophthalmologist or RetCam (retinal photograph) imaging after written informed consent.
• Patients with suspected or proven AHT, penetrating eye trauma, and elective admissions were excluded.

Results

• The prevalence of RH was 15.1% (24/159; 95% confidence interval [CI]: 9.5%–21%); 16/24 (66%) mild, and 2/24 (8%) moderate.
• Severe multilayered RH were seen in only 6 patients (3.7%), 3 with myeloid leukemia and sepsis, 2 with severe accidental head injury, and 1 with severe coagulopathy secondary to late onset hemorrhagic disease of newborn.
• There was no detectable impact of age, gender, seizures, coagulopathy or cardiopulmonary resuscitation on prevalence of severe multilayered RH; however, sepsis (odds ratio: 3.2; 95% CI: 1.3–8.0, P = .018) and coagulopathy (odds ratio: 2.8; 95% CI: 1.2–7.0, P = .025) were significantly associated with any RH.
• Only admission diagnosis was independently associated with severe multilayered RH on logistic regression.

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