NCJ Number
243553
Journal
Child Abuse Review Volume: 22 Issue: 1 Dated: January - February 2013 Pages: 29-43
Date Published
February 2013
Length
15 pages
Annotation
This systematic review addresses non-traumatic causes of retinal hemorrhages (RH) in children with one or more overlapping clinical features of abuse (bruising, fractures, intracranial hemorrhage).
Abstract
Retinal hemorrhages (RH) in a young child suggest child abuse, yet other causes merit consideration. This systematic review addresses non-traumatic causes of RH in children with one or more overlapping clinical features of abuse (bruising, fractures, intracranial hemorrhage). Searching 12 databases (1950-2009) identified 338 studies for review by 2 reviewers. Inclusion criteria included: children less than 15 years examined by an ophthalmologist detailing retinal findings, confirmed organic cause and exclusion of abuse. Exclusion criteria included: diagnosed coagulopathy, ocular mass lesion and post-mortem cases. Twenty included studies identified nine relevant conditions (metabolic diseases, bony dysplasias, bleeding disorders and vascular malformations). Where detailed, the RH was bilateral and involved only one area of the retina (the posterior pole). Among proposed confounders of RH, no child with a cough (100 children) or acute life-threatening event (184 cases) had RH. Just two of 217 children with seizures had posterior pole RH, one unilateral and one bilateral. One cardiopulmonary resuscitation (CPR) study (43 cases) was included where a child with co-existent clotting abnormalities had tiny (bilateral dot) RH after 60 minutes' resuscitation. Child abuse remains the commonest cause of RH in young children, although rarer disorders merit consideration. There are insufficient data to conclude that CPR is a confounder in children with RH. Abstract published by arrangement with John Wiley & Sons.