Dating retinal hemorrhages

During a 9-month period, we examined 8 children (median age, 2.25 months; age range, 0.8-18.0 months) admitted to the pediatric intensive care unit. The primary admitting diagnosis, retinal findings, and computed tomographic scan results of the head are shown in Table 1.A history of trauma was found in 4 patients: fall from a couch (n = 2), dropping the child 105 cm to the floor (n = 1), and a child's head hitting the sink (n = 1).Multiple photographs were obtained, allowing for selection of the best and elimination of inferior-quality and out-of-focus images. Perpetrators were the father or male caretaker in 3 cases and the mother in 1.At hospital discharge, 2 patients were released to foster care, 1 was institutionalized, and 2 were released to their mother. Retinal hemorrhages associated with abusive head trauma are different than those associated with increased intracranial pressure, cardiopulmonary resuscitation, or childbirth.Digital photography provides another alternative for documenting retinal pathological features.This technology has been incorporated into a wide-field digital ophthalmic camera (Ret Cam 120; Massie Research Laboratories, Inc, Dublin, Calif) capable of producing high-quality real-time images of the retina.All patients underwent a formal examination by a pediatric ophthalmologist (R. and others) using a wide-field digital ophthalmic camera. The wide-field digital ophthalmic camera allowed good visualization and produced high-quality photographic images, resulting in instant bedside documentation of retinal pathological features.

Eight children were studied during a 9-month period.Traditionally, retinal hemorrhages are documented by freehand drawings, which can be time-consuming and may not accurately reflect retinal pathological features.While these drawings may give investigators and medical personnel an idea of the severity and number of the hemorrhages, they do not compare to actual retinal photographs.Of the 8 patients, 6 had bilateral preretinal and intraretinal hemorrhages by direct ophthalmic examination and 2 had no retinal hemorrhages.Subdural and/or subarachnoid bleeding was noted on computed tomographic images of the head in all patients.

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Clearly, accurate documentation of retinal hemorrhages is important for diagnosing shaken baby syndrome.

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