Emerson et al evaluated newborn infants for intraretinal hemorrhage. The authors are from Yale University in New Haven, Connecticut.
Risk factors (associated with difficult deliveries):
(1) vacuum-assisted delivery
(2) increased maternal age (mean 29.1 years)
Cesarean section reduced the risk.
Hemorrhages may be unilateral or bilateral.
Appearance:
(1) dot blot
(2) flame shaped
(3) larger blot hemorrhages with or without central pallor
(4) subretinal (rare)
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Zone
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Location
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Zone I
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one disc diameter around the optic nerve head and fovea
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Zone II
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from zone I to the equator
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Zone III
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from the equator to the ora serrata
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Number of Hemorrhages
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Grade
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1 or 2
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I
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3 to 10
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II
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>= 11
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III
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Additional notes:
(1) preretinal and vitreal blood was absent
(2) subretinal hemorrhage was rare and isolated
(3) intraretinal hemorrhages disappeared by 1 month of age
The presence of any of these should prompt an investigation for a cause other than birthing.
