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首页> 外文期刊>British journal of ophthalmology >Appearance and location of retinal haemorrhages in critically ill children
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Appearance and location of retinal haemorrhages in critically ill children

机译：重症儿童视网膜出血的外观和位置

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Background: There are few high-quality studies describing the appearance and location of retinal haemorrhages in critically ill children not due to birth or abusive head trauma. Methods: Prospective study from February 2008 to December 2009 of emergency admissions to a paediatric intensive care unit aged over 6 weeks. Children with a penetrating eye injury or suspected or proven abusive head injury were excluded. The children underwent either dilated funduscopy performed by a paediatric ophthalmologist or RetCam imaging. Results: Retinal haemorrhages were identified in 24/159 (15%) patients. 50% of the haemorrhages were bilateral. The severity was mild (<5 retinal haemorrhages) or moderate (5-20 retinal haemorrhages) in 75%. The location was in zone 1 in 45.8%, zones 1 and 2 in 33.3%, zone 2 alone in 8.3% and not described in 8.3%. Schisis cavities and perimacular folds were identified in two patients with one having a pseudohypopyon appearance; a further one patient had bilateral haemorrhagic retinal detachments. Three patients had exudates or scarring consistent with cytomegalovirus infection. Conclusions: Retinal haemorrhages are seen in a proportion of critically ill children, however most retinal bleeding is not extensive as indicated by location within the retina or layer of bleeding. Higher numbers and extent of retinal haemorrhages were only observed in the presence of severe coagulopathy, leukaemia, one victim of a road traffic accident, and one child who sustained a fatal witnessed fall down the stairs; all circumstances that would be readily distinguished by history and laboratory testing from abusive head injury.
机译：背景：很少有高质量的研究描述重症儿童并非因出生或虐待性颅脑损伤而引起的视网膜出血的外观和位置。方法：2008年2月至2009年12月对6周以上小儿重症监护病房的急诊入院进行前瞻性研究。排除了眼部穿透性损伤或怀疑或证实的虐待性头部受伤的儿童。对儿童进行小儿眼科医生进行的扩大眼底镜检查或RetCam成像。结果：在24/159（15％）患者中发现了视网膜出血。 50％的出血是双侧的。轻度（<5眼视网膜出血）或中度（5-20​​眼视网膜出血）的严重程度为75％。该位置位于15.8％的区域，1和2％的区域为33.3％，仅2％的区域为8.3％，未描述的区域为8.3％。在两名患者中发现了Schisis腔和周缘褶皱，其中一名患有假性hypopyon。另一例患者患有双侧出血性视网膜脱离。三例患者有与巨细胞病毒感染一致的渗出液或疤痕。结论：在一定比例的危重症患儿中发现了视网膜出血，但是大多数视网膜出血并未如视网膜内或出血层中所显示的那样广泛。仅在存在严重凝血病，白血病，一名道路交通事故的受害者以及一名致命的儿童目击者下楼梯的情况下，才观察到更多数量和程度的视网膜出血。根据病史和实验室检查可以容易地将其与虐待性颅脑损伤区分开来的所有情况。

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