Retinal haemorrhages associated with fatal paediatric infections

For many physicians, retinal haemorrhages (RHs) in infants and young children remain highly diagnostic of non-accidental (abusive) head trauma. Because clinicians have applied indirect ophthalmoscopy selectively to cases of suspected child abuse, the association between RH and other conditions such...

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Bibliographic Details
Published in:Medicine, science, and the law science, and the law, 2015-04, Vol.55 (2), p.121-128
Main Authors: Salvatori, Marcus C., Lantz, Patrick E.
Format: Article
Language:English
Subjects:
Child, Preschool
Enteritis - complications
Fatal Outcome
Female
Humans
Infant
Male
Meningococcal Infections - complications
Meningoencephalitis - complications
Ophthalmoscopy
Respiratory Aspiration - etiology
Retinal Hemorrhage - diagnosis
Retinal Hemorrhage - etiology
Sepsis - complications
Subarachnoid Hemorrhage - pathology
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Summary:For many physicians, retinal haemorrhages (RHs) in infants and young children remain highly diagnostic of non-accidental (abusive) head trauma. Because clinicians have applied indirect ophthalmoscopy selectively to cases of suspected child abuse, the association between RH and other conditions such as infection, coagulopathy and accidental trauma has encountered habitual bias, creating the potential for iatrogenic misdiagnosis of child abuse. We present an autopsy case series of four children, aged three years old or younger, in whom RHs were detected by post-mortem monocular indirect ophthalmoscopy after the patients had died from infections. We discuss the laterality, number, type and location of RHs in these cases, and summarize proposed mechanisms of RH formation in fatalities from paediatric infection. We demonstrate that many of the ophthalmological findings that have been considered diagnostic of abusive head trauma can also occur in association with infective processes.
ISSN:0025-8024
2042-1818
DOI:10.1177/0025802414527077