Risk Factors for Neonatal White-Centered Retinal Hemorrhages: Clinical Implications for Prevention

Cong He,1 Yuanqiao Liao,2 Xinyang He,3 Zhenwei Ye,1 Shaosheng Su,2 Yanli Zhang1,3 1Department of Ophthalmology, Aier Eye Hospital, Jinan University, Guangzhou, Guangdong, 510000, People’s Republic of China; 2Information Department, Zhongshan City People’s Hospital, Zhongshan, Guangdong, 528406, People’s Republic of China; 3Department of Ophthalmology, Zhongshan Aier Eye Hospital, Zhongshan, Guangdong, 528406, People’s Republic of ChinaCorrespondence: Yanli Zhang, Email [email protected]: Neonatal white-centered retinal hemorrhage (NWCRH) is characterized by white or yellowish-white central spots within retinal hemorrhages, resembling Roth spots. Elucidating the etiological factors may enhance preventive strategies and deepen understanding of NWCRH. This study examined correlations between NWCRH and perinatal maternal conditions, delivery factors, and neonatal characteristics.Methods: From January 2013 to December 2015, neonates delivered at the Department of Obstetrics at Zhongshan People’s Hospital underwent RetCam III fundus screening within four days postpartum were enrolled. Demographic and clinical information of neonates and mothers were collected, and univariate and multivariate logistics regression analyses were used to explore the influencing factors of NWCRH and its severity.Findings: WCRH was identified in 574 out of 3606 neonates (15.92%), with retinal hemorrhage detected in 868 cases (24.07%). For Grade I retinal hemorrhage, 441 cases were documented, with WCRH present in 169 cases (38.32%). For Grade II retinal hemorrhage, 239 cases were recorded, with 223 (93.31%) exhibiting WCRH. In Grade III retinal hemorrhage, 182 out of 188 cases (96.81%) displayed WCRH. In the multivariate analysis of Groups II and III, neonatal blood type B was found to be statistically significant for Roth spot formation. In the univariate analysis of maternal factors, gestational diabetes and hypertension were associated with an increased risk of Roth spots.Conclusion: This study identified key risk factors for the formation of neonatal Roth spots, including mode of delivery, umbilical cord around the neck, and blood group B. Given its potential long-term effects on vision, early screening and preventive measures are recommended. For neonates with a history of umbilical cord around the neck and rapid delivery, fundus screening can facilitate timely intervention and improve neonatal eye health.Keywords: Roth spots, neonatal white-centered retinal hemorrhage, full-term infants, Roth spot-like changes