Retinal Hemorrhages and Long-Term Ocular Outcomes in Neonatal Hypoxic-Ischemic Encephalopathy.

This study aims to investigate the clinical significance and risk factors of retinal hemorrhages (RH) and white-centered retinal hemorrhages (Roth spots, RS) in neonates with hypoxic-ischemic encephalopathy (HIE), as well as their long-term ophthalmologic outcomes. Neonates diagnosed with HIE were classified into three stages according to the Sarnat classification. A comprehensive ophthalmologic assessment was performed within the first three days of life and at two years of age. Retinal hemorrhages were staged based on the Egge classification, and the presence of RS was also documented. The clinical characteristics and risk factors associated with RH and RS were systematically recorded. Retinal hemorrhages were identified in 178 eyes (42.3%), and RS were observed in 180 eyes (42.8%). The prevalence of both RH and RS was significantly higher in neonates with Stage 2 and Stage 3 HIE ( < 0.001). The resolution time for both RH and RS was significantly prolonged in neonates with Stage 3 HIE compared to those with lower grades ( < 0.001). Furthermore, the frequency of grade 3 RH increased with advancing HIE stages ( < 0.001). Logistic regression analysis revealed that Stage 2 HIE (OR: 5.41, 95% CI: 1.19-24.54, = 0.03) and Stage 3 HIE (OR: 27.17, 95% CI: 5.38-137.25, < 0.001) were significantly associated with RS. Similarly, Stage 2 HIE (OR: 4.54, 95% CI: 1.00-20.68, = 0.05) and Stage 3 HIE (OR: 40.88, 95% CI: 7.75-215.68, < 0.001) were significantly associated with RH. At the age of two, strabismus was identified in 34 (18.4%) patients, while refractive errors were detected in 68 (37.4%) patients. The prevalence of RH and RS increases in correlation with the severity of HIE. While these hemorrhages generally resolve spontaneously, the risk of refractive errors and strabismus remains elevated.