Hemorràgia retinal neonatal d’evolució prolongada

catalaIntroduccio. Es presenta el cas d’un nounat amb hemorragies retinals d’origen perinatal i evolucio atipica, i es discuteix el valor de la presencia d’hemorragies retinals en els infants menors de 12 mesos amb lesions que facin sospitar un possible maltractament. Cas clinic. Nado fill d’una mare sense control de l’embaras en la qual es detecta serologia positiva a lues durant el part. L’estudi del nado no presenta signes d’infeccio luetica, pero, en fer el cribratge d’una possible corioretinitis luetica, s’observen hemorragies retinals. El seguiment de l’evolucio de les hemorragies mostra signes de reabsorcio als 2 mesos que persisteixen mes enlla dels 3 mesos. Comentaris. La frequencia global d’hemorragies retinals en nadons sense altres simptomes varia, segons el tipus de part, entre un 10% en els casos de cesaria electiva i fins a un 50% en els parts instrumentats amb vacuum . La majoria es reabsorbiran en 2-4 setmanes i la literatura nomes recull un cas que va desapareixer als 58 dies. El cas presentat demostra que no es impossible que durin mes enlla d’aquest limit. D’altra banda, la presencia d’hemorragies retinals en els infants amb lesions cerebrals es un dels signes que han de fer pensar en una causa no accidental, es a dir, per maltractament. S’ha de considerar, per tant, la poca especificitat de la presencia d’hemorragies retinals en els primers 2-3 mesos de vida. EnglishIntroduction . We present the case of a newborn with retinal hemorrhages of perinatal origin with an atypical evolution, and we discuss the significance of retinal hemorrhages in infants younger than 12 months of age, which could represent signs of child abuse. Case report. Newborn from a mother with no pregnancy control, who was found to have positive syphilis serology during delivery. On examination, the newborn did not have signs of congenital syphilis; however, during the screening for evidence of corioretinal disease, retinal hemorrhages were noted. On follow-up, the hemorrhages showed some signs of reabsorption at two months, but persisted beyond three months. Comments. The overall frequency of retinal hemorrhages in the newborn without other symptoms varies according to the type of delivery; it has been reported to be 10% in cases of elective caesarean section, and up to 50% in the instrumental delivery with vacuum. Most hemorrhages reabsorb within two to four weeks, but have also been reported to persist up to 58 days in one case. The case presented shows that in some cases resolution of neonatal retinal hemorrhages can be significantly delayed. Moreover, the presence of retinal hemorrhages in children with brain injuries could suggest a non-accidental cause, usually head trauma resulting from abuse. Given the low specificity of the presence of retinal hemorrhages during the first two to three months of life, a wide differential diagnosis must be considered.