Retinal abnormalities in Universal Eye Screening of healthy, full-term newborn infant in Jakarta. The incidence and its risk factors:  A Pilot study.

Abstract Background: To document ocular abnormalities in healthy full-term newborn infants using wide-field digital imaging and to analyze factors associated with the findings. Methods: A total of 1208 full-term newborn infants at a tertiary eye hospital (Cipto Mangunkusumo National Referral Hospital) and a district hospital in Jakarta (Koja Hospital) were enrolled to the study. All eligible newborns underwent fundus examination within 48 hours after birth using the RetCam shuttle (Natus Medical Incorporated, USA). Retinal hemorrhages findings were documented and analyzed according to obstetric and neonatal risk factors. Results: Of the 1208 newborn infants enrolled, ocular abnormalities were found in 150 infants (12.4%). Retinal hemorrhage (RH) was the most common findings (88%) in which 2.67% involved the macula, followed with chorioretinitis (4.67%). Univariate analysis showed caesarean section (C-section) (OR 0.27, 95% CI 0.18-0.41, p<0.001) as the protective factor towards RH, while prolonged labor increased the risk of developing RH (OR 1.84, 95% CI 1.24-2.72, p=0.002). Further multivariate analysis showed similar protective association between C-section and risk of RH (OR 0.29, 95% CI 0.19-0.44, p<0.001), while other risk factors were not. Conclusions: Our study supports previous reports that universal eye screening is an essential procedure which may detect several important ocular abnormalities. Retinal hemorrhage is the most common ocular abnormality and is associated with the methods of delivery and duration of labor. As the ocular abnormalities may go unnoticed during standard practice, a universal eye screening program could be considered as an essential part of newborn screening especially amongst those with prolonged labors.