{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:16:37Z","timestamp":1789992997579,"version":"4.0.1"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2021,11,9]],"date-time":"2021-11-09T00:00:00Z","timestamp":1636416000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002560","name":"soonchunhyang university","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002560","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>To report the prevalence, related factors, and characteristics of birth-related retinal hemorrhages (RHs) according to their severity in healthy newborns using a telemedicine network and wide-field digital retinal imaging (WFDRI).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Newborns who underwent WFDRI at 61 obstetrics\/gynecology hospitals between January 2017 and December 2019 were enrolled. Demographics and related factors were compared among newborns with and without RHs. The newborns\u2019 eyes were divided into the minimal, mild, moderate, and severe groups according to the number of RHs, and characteristics like bilaterality, laterality, involved retinal layer, involved zone, macular and\/or optic nerve (ON) involvement were compared.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Among 56247 newborns, 13026 had birth-related RHs (23.2%). Normal spontaneous vaginal delivery (NSVD) showed the highest association with RHs (odds ratio, 19.774; 95% confidence interval, 18.277\u201321.393; <jats:italic>P<\/jats:italic> &lt; 0.001) on multivariate analysis. Bilateral RHs (8414\/13026; 64.59%) were more common than unilateral RHs (4612\/13026; 35.41%); however, unilateral RHs (2383\/4217; 56.51%) were more common than bilateral RHs (1834\/4217; 43.49%) in the minimal group. RHs showed no laterality differences between the two eyes (<jats:italic>P<\/jats:italic> = 0.493). Most RHs were intraretinal (18678\/21440; 87.12%), and 2328 (31.65%) eyes with preretinal hemorrhage were observed in the severe group. Zone I RHs were common in the minimal (7072\/7090; 99.75%), mild (4953\/4960; 99.86%), and moderate (2013\/2035; 98.92%) groups; zone I and II RHs were common in the severe group (4843\/7355; 65.85%); and RHs in zone III were rare (7\/21440; 0.03%). Most RHs showed no macular and\/or ON involvement in the minimal and mild group; however, this was common in the severe group (7111\/7355; 96.68%).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Birth-related RHs were common in healthy newborns and were significantly associated with NSVD. RHs were usually bilateral, intraretinal, and distributed posterior to the retina, but severe RHs had unique characteristics. Future long-term and longitudinal studies are required to elucidate the prognosis of severe RHs.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0259378","type":"journal-article","created":{"date-parts":[[2021,11,9]],"date-time":"2021-11-09T18:47:05Z","timestamp":1636483625000},"page":"e0259378","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":12,"title":["Birth-related retinal hemorrhages: The Soonchunhyang University Cheonan Hospital universal newborn eye screening (SUCH-NES) study"],"prefix":"10.1371","volume":"16","author":[{"given":"In Hwan","family":"Cho","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Seong","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7278-2214","authenticated-orcid":true,"given":"Nam Hun","family":"Heo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1824-986X","authenticated-orcid":true,"given":"So Young","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,11,9]]},"reference":[{"issue":"1","key":"pone.0259378.ref001","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1186\/s12886-018-0943-7","article-title":"Universal ocular screening of 481 infants using wide-field digital imaging system","volume":"18","author":"Y Ma","year":"2018","journal-title":"BMC Ophthalmol"},{"issue":"1","key":"pone.0259378.ref002","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1038\/eye.2017.129","article-title":"Outcome of universal newborn eye screening with wide-field digital retinal image acquisition system: a pilot study.","volume":"32","author":"P Goyal","year":"2018","journal-title":"Eye (Lond)"},{"issue":"1","key":"pone.0259378.ref003","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1186\/s12886-018-0887-y","article-title":"The efficacy and safety of Retcam in detecting neonatal retinal hemorrhages.","volume":"18","author":"F Chen","year":"2018","journal-title":"BMC Ophthalmol."},{"issue":"12","key":"pone.0259378.ref004","doi-asserted-by":"crossref","first-page":"983","DOI":"10.3928\/23258160-20171130-05","article-title":"Full-Term Neonatal Ophthalmic Screening in China: A Review of 4-Year Outcomes.","volume":"48","author":"LH Li","year":"2017","journal-title":"Ophthalmic Surg Lasers Imaging Retina"},{"issue":"5","key":"pone.0259378.ref005","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1016\/j.ophtha.2016.01.004","article-title":"Retinal and Optic Nerve Hemorrhages in the Newborn Infant: One-Year Results of the Newborn Eye Screen Test Study","volume":"123","author":"NF Callaway","year":"2016","journal-title":"Ophthalmology"},{"issue":"7","key":"pone.0259378.ref006","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1007\/s00417-015-3052-9","article-title":"Birth-related retinal hemorrhages in healthy full-term newborns and their relationship to maternal, obstetric, and neonatal risk factors","volume":"253","author":"Q Zhao","year":"2015","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"issue":"5","key":"pone.0259378.ref007","first-page":"e372","article-title":"Universal ocular screening of 1021 term infants using wide\u2010field digital imaging in a single public hospital in I ndia\u2013a pilot study.","volume":"93","author":"A Vinekar","year":"2015"},{"issue":"1","key":"pone.0259378.ref008","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.jaapos.2012.07.012","article-title":"Newborn retinal hemorrhages: a systematic review.","volume":"17","author":"P Watts","year":"2013","journal-title":"J AAPOS"},{"issue":"5","key":"pone.0259378.ref009","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1136\/bjophthalmol-2012-302539","article-title":"Findings of perinatal ocular examination performed on 3573, healthy full-term newborns","volume":"97","author":"LH Li","year":"2013","journal-title":"Br J Ophthalmol"},{"issue":"2","key":"pone.0259378.ref010","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.jaapos.2005.12.005","article-title":"Incidence, distribution, and duration of birth-related retinal hemorrhages: a prospective study.","volume":"10","author":"LA Hughes","year":"2006","journal-title":"J AAPOS"},{"issue":"1","key":"pone.0259378.ref011","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/S0161-6420(00)00474-7","article-title":"Incidence and rate of disappearance of retinal hemorrhage in newborns","volume":"108","author":"MV Emerson","year":"2001","journal-title":"Ophthalmology"},{"issue":"5","key":"pone.0259378.ref012","doi-asserted-by":"crossref","first-page":"311","DOI":"10.3341\/kjo.2011.25.5.311","article-title":"Retinal hemorrhage associated with perinatal distress in newborns.","volume":"25","author":"YJ Choi","year":"2011","journal-title":"Korean J Ophthalmol"},{"issue":"2","key":"pone.0259378.ref013","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.jaapos.2017.12.006","article-title":"Comparison of the characteristics of retinal hemorrhages in abusive head trauma versus normal vaginal delivery.","volume":"22","author":"SY Kim","year":"2018","journal-title":"J AAPOS."},{"issue":"1","key":"pone.0259378.ref014","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1038\/eye.2017.133","article-title":"Universal newborn eye screening: an effective strategy to improve ocular health?","volume":"32","author":"RI Chee","year":"2018","journal-title":"Eye (Lond)"},{"issue":"10","key":"pone.0259378.ref015","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1001\/jamaophthalmol.2014.1604","article-title":"Validity of a telemedicine system for the evaluation of acute-phase retinopathy of prematurity","volume":"132","author":"GE Quinn","year":"2014","journal-title":"JAMA Ophthalmol"},{"issue":"13","key":"pone.0259378.ref016","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1503\/cmaj.131357","article-title":"Using telemedicine to screen for retinopathy of prematurity.","volume":"186","author":"AA Abdul Aziz","year":"2014","journal-title":"CMAJ"},{"issue":"1","key":"pone.0259378.ref017","first-page":"23","article-title":"Efficacy of wide-field digital retinal imaging for retinopathy of prematurity screening.","volume":"39","author":"S Dai","year":"2011","journal-title":"Clin Exp Ophthalmol"},{"issue":"7","key":"pone.0259378.ref018","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1001\/archopht.123.7.991","article-title":"The international classification of retinopathy of prematurity revisited.","volume":"123","author":"Prematurity ICftCoRo","year":"2005","journal-title":"Archives of ophthalmology"},{"issue":"3","key":"pone.0259378.ref019","first-page":"268","article-title":"Forbes BJJJoAAfPO, Strabismus. Odds of abuse associated with retinal hemorrhages in children suspected of child abuse","volume":"13","author":"G Binenbaum","year":"2009","journal-title":"Journal of American Association for Pediatric Ophthalmology"},{"key":"pone.0259378.ref020","first-page":"3","article-title":"Prospective observational study of universal newborn eye screening in a hospital and community setting in New Zealand","author":"SK Simkin","year":"2019","journal-title":"BMJ Paediatr Open"},{"issue":"5","key":"pone.0259378.ref021","first-page":"688","article-title":"Obstetric correlates of neonatal retinal hemorrhage.","volume":"81","author":"MC Williams","year":"1993","journal-title":"Obstet Gynecol."},{"key":"pone.0259378.ref022","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/0002-9394(60)91824-9","article-title":"Retinal hemorrhages in the newborn","volume":"49","author":"CL Giles","year":"1960","journal-title":"Am J Ophthalmol"},{"issue":"4","key":"pone.0259378.ref023","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1136\/bjo.55.4.248","article-title":"Retinal haemorrhages in newborn infants","volume":"55","author":"F. Sezen","year":"1971","journal-title":"Br J Ophthalmol"},{"issue":"6","key":"pone.0259378.ref024","first-page":"558","article-title":"Retinal hemorrhages in newborn\u2014fetal causative factors.","volume":"26","author":"HK Bist","year":"1989","journal-title":"Indian Pediatr"},{"issue":"1","key":"pone.0259378.ref025","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1097\/ICB.0b013e31818c5e2e","article-title":"Bilateral circumferential macular folds in inflicted childhood neurotrauma.","volume":"4","author":"S Airiani","year":"2010","journal-title":"Retin Cases Brief Rep"},{"issue":"2","key":"pone.0259378.ref026","doi-asserted-by":"crossref","first-page":"e430","DOI":"10.1542\/peds.2013-0262","article-title":"Patterns of retinal hemorrhage associated with increased intracranial pressure in children","volume":"132","author":"G Binenbaum","year":"2013","journal-title":"Pediatrics"},{"issue":"5","key":"pone.0259378.ref027","first-page":"961","article-title":"Retinal hemorrhage in abusive head trauma.","volume":"126","author":"AVJP Levin","year":"2010"},{"issue":"1","key":"pone.0259378.ref028","first-page":"98","article-title":"Retinal hemorrhages and shaken baby syndrome: an evidence-based review.","volume":"37","author":"BM Togioka","year":"2009"},{"issue":"3","key":"pone.0259378.ref029","first-page":"354","article-title":"Correlation between retinal abnormalities and intracranial abnormalities in the shaken baby syndrome.","volume":"134","author":"Y Morad","year":"2002"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0259378","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,9]],"date-time":"2021-11-09T18:47:27Z","timestamp":1636483647000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0259378"}},"subtitle":[],"editor":[{"given":"Ahmed","family":"Awadein","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,11,9]]},"references-count":29,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0259378","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,9]]}}}