Aim Retinal haemorrhages (RH) in an infant raise the possibility of Abusive Head Trauma (AHT), but may occur following birth. We aim to define the obstetric correlates, characteristics, prevalence and evolution of RH found in newborns.

Methods A systematic review, searching ten databases (1970-2011), identified 45 studies which underwent two independent reviews using standardised critical appraisal. Included: examination by an ophthalmologist; using indirect ophthalmoscopy; first examination conducted within 120 hours of birth, prior to hospital discharge.

Results 13 included studies (1777 infants), highlighted that 31% of spontaneous vaginal deliveries had RH, while vacuum extraction (OR 2.76; 95% CI 1.35-5.63), or double instrumental delivery (i.e. forceps and vacuum) (OR 3.29; 95% CI 1.82-5.97) both significantly increase the likelihood of RH. The haemorrhages are commonly bilateral (59%), of varying severity from ‘mild’ (22-56%) to ‘severe’ (18-37%); predominantly intraretinal and in the posterior pole. The majority (83%) of RH resolve within 10 days, with only isolated cases persisting to 58 days.

Conclusions Birth related RH are an important consideration when assessing young infants, particularly following instrumental delivery. Their features differ from those in AHT, and they usually resolve rapidly, very rarely persisting beyond six weeks.