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Retinal haemorrhage in infants with pertussis
  1. Naz Raoof1,
  2. Susana Pereira2,
  3. Shuan Dai1,3,
  4. Jocelyn Neutze4,
  5. Cameron Charles Grant5,6,
  6. Patrick Kelly2,5
  1. 1Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
  2. 2Te Puaruruhau (Child Protection Team), Starship Children’s Hospital, Auckland, New Zealand
  3. 3Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
  4. 4Emergency Department, Kidz First Middlemore Hospital, Auckland, New Zealand
  5. 5Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
  6. 6Department of General Paediatrics, Starship Children’s Hospital, Auckland, New Zealand
  1. Correspondence to Dr Patrick Kelly, Te Puaruruhau (Child Protection Team), Starship Children’s Hospital, Auckland District Health Board, Auckland, 92024, New Zealand; patrickk{at}adhb.govt.nz

Abstract

Aims It has been hypothesised that paroxysmal coughing in infantile pertussis (whooping cough) could produce retinal haemorrhages identical to those seen in abusive head trauma. We aimed to test this hypothesis.

Methods This is a prospective study of infants hospitalised with pertussis in Auckland, New Zealand, from 2009 to 2014. The clinical severity of pertussis was categorised. All infants recruited had retinal examination through dilated pupils by the paediatric ophthalmology service using an indirect ophthalmoscope.

Results Forty-eight infants with pertussis, aged 3 weeks to 7 months, were examined after a mean of 18 days of coughing. Thirty-nine had severe pertussis and nine had mild pertussis. All had paroxysmal cough, and all were still coughing at the time of examination. No retinal haemorrhages were seen.

Conclusions We found no evidence to support the hypothesis that pertussis may cause the pattern of retinal haemorrhages seen in abusive head trauma in infants.

  • child abuse
  • abusive head trauma
  • shaken baby syndrome
  • retinal haemorrhage
  • whooping cough

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Footnotes

  • Contributors NR analysed the data, wrote the first draft of the manuscript and approved the final manuscript. SP was the primary investigator during the study, collected most of the data, double-checked the data analysis and approved the final manuscript. SD helped design the study, performed or supervised the ophthalmoscopy and approved the final manuscript. JN contributed to data collection and approved the final manuscript. CCG helped design the study, edited the draft manuscript and approved the final manuscript. PK designed the study, contributed to data collection, supervised and reviewed the data analysis, revised the draft manuscript, and approved the final manuscript.

  • Funding This study received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Health and Disability Ethics Committee, New Zealand Ministry of Health.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Non-identifying data in the form of an Excel spreadsheet that links basic demographics, laboratory results and clinical findings could be made available to bona fide scientific researchers—for example, for the purposes of systematic review or meta-analysis.

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