TY - JOUR T1 - Child protection JF - Archives of Disease in Childhood JO - Arch Dis Child SP - A44 LP - A45 VL - 94 IS - Suppl 1 A2 - , Y1 - 2009/03/01 UR - http://adc.bmj.com/content/94/Suppl_1/A44.abstract N2 - S. Moynihan, H. Bunting, M. Mann, P. Watts, V. Tempest, A. Kemp, S. Maguire. Cardiff University, Cardiff, Wales, UKAims: Retinal haemorrhages (RH) carry both clinical and legal significance in suspected child abuse; however, other confounders are frequently proposed in court. We systematically reviewed the association between seizures, cardiopulmonary resuscitation (CPR), acute life-threatening events (ALTE), coughing and RH.Methods: A literature search of 11 databases, conference abstracts and references from 1950 to 2007. Of 7894 potential studies, 315 underwent two independent reviews by paediatric, ophthalmology and pathology specialists, using standardised critical appraisal methodology. Inclusion: primary studies of live children less than 11 years of age examined for evidence of RH (by an ophthalmologist), due to explicitly confirmed non-abusive aetiologies (CPR, seizure, ALTE, coughing). Exclusion: mixed adult and child data, management or outcome.Results: We included nine studies (six cross-sectional/three case series) published between 1990 and 2007, including 559 children. RH in association with seizure was only recorded in two of 219 children (aged 6 and 8 months) both in the posterior pole (one unilateral/one bilateral). Only one of 43 children developed diffuse punctuate RH post-CPR. There was no documented association of cough (123 studied) or ALTE (174 studied) as a cause for RH.Conclusion: RH is a rare complication of seizures or CPR and appears to be confined to the posterior pole. RH has not been described in association with ALTE or coughing, when abuse is excluded. The published literature does not support these as confounders in abusive retinopathy.1T. Allport, 2R. Edwards, 2N. Stoodley, 2M. Carter, 1F. O’Callaghan, 1A. Ramanan. 1University of Bristol, Bristol, UK, 2North Bristol NHS Trust, Bristol, UKAims: The isolated finding of an unexplained chronic subdural haematoma in an infant remains controversial and challenging both clinically and … ER -