From the Research
Bilateral vitreous hemorrhage in a 36-week preterm infant requires urgent ophthalmology consultation for evaluation and management, with a focus on determining the underlying cause and preventing further complications, as highlighted in a case report of very late-onset reactivation of retinopathy of prematurity post anti-VEGF bevacizumab treatment 1. The immediate recommendation is to arrange for a pediatric ophthalmologist to perform a dilated eye examination within 24-48 hours to determine the cause and severity of the hemorrhage. Key considerations in the evaluation of bilateral vitreous hemorrhage in preterm infants include:
- The most common cause in preterm infants is retinopathy of prematurity (ROP), but birth trauma, coagulopathy, or other vascular abnormalities may be responsible, as discussed in a study on vitreous hemorrhage in children 2.
- While awaiting specialist assessment, ensure the infant's vital signs are stable and check for any coagulation abnormalities with laboratory tests including complete blood count, PT/PTT, and fibrinogen levels.
- No specific medications should be administered until the ophthalmologist's evaluation, as the management will depend on the underlying cause - ROP may require laser photocoagulation or anti-VEGF therapy such as bevacizumab (0.625-0.75 mg/0.03 mL), while traumatic hemorrhages often resolve spontaneously over weeks to months, as noted in a study on retinal haemorrhages in premature infants 3. Regular follow-up examinations will be necessary, typically weekly initially, then extending to biweekly or monthly depending on resolution. It is essential to consider the characteristics of retinal hemorrhages in infants with ROP and conduct any necessary investigation, as highlighted in a case report of shaken baby syndrome in an infant treated for retinopathy of prematurity with anti-VEGF injection 4. Vitreous hemorrhage in preterm infants can lead to amblyopia or permanent vision loss if not properly managed, making timely intervention crucial for preserving visual development, as emphasized in a study on vitreous hemorrhage in infants 5.