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American Academy of Pediatrics
Visual Diagnosis

Abnormal Ocular Examination Findings in a Term Infant

Matthew Ryzewski, Malgorzata Bulanowski, Lauren Ramos and Christopher Rouse
NeoReviews March 2021, 22 (3) e207-e210; DOI: https://doi.org/10.1542/neo.22-3-e207
Matthew Ryzewski
*Elliot Health System NICU, Manchester, NH
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Malgorzata Bulanowski
*Elliot Health System NICU, Manchester, NH
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Lauren Ramos
*Elliot Health System NICU, Manchester, NH
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Christopher Rouse
*Elliot Health System NICU, Manchester, NH
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The Case

A 3-hour-old full-term female neonate presents with white pupils noted at the time of NICU admission.

Prenatal and Birth Histories

  • Born to a 34-year-old gravida 1, para 0 white woman

  • Pregnancy complicated by gestational hypertension, headaches, anxiety, and depression. Maternal medications included prenatal vitamins, fluoxetine, and sumatriptan

  • Prenatal maternal laboratory findings: Blood type B+, antibody negative, rubella immune, hepatitis B surface antigen negative, rapid plasma reagin nonreactive, HIV negative

  • Estimated gestational age: 37 6/7 weeks’ gestation

  • Vaginal delivery after the induction of labor because of maternal hypertension

  • Apgar score: 2, 7, and 8 at 1, 5, and 10 minutes, respectively

The infant was limp and cyanotic at delivery and required positive pressure ventilation for 5 minutes. No risk factors for sepsis were noted and there was no evidence of placental abruption. In addition, the fetal heart rate tracing was normal before delivery. The reasons for the perinatal depression at birth were unclear. Subsequently, the infant started breathing spontaneously and was transitioned to room air. Neurologic examination findings obtained at the outside facility were significant for wide-eyed appearance with staring and generalized low muscle tone.

Presentation

The infant was transferred to the NICU at 3 hours of age for therapeutic hypothermia evaluation. Initial physical examination findings were remarkable for the presence of leukocoria bilaterally. This was visualized easily with both ambient lighting in the patient room as well as direct examination with an ophthalmoscope (Fig 1). Red reflex was absent bilaterally.

Figure 1.

Bilateral leukocoria.

The infant’s neurologic assessment findings at admission were consistent with moderate hypoxic-ischemic encephalopathy. Therapeutic whole-body cooling was initiated. An umbilical venous catheter was placed and continuous electroencephalogram obtained. The infant also received ampicillin and ceftazidime, intravenous fluids, and continuous fentanyl infusion.

Vital Signs (3 Hours of Age)

  • Heart rate: 115 beats/min

  • Respiratory rate: 40 breaths/min

  • Blood pressure: 80/68 mm Hg

  • Oxygen saturation: 100% (in room air)

  • Temperature: 97.7°F (36.5°C) …

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NeoReviews
Vol. 22, Issue 3
1 Mar 2021
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Abnormal Ocular Examination Findings in a Term Infant
Matthew Ryzewski, Malgorzata Bulanowski, Lauren Ramos, Christopher Rouse
NeoReviews Mar 2021, 22 (3) e207-e210; DOI: 10.1542/neo.22-3-e207

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Abnormal Ocular Examination Findings in a Term Infant
Matthew Ryzewski, Malgorzata Bulanowski, Lauren Ramos, Christopher Rouse
NeoReviews Mar 2021, 22 (3) e207-e210; DOI: 10.1542/neo.22-3-e207
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More in this TOC Section

  • Neck Mass in a Full-term Infant with Hypoxic-Ischemic Encephalopathy
  • Sudden Onset of a Unilateral Erythematous Preauricular Mass in a Preterm Infant
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