Resuscitation attempts have been hypothecated to explain
retinal hemorrhages in infants who are suspected victims of child abuse. This study was undertaken to test that hypothesis by postmortem ocular examinations following unsuccessful
resuscitation attempts on a sample of 169 children selected by 19 prosectors willing to contribute to the study.
Cardiopulmonary resuscitation had been attempted for a minimum of 30 min in 131 of the children, whereas 38 controls did not have such protracted attempts; 70 children with prolonged
resuscitation attempts had no
retinal hemorrhages, including eight children whose fatal blunt force
injuries of the trunk represented extremes of the forces used in
resuscitation attempts. Children who died of
asphyxia, respiratory illnesses,
sudden infant death syndrome, and various other causes had no
hemorrhages; neither did 21 children who died of
head injury or central nervous system (
CNS) diseases, nor did 29 controls.
Retinal hemorrhages were present in 70 children, 61 with prolonged
resuscitation attempts and nine controls. Among those with attempted
resuscitation, 56 had
head injuries, and four had
CNS diseases and
sepsis, all recognized causes of
retinal hemorrhages. The other death that involved a
resuscitation attempt and
retinal hemorrhages was an officially "undetermined" death. The child had come from a household with two prior child deaths and documented abuse. No case is found in this study to support the hypothesis that
retinal hemorrhages are caused by
resuscitation attempts.