Retinal Hemorrhages in a Newborn with Prenatal Cocaine Exposure

A term male newborn small for gestational age and with microcephaly was born from uncomplicated vaginal delivery. Pregnancy was not followed up until 32 weeks. Maternal serologies and vaginal/rectal swabs were negative. Routine ophthalmoscopy revealed hemovitreous in the right eye and massive retinal hemorrhages (RH) in the left eye; subsequent RetCam II examination with fluorescein angiography revealed bilateral RH, involving the fovea in the left eye. Retinal vascularization was normal in both eyes, without signs of ischemic injury or pathological angiogenesis. Complete blood count, coagulation, and thrombophilic studies were normal; a toxicology screen, performed on a hair sample from both mother and infant, was positive for cocaine. With its significant vasoconstrictive effects, cocaine may induce ischemic-hypoxic damage in the developing retinal vascular system of the fetus, leading to extensive RH. Although cocaine-related RH is indistinguishable from other birth-related RH, the formers persist for longer periods, warranting prolonged follow-up and long-term evaluation of visual function.