When a newborn is diagnosed with retinal hemorrhage, parents naturally feel worried. Finding out that your baby has bleeding in the eye can be frightening, especially when you’re already adjusting to life with a new child. But in most cases, retinal hemorrhages in newborns are a common, temporary result of the birthing process itself. They usually resolve on their own within a few weeks and don’t cause lasting vision problems.

That said, understanding what retinal hemorrhage is, why it happens, and when it requires closer attention can help you feel more informed and confident in your baby’s care. This page explains the medical facts about retinal hemorrhage in newborns, including how delivery method affects risk, what doctors look for during examinations, and what follow-up care may be needed. Whether you’re preparing for delivery, just learned about a diagnosis, or simply want to understand more about this condition, the information here can guide you through what to expect.

What Is Retinal Hemorrhage In Newborns?

Retinal hemorrhage refers to bleeding into the layers of the retina, the light-sensitive tissue at the back of the eye that allows us to see. In newborns, these hemorrhages typically appear as small, dot-like or blot-like areas of bleeding within the retina itself. They most often occur in both eyes and are usually concentrated around the macula, the central part of the retina responsible for detailed vision.

The bleeding can occur at different depths within the retina. Most birth-related hemorrhages are intraretinal, meaning they happen within the tissue layers of the retina itself. Less commonly, bleeding may occur in front of the retina (preretinal) or beneath it (subretinal). The location and extent of bleeding can help doctors understand what caused it and whether any follow-up is needed.

Unlike a subconjunctival hemorrhage, which creates a visible red patch on the white of the eye, retinal hemorrhages are not visible from the outside. They can only be detected through a specialized eye examination performed by a doctor using an ophthalmoscope or advanced imaging equipment.

How Common Are Retinal Hemorrhages After Birth?

Retinal hemorrhages occur in roughly one-quarter to one-third of all term infants shortly after birth. Research from multiple hospitals and clinical studies consistently shows that these hemorrhages are a frequent finding when newborns undergo eye examinations in the first day or two of life.

The likelihood of developing retinal hemorrhages varies significantly based on how the baby was delivered:

Normal vaginal delivery: About 25 to 34% of infants born through uncomplicated vaginal birth develop retinal hemorrhages
Vacuum-assisted vaginal delivery: Approximately 35 to 80% of infants, with some studies reporting rates as high as 78%
Forceps-assisted delivery: Roughly 13 to 33% of infants, falling between spontaneous vaginal and vacuum-assisted births
Cesarean section: About 6 to 10%, representing the lowest rate among all delivery methods

One frequently cited prospective study that examined newborns using specialized retinal imaging found that 34% of all examined infants had retinal hemorrhages. When broken down by delivery method, 77.8% of vacuum-assisted births showed hemorrhages, compared to 30.4% after normal vaginal delivery, 30.3% after forceps delivery, and just 8.3% after cesarean section.

These numbers help put the condition in perspective. If your baby has retinal hemorrhages after a vaginal delivery, especially one involving assistance with vacuum or forceps, your child is experiencing something that affects many other newborns in similar circumstances.

Why Do Retinal Hemorrhages Happen During Birth?

Birth is a physically intense process for babies. As the baby moves through the birth canal, the head undergoes significant compression. This compression causes a rapid increase in pressure within the baby’s skull and in the small blood vessels throughout the body, including those in the eyes.

The retina contains extremely delicate veins and capillaries. When pressure rises quickly during labor and delivery, these fragile vessels can become congested and may rupture, causing small areas of bleeding. Think of it as similar to how intense physical strain can sometimes cause broken blood vessels in other parts of the body, except that in newborns, the stress of birth creates the conditions for this to happen in the eyes.

This process is particularly common in vaginal deliveries because of the repeated compression the baby’s head experiences as it passes through the birth canal. Each contraction adds pressure, and the cumulative effect can lead to vessel rupture in susceptible infants. The process is generally not a sign that anything went wrong during delivery; rather, it reflects the normal mechanical forces involved in birth.

What Factors Increase The Risk Of Retinal Hemorrhage?

Several factors make it more likely that a newborn will develop retinal hemorrhages during birth. Understanding these risk factors can help explain why some babies develop the condition while others delivered in similar ways do not.

Delivery method stands out as the strongest predictor. Vaginal delivery carries about 20 times the risk of retinal hemorrhage compared to cesarean section, even after accounting for other factors like birth weight. This dramatic difference reflects the mechanical compression involved in passing through the birth canal.

Vacuum or forceps assistance significantly increases risk beyond that of unassisted vaginal delivery. Vacuum extractors create additional suction and traction on the baby’s head, while forceps apply direct pressure. Both instruments, while sometimes medically necessary, add to the forces the baby experiences.

Lower birth weight within the term range appears to increase vulnerability. Even among full-term babies, those on the smaller end of the weight range are more susceptible to retinal hemorrhages. Smaller babies may have more fragile blood vessels or may experience proportionally greater forces during delivery.

Scalp trauma markers like cephalohematoma (a collection of blood under the scalp) or caput succedaneum (swelling of the scalp) often occur alongside retinal hemorrhages. While these don’t directly cause the eye bleeding, they indicate that the baby experienced significant head compression during birth.

Prolonged or precipitous labor can contribute to risk. Very fast deliveries compress the head rapidly, while prolonged pushing stages extend the duration of pressure. Both scenarios can increase the likelihood of vessel rupture.

Neonatal asphyxia and perinatal complications have also been linked to higher rates of retinal hemorrhage, though the exact mechanisms are less clear. These factors may affect blood vessel fragility or increase pressure in ways that make hemorrhages more likely.

It’s important to remember that even babies without any of these risk factors can develop retinal hemorrhages, and many babies with multiple risk factors will have perfectly clear retinas. These are general patterns observed across large groups of infants, not absolute predictors for any individual child.

Do Birth-Related Retinal Hemorrhages Cause Symptoms?

In most cases, retinal hemorrhages in newborns produce no obvious symptoms. Babies with retinal hemorrhages typically look and behave exactly like babies without them. You won’t see redness in the white part of the eye, and your baby’s behavior, feeding, and alertness are usually completely normal.

This is one reason why retinal hemorrhages often go undetected unless a doctor specifically examines the back of the eye. Unlike external eye bleeding that you can see, retinal hemorrhages are internal and require special equipment to visualize.

Some newborns may have other visible signs of birth trauma, such as:

Subconjunctival hemorrhages (red patches on the white of the eye)
Bruising or swelling on the scalp
Facial petechiae (tiny red dots on the skin)

However, these external signs don’t reliably predict whether retinal hemorrhages are present. Some babies have both external and internal bleeding, while others have one without the other.

The lack of symptoms is actually reassuring in most cases, as it indicates that the hemorrhages are not interfering with your baby’s immediate wellbeing or visual function.

How Are Retinal Hemorrhages Detected And Diagnosed?

Retinal hemorrhages are discovered through direct examination of the back of the eye using specialized instruments. The most common method is indirect ophthalmoscopy, where a doctor uses a bright light and special lenses to view the retina. Some hospitals and research centers use wide-field digital imaging systems like RetCam, which can photograph the entire retina and create a permanent record of the findings.

Most newborns do not receive routine eye examinations unless there’s a specific reason to look. Retinal hemorrhages might be discovered during evaluations for:

Suspected birth trauma or difficult delivery
Known use of vacuum or forceps during birth
Neurological concerns or suspected intracranial bleeding
Research studies on birth-related eye findings
Unexplained symptoms that prompt comprehensive evaluation

In many cases, retinal hemorrhages are found incidentally when a baby is examined for something else entirely. If your baby’s doctor recommends an eye examination, it’s typically because something about the delivery or your baby’s condition suggests it would be helpful to check.

The examination itself is generally quick and well-tolerated by newborns, though babies may fuss when their eyes are held open and bright lights are shined in them. Eye drops may be used to dilate the pupils, making it easier to see the entire retina.

How Long Do Birth-Related Retinal Hemorrhages Last?

The vast majority of birth-related retinal hemorrhages resolve quickly and completely on their own. Around 85% disappear within one to two weeks after birth, and nearly all are gone by four weeks. This rapid resolution is one of the key features that distinguishes normal birth-related hemorrhages from more serious types of retinal bleeding.

In studies that followed newborns with retinal hemorrhages using repeated imaging, most showed complete clearing within 16 days. Even in cases involving vacuum-assisted delivery, which tend to produce more extensive hemorrhages, most resolved within this timeframe. A small number of infants, particularly those delivered by vacuum, had hemorrhages that persisted slightly longer, up to four to eight weeks, but these eventually cleared as well.

During this resolution period, the blood is gradually reabsorbed by the body. The retina heals naturally, and in the vast majority of cases, no scar tissue forms and no permanent changes occur. Your baby’s visual development continues normally during this time.

Do Retinal Hemorrhages Affect Long-Term Vision?

Current medical evidence strongly suggests that uncomplicated birth-related retinal hemorrhages rarely cause lasting vision problems. Studies that have followed infants with documented birth-related hemorrhages through childhood have found normal visual development in the great majority of cases.

This reassuring prognosis applies particularly to the small, intraretinal hemorrhages that are most common after vaginal delivery. These typically resolve completely without leaving any trace, and babies go on to develop normal vision as they grow.

There are some situations where follow-up may be recommended:

When hemorrhages involve the macula or fovea (the central part of the retina critical for detailed vision), pediatric ophthalmologists may want to monitor visual development more closely. Even though these usually resolve without problems, doctors may check to ensure that central vision is developing normally and that no subtle effects on focus or visual acuity have occurred.

When hemorrhages are unusually dense or extensive, follow-up examinations help confirm that resolution is proceeding as expected. While still typically benign, more significant bleeding takes longer to clear and warrants periodic checking.

When hemorrhages persist beyond four weeks, additional evaluation is appropriate to ensure that no other underlying problem is present and that the bleeding is indeed related to birth rather than some other cause.

For most families, the message is one of reassurance. The eye bleeding your newborn experienced during birth is almost certainly temporary and will not affect your child’s ability to see, learn, or develop normally.

When Do Retinal Hemorrhages Indicate A More Serious Problem?

While birth-related retinal hemorrhages are usually benign, it’s important to understand when retinal bleeding might signal something more serious. This distinction is particularly important as babies get older and move beyond the newborn period.

Timing matters significantly. Birth-related hemorrhages appear within the first day or two of life and begin resolving within weeks. If retinal hemorrhages are discovered for the first time in an older infant (beyond one month of age) or if they persist or worsen after the initial newborn period, doctors will investigate other possible causes.

In older infants and young children, extensive retinal hemorrhages, especially those that are too numerous to count, extend to the periphery of the retina, and involve multiple layers (preretinal, intraretinal, and subretinal simultaneously), are strongly associated with abusive head trauma, sometimes called shaken baby syndrome. This pattern of injury is distinctly different from typical birth-related hemorrhages.

Birth-related hemorrhages are:

Present in the first days of life
Usually small and dot-like
Predominantly intraretinal
Quick to resolve (days to weeks)
Often clustered around the macula

Hemorrhages from abusive head trauma are:

Discovered after the newborn period
Often extensive and too numerous to count
Present in multiple retinal layers simultaneously
May extend to the periphery of the retina
Often accompanied by other injuries

Other serious causes of retinal hemorrhage in infants include bleeding disorders (like severe vitamin K deficiency or inherited clotting problems), leukemia, severe infections, or significantly increased pressure inside the skull from hydrocephalus or other causes. Each of these conditions typically presents with additional symptoms beyond the eye findings.

If your baby is diagnosed with retinal hemorrhages, the context matters enormously. Hemorrhages found during a routine examination in the first week after a vaginal delivery are approached very differently than hemorrhages discovered in a three-month-old who arrives at an emergency room with concerning neurological symptoms.

What Treatment Do Birth-Related Retinal Hemorrhages Require?

In the vast majority of cases, birth-related retinal hemorrhages require no treatment at all. The standard medical approach is observation and reassurance while the hemorrhages resolve naturally over time.

There are no medications to speed healing, no procedures to remove the blood, and no interventions that have been shown to improve outcomes compared to simply waiting. The body’s natural healing processes are highly effective at clearing these hemorrhages, and medical intervention would offer no benefit while potentially carrying risks of its own.

For typical cases, your baby’s doctor will:

Explain the findings and expected timeline for resolution
Reassure you that vision should develop normally
Advise you to watch for any unusual symptoms (though these are rare)
Determine whether follow-up examination is needed

For more extensive hemorrhages or those involving the macula, a pediatric ophthalmologist may recommend:

Repeat examination at four to six weeks to confirm resolution
Monitoring of visual development as your baby grows
Assessment for refractive errors or amblyopia (lazy eye) in early childhood, though these complications are uncommon

When hemorrhages are part of a larger medical picture, such as bleeding disorders or suspected abusive head trauma, treatment focuses on addressing the underlying condition rather than the eye findings themselves. The retinal hemorrhages are a sign of the broader problem, not the primary target of treatment.

Parents sometimes ask whether anything can be done to help the hemorrhages heal faster. While the desire to actively help your baby is completely understandable, the medical reality is that these hemorrhages heal at their own pace, and that pace is already quite rapid in most cases.

How Can Retinal Hemorrhages Be Prevented?

Because birth-related retinal hemorrhages result from the normal mechanical forces of vaginal delivery, they cannot be entirely prevented without fundamentally changing how babies are born. To some extent, these hemorrhages are considered part of the physiologic stress that accompanies labor and birth.

That said, understanding the risk factors does inform some obstetric practices:

Delivery method has the strongest influence on risk. Cesarean section dramatically reduces the likelihood of retinal hemorrhage compared to vaginal delivery, but cesarean delivery carries its own risks for both mother and baby. The decision about mode of delivery is based on many factors, and preventing retinal hemorrhage alone is not typically a reason to choose cesarean section.

Operative vaginal delivery practices matter. Data showing higher rates of retinal hemorrhage with vacuum extraction and, to a lesser extent, forceps delivery support the importance of careful patient selection for these procedures. Current obstetric guidelines from organizations like the American College of Obstetricians and Gynecologists emphasize:

Using vacuum and forceps only when medically indicated
Limiting the number of traction attempts
Ensuring proper technique and training
Monitoring for signs of excessive trauma
Considering alternative approaches when initial attempts are unsuccessful

These guidelines exist to minimize trauma to the baby (and mother) during operative deliveries, not specifically to prevent retinal hemorrhages, but the effect is the same.

Optimizing labor management may help reduce some birth trauma overall. This includes allowing adequate time for the baby to descend, ensuring proper positioning, and avoiding unnecessary interventions. However, labor is inherently unpredictable, and even the most carefully managed deliveries can result in retinal hemorrhages.

For families planning delivery, the key takeaway is that retinal hemorrhages are common after vaginal birth and usually benign. Making decisions about delivery methods should be based on standard obstetric considerations for maternal and fetal health rather than specifically on retinal hemorrhage risk.

What Should Parents Know About Retinal Hemorrhage Findings?

If you’re told that your newborn has retinal hemorrhages, it’s completely natural to feel anxious. The phrase “bleeding in the eye” sounds serious and frightening. Here’s what you should understand:

These hemorrhages are common. About one in three babies born vaginally will have some degree of retinal hemorrhage. You and your baby are not experiencing something rare or unusual.

They almost always resolve on their own. More than 85% disappear within two weeks, and virtually all are gone within a month. Your baby’s eyes are healing even if you can’t see it happening.

They don’t usually cause symptoms. Your baby can still see and should develop vision normally. The hemorrhages don’t cause pain or discomfort.

They’re different from serious eye injuries. Birth-related retinal hemorrhages are not the same as retinal detachments, severe trauma, or other conditions that might threaten vision. The terminology can sound scary, but the reality for most newborns is reassuring.

Follow-up is typically straightforward. Most babies won’t need any eye examinations beyond an initial check. For those who do need follow-up, it’s usually a single repeat visit to confirm that the hemorrhages have resolved.

You didn’t cause this. Parents sometimes worry that something they did during pregnancy or labor contributed to their baby’s hemorrhages. In reality, these result from the mechanical forces of birth itself, not from anything you did or didn’t do.

Don’t hesitate to ask your baby’s doctors questions. Request clear explanations of what was found, why it happened, what the expected timeline for healing is, and whether any follow-up is needed. Good communication with your medical team can significantly reduce anxiety and help you feel more confident in your baby’s care.

What Resources And Support Are Available In New York?

New York is home to numerous excellent pediatric hospitals and ophthalmology centers that provide comprehensive care for newborns with retinal hemorrhages and other eye conditions.

Major academic medical centers including NYU Langone, Columbia University Irving Medical Center, and Mount Sinai offer pediatric ophthalmology services with specialists experienced in evaluating and managing retinal hemorrhages in newborns. These centers also provide neurodevelopmental follow-up programs for infants who may need monitoring over time.

If your baby has been diagnosed with retinal hemorrhages and you have questions about follow-up care, your pediatrician can coordinate with pediatric ophthalmology specialists to ensure appropriate monitoring. Most cases require minimal to no follow-up, but when concerns arise, these subspecialists can provide expert evaluation.

For families navigating birth injuries or complications, having access to clear, accurate information is essential. NYBirthInjury.com exists to provide trusted medical information about birth-related conditions and to help connect families with qualified medical resources and support services throughout New York and beyond.

Early intervention programs through New York State’s Early Intervention Program can provide developmental support for children with any concerns about vision or other developmental areas, though most children with birth-related retinal hemorrhages will not need these services.

Your baby’s pediatrician remains your primary partner in care. They can address questions, coordinate referrals, and help you understand what follow-up, if any, is appropriate for your child’s specific situation.

Understanding The Difference Between Common And Concerning Findings

One of the most important things doctors consider when evaluating retinal hemorrhages is context. The same finding can have very different implications depending on when it’s discovered, how it looks under examination, and what other symptoms or circumstances are present.

In the newborn period, retinal hemorrhages discovered in the first few days after vaginal delivery are presumed to be birth-related unless there’s evidence suggesting otherwise. These are documented, but they’re not typically cause for alarm. The focus is on confirming that they resolve as expected.

Beyond the newborn period, any retinal hemorrhages require careful evaluation. If a six-month-old is found to have retinal bleeding during an evaluation for poor feeding, lethargy, or seizures, doctors will investigate much more thoroughly. This might include neuroimaging, blood tests to check for clotting problems, and consultation with multiple specialists.

The pattern and extent of hemorrhages provide important clues. Small, dot-like hemorrhages in the posterior retina look very different under examination than extensive, multilayered hemorrhages that cover large areas and extend to the periphery. Ophthalmologists are trained to recognize these patterns and understand their implications.

Associated findings matter greatly. Retinal hemorrhages in a baby who also has skull fractures, subdural hematomas, or other injuries raise serious concerns. Hemorrhages in an otherwise healthy newborn after vacuum-assisted delivery are viewed very differently.

Documentation is essential. When retinal hemorrhages are found, careful documentation of their appearance, extent, and location creates a baseline. This allows for comparison in follow-up examinations and helps distinguish evolving problems from resolving birth-related findings.

For families, the practical implication is that if your newborn has retinal hemorrhages documented shortly after birth, this is medical information that should be communicated clearly to you and included in your child’s medical records, but it should not typically be a source of ongoing worry. If hemorrhages are discovered or questioned later, expect a more thorough evaluation to determine their cause and significance.

Moving Forward With Confidence

Learning that your newborn has retinal hemorrhages can feel overwhelming in the moment, especially when you’re already adjusting to new parenthood and processing everything that happened during labor and delivery. It’s one more medical term to understand, one more item on your list of things to follow up on, and one more source of worry about your baby’s wellbeing.

The good news is that for the vast majority of newborns, birth-related retinal hemorrhages are a temporary finding that resolves quickly and completely. Your baby’s eyes are designed to heal from the stress of birth, and in nearly all cases, that healing happens smoothly and thoroughly.

As your baby grows, you’ll watch them begin to focus on faces, track moving objects, and eventually reach for toys and explore their world visually. These developmental milestones are powerful reassurance that vision is developing normally. The small hemorrhages that may have been present in those first days will likely have no impact on this unfolding process of visual development.

If follow-up has been recommended, attending those appointments provides an opportunity to confirm that healing is complete and to ask any lingering questions. If no follow-up was suggested, you can trust that your baby’s medical team believed the findings were typical and self-limited.

Remember that retinal hemorrhages after vaginal birth are common enough that pediatric ophthalmologists and neonatologists encounter them routinely. Your baby’s doctors have seen many infants with similar findings go on to develop perfectly normal vision. You’re not alone in this experience, and the medical professionals caring for your child have the expertise to distinguish expected findings from those requiring closer attention.

As you navigate the early weeks with your newborn, focus on the basics of caring for your baby, bonding, establishing feeding routines, and getting rest when you can. The retinal hemorrhages are resolving even if you can’t see it happening, and your baby’s visual system is developing right on schedule.

Retinal Hemorrhage