新生儿眼底出血及其相关影响因素分析

Retinal hemorrhages in newborns and associated factors

目的观察新生儿眼底出血的发生情况，探讨其相关影响因素。方法9558名出生后0～4d的新生儿纳入观察。采用第三代广角数码儿童视网膜成像系统进行眼底检查，眼底出血程度分为I、Ⅱ、Ⅲ度。记录新生儿出生时情况及母亲孕期、分娩时状况。进入统计的因素包括双胎、早产、巨大儿、分娩方式、出生胎位、产钳助产、吸引器助产、窒息、病理性黄疸、ABO溶血、头颅血肿、颅内出血、产妇年龄、初产妇、经产妇中前次生产方式、急产、第一产程延长、第二产程延长、第三产程延长、妊娠高血压、妊娠糖尿病、催产素、孕妇产后体重指数（BMI）值。多因素logistic回归分析。结果发现眼底出血者2753例，占28．8％；未发现眼底出血者6805例，占71．2％。2753例眼底出血的患儿中，出血程度为I度者1137例，占41．3％；Ⅱ度者895例，占32．5％；Ⅲ度者721例，占26．2％。多因素logistic回归分析结果显示，分娩方式、窒息、病理性黄疸、高龄产妇、经产妇前次顺产、孕妇产后BMI值是新生儿眼底出血的影响因素（r^2=0．146、5．841、1．847、0．071、0．246、1．770，P〈0．05）。眼底出血程度与新生儿体重、孕妇产后BMI值均无相关（F=1．321、0．545，P〉0．05）。结论新生儿眼底出血发生率为28．8％。分娩方式、窒息、病理性黄疸、高龄产妇、经产妇中前次生产方式、孕妇产后BMI值是影响眼底出血的因素。

Objective To investigate the related factors of the retinal hemorrhage in newborns. Methods 9558 newborns included in this observation between March of 2012 and July of 2013 in our hospital. The fundus was examined by the fully-integrated wide-field digital imaging system RetCam Ⅲ at 0 - 4 days after born. According to the literature, retinal hemorrhage was classified into degree I , Ⅲ and Ⅲ. The condition for baby and the mother during pregnancy were correlatively analyzed. The other factors were analyzed including twins, premature delivery, big baby, mode of delivery, fetal birth, forceps delivery, suction delivery, asphyxia, jaundice, ABO hemolytic, cranial hematoma, intraeranial hemorrhage, maternal age, first-time morn, the maternal previous mode of production, emergency delivery, the first stage of labor prolonged, the second stage of labor prolonged, the third stage of labor prolonged, pregnancy- induced hypertension, gestational diabetes, oxytocin, prenatal body mass index （BMI）. Multivariate logistic regression analysis was used. Results In 9558 cases of newborns,retinal hemorrhages were found in 2753 infants （28.8%）, including 1137 degree I （41.3%）, 895 degree Ⅱ （32.5%） and 721 degree Ⅲ （26.2%）. Multivariate logistic regression analysis showed that the mode of delivery, asphyxia, jaundice, advanced maternal age, maternal previous birth, prenatal BMI is a risk factor for neonatal values retinal hemorrhage （r = 0.146, 5. 841, 1. 847, 0.071, 0.246, 0.965; P 〈0.05）. The degree of fundus hemorrhage was not related to birth weight and BMI （P 〉 0.05）. Conclusions The neonatal retinal hemorrhage rate was 28.8%. Mode of delivery, asphyxia, neonatal jaundice, maternal age, the previous mode of delivery of mothers with more than one previous birth, prenatal BMI values may be risk factors lead to retinal hemorrhage.