影响健康足月新生儿视网膜出血程度的临床因素分析

Clinical analysis of risk factors for degree of retinal hemorrhages in healthy full-term newborns

背景新生儿视网膜出血在临床上较常见，严重的视网膜出血预后不佳，目前对影响新生儿视网膜出血程度的因素尚未完全明确，探索其相关因素有助于对其进行早期干预和预防。目的研究健康足月新生儿视网膜出血程度与产妇、分娩和新生儿临床因素之间的关系。方法采用横断面研究方法，于2013年1—12月对中山市人民医院产科出生的1 311名足月新生儿进行眼底筛查，所有新生儿在出生后4 d内行Ret Cam Ⅲ眼底检查，分别由2位有经验的审核者采用盲法独立读片。按照新生儿视网膜出血程度采用Egge分级标准分为Ⅰ、Ⅱ和Ⅲ度视网膜出血组，无视网膜出血的新生儿作为正常对照组。采用逐步回归法探讨新生儿一般因素、产妇因素、生产因素和新生儿因素对视网膜出血程度的影响因素，对P〈0.10的影响因素进一步进行有序多分类logistic回归分析。结果1 311名新生儿中视网膜出血者371例，占28.30%，其中Ⅰ、Ⅱ、Ⅲ度视网膜出血分别为152、116和103例，分别占11.59%、8.85%和7.86%。经有序多分类logistic回归分析，脐带绕颈[相对危险度（OR）＝1.308，95%可信区间（CI）∶1.011～1.693，P＝0.041]是视网膜出血程度加重的危险因素，生产方式中经阴道分娩是视网膜出血程度加重的危险因素（OR＝0.134，95%CI：0.132～0.137，P〈0.001），剖宫产则不是视网膜出血程度加重的危险因素。结论经阴道分娩和脐带绕颈是足月新生儿视网膜出血程度加重的危险因素，具有这些危险因素的新生儿应进行早期检查以排除视网膜出血。

BackgroundRetinal hemorrhage in newborns is a common clinical finding, and serious retinal henorrhage resulting in poor prognosis.The factors affecting retinal henorrhage in newborns are unelucidated now.Identifying these factors is helpful for the early prevention and treatment.ObjectiveThis study was to explore the underlying maternal, obstetric, and neonatal clinical factors for degree of retinal hemorrhages in healthy full-term newborns.MethodsA cross-sectional study was performed in the approval of Ethic Committee of Zhongshan City People＇s Hospital.A total of 1 311 full-term infants, with gestational age more than 37 weeks and Apgar ≥9 scores were included in this study.Infants with severe systemic diseases or any other eye diseases were excluded.Ocular fundus of the infants were examined with Ret Cam Ⅲ within 4 days of birth and were independently identified by 2 eye doctors.The newborns of retinal hemorrhage were divided into grade Ⅰ, Ⅱ and Ⅲ groups based on Egge criteria, and the infants without retinal hemarrhage served as the normal control group.Maternal, obstetric, neonatal parameters and general factors were analyzed and compared among different groups, and the risk factors that affected the newborns retinal hemorrhage were analyzed by logistic regression analysis.ResultsRetinal hemorrhage was seen in 28.30% infants （371/1 311）, and 152, 116 and 103 infants were identified as gradeⅠ, Ⅱ and Ⅲ, with the percentage of 11.59%, 8.85% and 7.86%, respectively.Among the factors that examined in the study, cord around fetal neck was the risk factor of aggravation of degree of retinal hemorrhage in newborns（OR=1.308, 95%CI： 1.011-1.693, P=0.041）. In the mode of delivery, spontaneous vaginal delivery appeared to be the positive factor of the incidence of retinal hemorrhage （OR=0.134, 95%CI： 0.132-0.137, P〈0.001）, but cesarean section was not a main risk factor.ConclusionsSpontaneous vaginal delivery and cord around fetal neck are the potential risk factors for the aggravation of degree of retinal hemorrhage in full-term infants.Accordingly, infants with these risk factors should be paid more attention to prevent the progression of retinal hemorrhage.