新生儿视网膜出血的高危因素及转归特点

Risk factors and prognosis of retinal hemorrhage in neonates

目的探讨我院新生儿视网膜出血(RH)的发生率、高危发病因素及其转归情况。方法采用广域眼底照相系统对2022年1月至8月在我院出生的876名(1752眼)新生儿进行眼底筛查,分别对有无RH新生儿的出生基本情况、母体相关因素和自身相关因素进行比较;多因素Logistic回归分析新生儿RH高危因素;并分析新生儿RH的吸收时间与转归情况。结果876名(1752眼)新生儿中,新生儿RH 164例(286眼),新生儿RH患眼发生率为16.32%。妊娠高血压、妊娠糖尿病、羊膜早破和产钳辅助分娩均是新生儿RH发生的母体相关因素(均为P<0.05)。新生儿颅内出血、新生儿窒息、新生儿肺炎和早产是新生儿RH发生的自身相关因素(均为P<0.05)。多因素Logistic回归分析结果显示,新生儿RH发病的高危因素为:新生儿窒息、妊娠高血压、自然阴道分娩、新生儿颅内出血与产钳辅助分娩。新生儿RH中I级出血(191眼)与II级出血(85眼)均在4周内全部吸收,II级出血中2眼周边视网膜遗留白色瘢痕;III级出血10眼(5例),6眼在4周内全部吸收,其余4眼直到10周后逐渐全部吸收,其中2眼周边视网膜遗留白色瘢痕。结论新生儿RH主要危险因素为新生儿窒息、妊娠高血压、自然阴道分娩、新生儿颅内出血、产钳辅助分娩。新生儿RH的吸收时间和转归情况与其出血程度和部位有关。

Objective To investigate the incidence,high-risk factors and prognosis of retinal hemorrhage(RH)in neonates.Methods A total of 876 neonates(1752 eyes)born in our hospital between January and August 2022 were enrolled.The wide-field fundus photography was used for fundus screening.The birth conditions,maternal-related and neonate-related pathogenic factors were compared among neonates with and without RH.The high-risk factors of RH were analyzed by multivariate logistic regression.The absorption time and prognosis of RH were also analyzed.Results Among 876 neonates(1752 eyes),164(286 eyes)had RH(16.32%).Pregnancy-induced hypertension and diabetes,premature rupture of the amniotic membrane and forceps delivery were the maternal-related factors of RH(all P<0.05).Intracranial hemorrhage,asphyxia,pneumonia and premature birth were the neonate-related factors of RH(all P<0.05).The multivariate logistic regression analysis results showed that the risk factors of RH in neonates included neonatal asphyxia,intracranial hemorrhage,pregnancy-induced hypertension,spontaneous vaginal delivery,and forceps delivery.Among the 286 eyes,bleeding in 282 eyes(grade I:191 eyes;grade II:85 eyes;grade III:6 eyes)was completely absorbed within 4 weeks,and that in the rest 4 eyes(grade III)was completely absorbed after 10 weeks.White scars were found in the peripheral retina in 4 eyes(grade II:2 eyes and grade III:2 eyes).Conclusion Risk factors of RH in neonates include neonatal asphyxia,pregnancy-induced hypertension,spontaneous vaginal delivery,neonatal intracranial hemorrhage and forceps delivery.The absorption time and prognosis of RH are associated with the bleeding grade and position.