The Alexandria retinopathy of prematurity model(Alex-ROP): postnatal weight gain screening algorithm application in a developing country

AIM: To suggest a novel retinopathy of prematurity(ROP) screening model in developing countries incorporating postnatal weight gain ratios(PWGR) to traditional parameters to maintain sensitivity and improve specificity in detecting ROP. METHODS: Analysis of weekly PWGR of infants from one tertiary referral center during six months to determine the age at which the PWGR with the highest predictability for ROP development which was referred to as the postnatal net weight gain ratio(NWGR). NWGR was added to conventional criteria to describe a new model(The Alex-ROP model). RESULTS: Of 560 infants were included. NWGR 28 d after birth was the most predictive factor for the development of ROP. A new model Alex-ROP recommending screening infants with gestational age(GA) ≤33 wk or birth weight ≤1500 g and NWGR at 28 d after birth <0.3 was suggested. A second screening model referred to as High-grade AlexROP(Hg Alex-ROP) model to detect worse grade ROP(Both type 1 and type 2) recommending a cutoff point of NWGR <0.15 between birth and 28^(th) day. CONCLUSION: Both Alex-ROP and Hg Alex-ROP models are easy to apply to improve the specificity of ROP screening in developing countries while maintaining high sensitivity.

Colorectal cancer screening:20 years of development and recent progress

Colorectal cancer(CRC)is the second most common cancer in Europe and its incidence is steadily increasing.This trend could be reversed through timely secondary prevention(screening).In the last twenty years,CRC screening programs across Europe have experienced considerable improvements(fecal occult blood testing;transition from opportunistic to population based program settings).The Czech Republic is a typical example of a country with a long history of nationwide CRC screening programs in the face of very high CRC incidence and mortality rates.Each year,approximately 8000 people are diagnosed with CRC and some 4000 die from this malignancy.Twenty years ago,the first pilot studies on CRC screening led to the introduction of the opportunistic Czech National Colorectal Cancer Screening Program in 2000.Originally,this program was based on the guaiac fecal occult blood test(FOBT)offered by general practitioners,followed by colonoscopy in cases of FOBT positivity.The program has continuously evolved,namely with the implementation of immunochemical FOBTs and screening colonoscopy,as well as the involvement of gynecologists.Since the establishment of the Czech CRC Screening Registry in 2006,2405850 FOBTs have been performed and 104565 preventive colonoscopies recorded within the screening program.The overall program expanded to cover 25.0%of the target population by 2011.However,stagnation in the annual number of performed FOBTs lately has led to switching to the option of a population-based program with personal invitation,which is currently being prepared.

Gastric cancer mortality related to direct radiographic and endoscopic screening:A retrospective study

BACKGROUND Despite its decreased incidence in Japan,gastric cancer continues among the leading causes of cancer-related deaths in both men and women.Accordingly,efforts are still required to lower the mortality rate of gastric cancer in Japan.Maebashi City introduced endoscopic gastric cancer screening in 2004,and participants are able to choose between direct radiography and endoscopy.Hence,we expected to see a decrease in mortality rate from gastric cancer after introducing endoscopic screening and a difference in mortality rate reduction between screening methods.AIM To evaluate the impact on gastric cancer mortality rate of two types of gastric cancer screening in Maebashi City,Japan.METHODS Participants aged 40 to 79 years of the Maebashi City gastric cancer screening program in 2006 who were screened by direct radiography(n=11155)or endoscopy(n=10747)were included.Participants were followed until March 31,2012,by cross-referencing their data against the Gunma Prefecture cancer registry data.We compared the detection rate of gastric cancers.Then,we compared the mortality rate between the two groups.The Cox proportional hazards model was used to estimate the hazard ratio(HR)of gastric cancer death.Finally,the reduction in gastric cancer mortality rate associated with each screening method was evaluated.RESULTS Gastric cancer was detected in 22 participants undergoing direct radiography(detection rate,0.20%)and in 52 participants undergoing endoscopy(detection rate,0.48%).However,most gastric cancers detected by endoscopic screening were early cancers that may not have resulted in death.We found no significant difference in gastric cancer mortality rate between participants receiving annual screening and those who do not.When the number of gastric cancer deaths in the direct radiography group was set as 1 in the Cox proportional hazard analysis,the HR of gastric cancer death was 1.368(95%CI:0.7308-2.562)in the overall group of participants.The results showed no significant difference between the two screening methods in any of the analysis groups.CONCLUSION Although endoscopic screening detected more gastric cancer than direct radiographic screening,no significant difference in the reduction of gastric cancer mortality rate between the two screening methods was found.

Amblyopia screening for first and second-grade children in Jordan

AIM:To share the results of a national screening program for amblyopia in school children in the north of Jordan.METHODS:This is a prospective national screening study for amblyopia.The program rolls first and second-grade children(6 to 7 years old) in the north of Jordan.The eye examination included:best-corrected visual acuity,cover-uncover test,and cycloplegic retinoscopy.Monocular visual acuity was tested using an ETDRS visual acuity chart without correction.Moreover,children were tested with full cycloplegic refraction when the test criteria were met.Unilateral amblyopia was defined as a best-corrected visual acuity difference of 2 or more lines.In comparison,bilateral amblyopia was defined as a best-corrected visual acuity of 20/40 or worse in the best eye.RESULTS:The prevalence of amblyopia for the total sample tested(n=17 203) was 2.78%(n=479).The most common cause of amblyopia was hypermetropia(64.45%),followed by previous ocular surgeries(15.1%),myopia(10.43%),strabismus(9.39%),and congenital cataract(0.63%).CONCLUSION:This is the first and only study,identifing modifiable risk factors in Jordanian children with amblyopia.In their first couple of years of elementary education,many Jordanian children are affected by amblyopia and pass unnoticed.A more governmental effort is needed into screening programs to improve vision in the Jordanian population.

Insufficient awareness of celiac disease in China: population-based screening is needed

Celiac disease (CD),once considered a gastrointestinal condition,is now known as a systemic autoimmune disease initiated by exposure to dietary gluten mainly in human leukocyte antigen DQ2 (HLA-DQ2) or HLA-DQ8 carriers.The classic presentations of CD include intestinal manifestations such as chronic diarrhea,bloating,abdominal pain,constipation,weight loss,or poor growth in children.Iron-deficiency,osteoporosis,and neuropathy attributable to vitamin B12 deficiency is also frequently seen in celiac patients.Immune responses spreading to tissues apart from the intestine cause dermatologic conditions such as dermatitis herpetiformis,and even increased risk of miscarriage in women.

Population-based carrier screening and prenatal diagnosis of fragile X syndrome in East Asian populations

Identification of carriers of fragile X syndrome(FXS) with the subsequent prenatal diagnosis and knowledge of FXS-associated genetic profiles are essential for intervention in specific populations. We report the results of carrier screening of 39,458 East Asian adult women and prenatal diagnosis from 87 FXS carriers.The prevalence of FXS carriers and full mutation fetuses was estimated to be 1/581 and 1/3124 in East Asian populations, respectively. We confirmed the validity of the current threshold of CGG trinucleotide repeats for FMR1 categorization;the integral risks of full mutation expansion were approximately 6.0%,43.8%, and 100% for premutation alleles with 55—74, 75—89, and ≥ 90 CGG repeats, respectively. The protective effect of AGG(adenine-guanine-guanine nucleotides) interruption in East Asian populations was validated, which is important in protecting premutation alleles with 75—89 CGG repeats from full mutation expansion. Finally, family history was shown not an effective indicator for FXS carrier screening in East Asian populations, and population-based screening was more cost-effective. This study provides an insight into the largest carrier screening and prenatal diagnosis for FXS in East Asian populations to date. The FXSassociated genetic profiles of East Asian populations are delineated, and population-based carrier screening is shown to be promising for FXS intervention.

孕妇妊娠中期血清学筛查结果与妊娠结局相关性分析

目的:分析妊娠中期孕妇血清学筛查结果,探讨不同筛查风险与母胎不良结局的关联。方法:选取2019—2021年在合肥市新站区接受孕中期血清学筛查的孕妇,评估胎儿患21-三体综合征、18-三体综合征和开放性神经管缺陷的风险,分别计算3种疾病高风险和低风险的发生率,并随访获得妊娠结局,分析不同风险组胎儿不良妊娠结局的发生率。结果:在接受妊娠中期血清学筛查的11 821名孕妇中,检出21-三体综合征高风险孕妇560人,检出率为4.74%;检出18-三体综合征高风险孕妇28人,检出率为0.24%;检出开放性神经管缺陷高风险孕妇53人,检出率为0.45%。实际随访获得妊娠结局的孕妇共11 606人,其中,高风险组孕妇自然流产、死胎、出生缺陷和低出生体重的发生率分别为1.12%、1.60%、4.17%和3.37%,显著高于低风险组(0.32%、0.30%、1.16%和2.12%)。高风险组孕妇靶向疾病、其他染色体疾病、其他出生缺陷的发生率分别为1.12%、1.12%和1.44%,均高于低风险组(0.05%、0.02%和0.65%)。结论:妊娠中期血清学筛查高风险与自然流产、死胎、出生缺陷、出生低体重等母胎不良妊娠结局具有一定的相关性,对出生缺陷的预测具有指导意义。

山东省日照市东港区孕期保健综合服务模式效果分析

目的:通过实施孕期保健综合服务模式项目,提升孕期保健服务覆盖率,保障母婴安全,降低孕期死亡率,提高孕期保健服务水平。方法:2019年在日照市在东港区试点开展孕期保健综合服务模式,比较2017-2020年孕期保健服务模式实施前后情况,分析相关考察指标。结果:孕期保健综合服务模式实施后,接受孕期保健综合服务并完成妊娠的孕产妇共7778例,产前检查7586例。30~34岁孕产妇逐年增加,25~29岁孕产妇逐年减少;一胎比例逐年增加,二胎、三胎比例逐年减少(均P<0.05)。项目实施后孕期保健覆盖率明显提高,其中产前检查参检率(97.5%)高于项目实施前(93.4%、93,1%),产前检查≥5次(94.3%)以及早期产前检查率(95.6%)提高;孕期住院分娩率保持100%,剖宫产率波动在35.1%,产后访视率(93.3%)提升,2019年项目实施以来孕产妇死亡率为零。结论:本次调查的孕产妇年龄逐年增加,2胎、3胎占比逐年下降,高龄产妇占比增加,应加强孕产期管理。通过孕期保健综合服务模式实施,使本地区孕期保健服务水平明显提升,各项保健服务指标得到提升,母婴安全水平得到提高。

EPDS在产后抑郁筛查中应用

本研究共纳入１６７例在北医大一院产科病房住院分娩的产妇，所有产妇均评定了Ｅｄ－ｉｎｂｕｒｇｈ产后抑郁量表（ＥＰＤＳ）。对部分产妇同时评定了Ｚｕｎｇ氏抑郁量表和Ｈａｍｉｌｔｏｎ抑郁量表。结果表明ＥＰＤＳ之灵敏度、特异性及总效率均令人满意。与Ｚｕｎｇ氏量表相比，ＥＰＤＳ的效度更高，是比较理想的产后抑郁筛查工具。

Rapid screening for Klinefelter syndrome with a simple high-resolution melting assay： a multicenter study

Klinefelter syndrome （KS） is the set of symptoms that result from the presence of an extra X chromosome in males. Postnatal population-based KS screening will enable timely diagnosis of this common chromosomal disease, providing the opportunity for early intervention and therapy at the time point when they are most effective and may prevent later symptoms or complications. Therefore, through this study, we introduced a simple high-resolution melting （HRM） assay for KS screening and evaluated its clinical sensitivity and specificity in three medical centers using 1373 clinical blood samples. The HRM assay utilized a single primer pair to simultaneously amplify specific regions in zinc finger protein, X-linked （ZFX） and zinc finger protein, Y-linked （ZFY）. In cases of KS, the ratios of ZFX/ZFYare altered compared to those in normal males. As a result, the specific melting profiles differ and can be differentiated during data analysis. This HRM assay displayed high analytical specificity over a wide range of template DNA amounts （5 ng-50 ng） and reproducibility, high resolution for detecting KS mosaicism, and high clinical sensitivity （100%） and specificity （98.1%）. Moreover, the HRM assay was rapid （2 h per run）, inexpensive （0.2 USD per sample）, easy to perform and automatic, and compatible with both whole blood samples and dried blood spots. Therefore, this HRM assay is an ideal postnatal population-based KS screening tool that can be used for different age groups.

爱丁堡产后抑郁量表分量表在高危妊娠孕妇心理筛查中的应用研究

[目的]评价和比较爱丁堡产后抑郁量表(EPDS)3种分量表在高危妊娠孕妇心理筛查中的应用效果。[方法]采用方便抽样法,在产前检查门诊选择842例高危妊娠孕妇,进行EPDS测评,计算各分量表的敏感度、特异度、受试者工作特征曲线(ROC)下面积等以评价其筛查能力。[结果]高危妊娠孕妇EPDS总评分为(4.90±3.84)分;情感缺失分量表评分为(0.26±0.66)分;焦虑分量表评分为(3.33±2.31)分;抑郁分量表评分为(1.31±1.58分);焦虑分量表和抑郁分量表ROC曲线下面积均大于0.9,筛查能力较高;焦虑分量表以5分为临界值、抑郁分量表以3分为临界值时,敏感度、特异度、阳性预测值和阴性预测值指标间能达到较好的平衡;EPDS 3个分量表分值与其总评分均呈正相关(P<0.01)。[结论]高危妊娠孕妇的心理问题不容忽视,EPDS分量表具有快速、简便而高效的心理筛查效果,有助于尽早发现和干预产后抑郁的高危人群。

产后抑郁筛查量表中文版在产后抑郁筛查中的应用

目的比较产后抑郁筛查量表(PDSS)和爱丁堡产后抑郁量表(EPDS)在产后抑郁筛查中的应用价值。方法分别采用PDSS、爱丁堡产后抑郁量表(EPDS)及美国精神障碍诊断与统计手册第4版轴I障碍定式临床检查患者版(SCID-I/P)对378例产后42d的妇女进行评定,以SCID-I/P作为产后抑郁诊断标准。结果将两种量表的临界值分别界定为76分和13分。PDSS的敏感性为92.00%,特异性为95.25%,阳性预测值为77.02%,阴性预测值为99.01%;EPDS的敏感性为82.26%,特异性为81.33%,阳性预测值为44.73%,阴性预测值为97.30%。两种量表特异性和敏感性差异比较有统计学意义(P<0.05)。PDSS与EPDS阳性预测值比较差异有统计学意义(P<0.05),阴性预测值比较差异无统计学意义(P>0.05)。结论与EPDS比较,PDSS更适合产后抑郁的筛查。

绵阳地区1358例孕妇TORCH感染的血清学筛查

目的了解绵阳地区妊娠妇女TORCH感染的情况。方法采用酶联免疫吸附试验(ELISA)对1358例孕妇血清同时进行TORCH的IgM和IgG检测。结果孕妇TORCH(TOX、RV、CMV、HSVⅠ和HSVⅡ)IgM抗体感染的阳性率分别为0.15%、1.18%、0.37%、0.44%、0.22%;TORCH-IgG抗体感染的阳性率分别为6.12%、63.99%、94.70%、92.49%、17.82%。TORCH相关抗体检查4种筛查结果:lgG(+)IgM(-):TOX83例,RV869例,CMV1286例,HSVⅠ1256例,HSVⅡ242例;IgG(-)IgM(+):TOX1例,RV7例,CMV3例,HSVⅠ5例,HSVⅡ3例;IgG(+)IgM(+):TOX1例,RV9例,CMV2例,HSVⅠ1例,HSVⅡ0例;IgG(-)IgM(-):TOX1273例,RV473例,CMV67例,HSVⅠ96例,HSVⅡ1113例。结论孕前或孕期妇女同时进行TORCH-IgM/IgG检测,可及时了解孕妇TORCH感染阶段,尽早采取方法和措施,对提高人口素质具有重要意义。

新生大鼠小脑内发育相关基因的筛选

为筛选脑发育相关的基因 ,应用新发展的抑制消减杂交技术 ,以新生大鼠小脑mRNA逆转录cDNA作为测试者 (tester) ,成年大鼠小脑mRNA逆转录cDNA作为驱动者 (driver) ,进行消减杂交 ,克隆制备成新生大鼠小脑高表达的cDNA文库。挑选出 5 0个重组质粒 ,测序得到 37个不同基因片段序列。再次用反Northern杂交确认有意义的差异表达基因。同时将测序结果与GenBank注册序列进行同源性比较 ,2 0个大鼠中首次测得的基因表达序列标签 (EST)已被GenBank收录 (BG6 95 72 6 -BG6 95 74 5 )。

超声检测胎儿颈背皮肤透明带厚度在产前筛查21-三体综合征的研究

目的探讨超声测量胎儿颈背皮肤透明带厚度(nuchalskinfold thickness,NT)在染色体异常疾病21-三体综合征筛查的应用价值。方法经腹超声测量孕12～27周孕妇1500例胎儿颈背皮肤透明带厚度,并与染色体核型分析及随访后结果作对照。结果1500例胎儿中,21-三体综合征的发病率为3.3‰,其中NT增厚者有62例,其中4例为21-三体综合征;无NT增厚中,有1例21-三体综合征。敏感性为80%,特异性为96.07%,准确性为96.12%,阳性预测值为6.45%。结论NT检测对于21-三体综合征的早期诊断具有重要的意义,是早中期妊娠阶段产前筛查有效可行的方法。

TORCH感染的血清学筛查

目的:了解TORCH感染的血清学筛查及其在新生儿先天性疾病防治中的应用。方法:采用酶联免疫吸附法(en-zyme-linked immunosorbent assay,ELISA)检测800例孕妇血清中的特异性抗弓形虫IgM/IgG抗体(TOX-IgM/IgG)、抗风疹病毒IgM/IgG抗体(RV-IgM/IgG)、抗巨细胞病毒IgM/IgG抗体(CMV-IgM/IgG)、抗单纯疱疹病毒Ⅰ型IgM/IgG抗体(HSVⅠ-IgM/IgG)、抗单纯疱疹病毒Ⅱ型IgM/IgG抗体(HSVⅡ-IgM/IgG),对结果进行统计学处理,计算TORCH 10项的感染率。结果:TORCH 10项阳性率比较:TOX-IgG:1.0%,TOX-IgM:0.13%,RV-IgG:85.8%,RV-IgM:1.13%,CMV-IgG:98.3%,CMV-IgM:0.38%,HSVⅠ-IgG:97.5%,HSVⅠ-IgM:0.5%,HSVⅡ-IgG:12.12%,HSVⅡ-IgM:0.13%;TORCH10项检查4种筛查结果的比较:IgG(+)IgM(-):TOX 8例,RV 678例,CMV 783例,HSVⅠ776例,HSVⅡ97例;IgG(-)IgM(-):TOX 791例,RV 113例,CMV 14例,HSVⅠ20例,HSVⅡ702例;IgG(+)IgM(+):TOX 0例,RV 8例,CMV 3例,HSVⅠ4例,HSVⅡ0例;IgG(-)IgM(+):TOX 1例,RV 1例,CMV 0例,HSVⅠ0例,HSVⅡ1例。结论:孕前及孕期TORCH筛查,防止孕前、孕期的TORCH感染,以便及时采取方法和措施,预防出生缺陷,提高人口素质,对优生优育具有重大意义。

心理筛查异常孕妇产后抑郁发生状况及影响因素分析

目的调查建档产检时心理筛查异常孕妇产后抑郁症状发生情况并分析其影响因素。方法纳入建档产检时心理筛查异常孕妇681例。根据爱丁堡产后抑郁量表筛查结果判定产妇是否存在产后抑郁症状,采用Logistic回归分析探讨产后抑郁症状的影响因素。结果681例中出现产后抑郁症状105例(占15.4%)。个人精神心理疾病史,孕晚期存在焦虑症状、抑郁症状和焦虑抑郁症状并存是发生产后抑郁症状的危险因素(P<0.05,P<0.01)。结论建档产检时心理筛查异常产妇产后抑郁症状发生率不高,提示可能需要重新考虑合适的孕期心理筛查时间点和量表。需重视孕晚期心理筛查异常孕妇和有精神心理疾病史孕妇的跟踪随访,同时提高从业者的心理保健能力,保障心理保健效果。

Performance of Fasting Plasma Glucose and Postprandial Urine Glucose in Screening for Diabetes in Chinese High-risk Population

Background： The conventional approaches to diabetes screening are potentially limited by poor compliance and laboratory demand. This study aimed to evaluate the performance of fasting plasma glucose （FPG） and postprandial urine glucose （PUG） in screening for diabetes in Chinese high-risk population. Methods： Nine hundred and nine subjects with high-risk factors of diabetes underwent oral glucose tolerance test after an overnight fast. FPG, hemoglobin A 1 c, 2-h plasma glucose （2 h-PG）, and 2 h-PUG were evaluated. Diabetes and prediabetes were defined by the American Diabetes Association criteria. The area under the receiver operating characteristic （ROC） curve was used to evaluate the diagnostic accuracy of 2 h-PUG, and the optimal cut-off determined to provide the largest Youden index. Spearman correlation was used for relationship analysis. Results： Among 909 subjects, 33.4% （304/909） of subjects had prediabetes, and 17.2% （156/909） had diabetes. The 2 h-PUG was positively related to FPG and 2 h-PG （r = 0.428 and 0.551, respectively, both P 〈 0.001）. For estimation of 2 h-PG 〉 7.8 mmol/L and 2 h-PG ≥ 11.I mmol/L using 2 h-PUG, the area under the ROC curve were 0.772 （95% confidence interval [CI]： 0.738-0.806） and 0.885 （95% CI：0.850-0.921 ）, respectively. The corresponding optimal cut-offs for 2 h-PUG were 5.6 mmol/L and 7.5 retool/L, respectively. Compared with FPG alone, FPG combined with 2 h-PUG had a higher sensitivity fbr detecting glucose abnormalities （84.1% vs. 73.7%, P〈 0.001） and diabetes （82.7% vs. 48.1%, P〈 0.001）. Conclusion： FPG combined with 2 h-PUG substantially improves the sensitivity in detecting prediabetes and diabetes relative to FPG alone, and may represent an efficient layperson-oriented diabetes screening method.

中文版产后抑郁症筛查量表在产后6w产妇中的临界值研究

目的探索中文版产后抑郁症筛查量表(the Chinese version of the postpartum depression screening scale,C-PDSS)在产妇产后6周产后抑郁症(postpartum depression,PPD)初步筛查中的临床性能和适宜的临界值,提高PPD筛查的准确性。方法采取便利抽样法,选取2018年10月至2019年8月在广州市天河区某三级甲等综合医院产后6w复查的产妇889例,采用C-PDSS测评,同时采用爱丁堡产后抑郁量表(Edinburgh postnatal depression scale,EPDS)作为参照标准,计算C-PDSS各临界值的灵敏度、特异度、Youden指数、阳性预测值和阴性预测值,绘制受试者工作特征(receiver operating characteristic,ROC)曲线,并计算曲线下面积(Area Under Curve,AUC)。结果共完成研究868例。以EPDS≥13分的筛查结果为标准,经过ROC曲线测试,确定C-PDSS筛查PPD的最佳临界值为74.5(敏感度81.4%,特异度85.3%,阳性预测值56.9%,阴性预测值95.1%),AUC为90.4%(95%CI:0.880-0.929,P<0.001),27.5%的产妇初步筛查为PPD。结论C-PDSS在产后6周PPD筛查中的准确性较高,具有良好的临床使用性能。

育龄期妇女TORCH-IgM抗体筛查结果分析

目的了解本地区育龄女性TORCH感染情况,探讨育龄女性血清TORCH-IgM抗体检测的临床意义并为本地区孕妇保健提供参考依据。方法选取2015年1月~2018年12月于南方医科大学南海医院进行孕前筛查和孕期普查的妇女共2425例,应用ELISA方法对育龄妇女进行血清TORCH-IgM抗体检测。结果HSVII-IgM、RV-IgM、CMV-IgM、TOX-IgM抗体阳性率分别为4.70%、4.32%、0.64%、1.34%。RV-IgM、HSVII-IgM以及TOX-IgM在低龄孕妇组的阳性检出率都高于适龄孕妇组及高龄孕妇组,CMV-IgM抗体在适龄孕妇组高于低龄孕妇组和高龄孕妇组,但各项目检出率在三组年龄组间差异无统计学意义(P>0.05)。TOX-IgM、HSVII-IgM抗体不同季节的阳性检出率比较差异无统计学意义(P>0.05);RV-IgM抗体在春、夏两季为高发期,并与秋冬季比较差异有统计学意义(P<0.05);CMV-IgM在秋季的感染率较低,并与其他季节比较差异有统计学意义(P<0.05)。结论本地区育龄女性有一定的TORCH感染率,为达到优生优育目的,提高我国人口素质,必须对育龄妇女孕前及孕期及时进行检测,减少新生儿先天性TORCH感染。