Pu Q L, Zhou Q Y, Liu J, Li P, Huang H F, Jiang H Q
Department of Ophthalmology, The Maternal and Child Health Hospital of Jiaxing, Jiaxing 314000, China.
Zhonghua Yan Ke Za Zhi. 2017 May 11;53(5):358-362. doi: 10.3760/cma.j.issn.0412-4081.2017.05.008.
To observe and analyze related factors of neonatal asphyxia complicated with retinal hemorrhage. It was a retrospective case series. Seven hundred and twenty-one cases with neonatal asphyxia after 72 hours of birth were enrolled in this study. Fundus examination was performed on these newborns using the third generation wide-angle digital retina imaging system (RetCamⅢ), and the bleeding level was divided into level I, level Ⅱ and level Ⅲ. The conditions of the newborn and the mother during pregnancy were correlatively analyzed. The other factors were also analyzed including delivery mode, birth weight, gestational age, gender, grade of neonatal asphyxia, scalp hematoma, intracranial hemorrhage, fetal intrauterine distress, mother's age and antenatal complications. Single factor χ(2) test and multivariate logistic regression analysis were used to screen and judge risk factors causing retinal hemorrhage related to neonatal asphyxia. In 721 cases of neonatal asphyxia, retinal hemorrhage was found in 204 newborns (28.29%). The hemorrhage was at level Ⅰ in 77 cases (37.75%) , at level Ⅱ in 38 cases (18.63%) and at level Ⅲ in 89 cases (43.63%) . Four cases also had vitreous hemorrhage. Asphyxia was mild in 673 infants (93.34%) and severe in 48 infants (6.66%). The difference in the degree of retinal hemorrhage between the patients with mild and severe asphyxia was significant (χ(2)=22.336, 0.000). When asphyxia was aggravated, the degree of retinal hemorrhage increased. Relative factors analysis showed that delivery mode (χ(2)=158.643, 0.05), gestational age (χ(2)=24.522, 0.05), birth weight (χ(2)=11.916, 0.05) and grade of neonatal asphyxia (χ(2)=19.809, 0.05) had correlations with retinal hemorrhage. Logistic regression analysis indicated that grade of neonatal asphyxia and delivery mode were risk factors of retinal hemorrhage in neonatal asphyxia (0.304, 0.085). The incidence of retinal hemorrhage in neonatal asphyxia was 28.29%. The degree of neonatal asphyxia and delivery mode may play roles in the occurrence of retinal hemorrhage in newborns with asphyxia. With aggravation of asphyxia, the degree of retinal hemorrhage may increase. 358-362.
观察并分析新生儿窒息合并视网膜出血的相关因素。这是一项回顾性病例系列研究。本研究纳入了721例出生后72小时内发生新生儿窒息的病例。使用第三代广角数字视网膜成像系统（RetCamⅢ）对这些新生儿进行眼底检查，并将出血程度分为Ⅰ级、Ⅱ级和Ⅲ级。对新生儿及其母亲孕期的情况进行相关性分析。还分析了其他因素，包括分娩方式、出生体重、孕周、性别、新生儿窒息程度、头皮血肿、颅内出血、胎儿宫内窘迫、母亲年龄及产前并发症。采用单因素χ(2)检验和多因素logistic回归分析筛选并判断与新生儿窒息相关的视网膜出血危险因素。在721例新生儿窒息病例中，204例新生儿（28.29%）发现有视网膜出血。出血为Ⅰ级的有77例（37.75%），Ⅱ级的有38例（18.63%），Ⅲ级的有89例（43.63%）。4例还伴有玻璃体出血。673例婴儿（93.34%）窒息程度为轻度，48例婴儿（6.66%）为重度。轻度和重度窒息患者视网膜出血程度差异有统计学意义（χ(2)=22.336，P=0.000）。随着窒息程度加重，视网膜出血程度增加。相关因素分析显示，分娩方式（χ(2)=158.643，P=0.05）、孕周（χ(2)=24.522，P=0.05）、出生体重（χ(2)=11.916，P=0.05）和新生儿窒息程度（χ(2)=19.809，P=0.05）与视网膜出血有关。logistic回归分析表明，新生儿窒息程度和分娩方式是新生儿窒息合并视网膜出血的危险因素（比值比分别为0.304、0.085）。新生儿窒息合并视网膜出血的发生率为28.29%。新生儿窒息程度和分娩方式可能在窒息新生儿视网膜出血的发生中起作用。随着窒息程度加重，视网膜出血程度可能增加。 358 - 362
