新生儿视网膜出血的发生隋况及其影响因素

目的应用广角数码视网膜图像采集系统（RetCamⅡ）研究新生儿视网膜出血的发生情况，并分析视网膜出血的影响因素。方法横断面研究。2010年8月至2011年8月在昆明市妇幼保健院出生的3646例新生儿，在出生3d内采用RetCamⅡ拍摄眼底照片，观察新生儿视网膜出血的发生情况。根据不同的分娩方式，将新生儿分为经阴道分娩组（1833例）和剖宫产组（1813例），使用卡方检验比较不同分娩方式的视网膜出血发生率。并对经阴道分娩组和剖宫产组的胎儿性别、胎儿体重、产程、产妇年龄、孕周以及是否发生胎儿宫内窘迫进行计数。使用卡方检验分析经阴道分娩和剖宫产新生儿发生视网膜出血的相关因素。结果新生儿视网膜出血总体发生率为20．50％（747／3646），6．80％（248／3646）单眼发病，13．69％（499／3646）双眼发病。其中经阴道分娩的新生儿发生率为36．66％（672／1833），高于剖宫产组的4．14％（75／1813）（X^2=591．800，P〈O．01）。在经阴道分娩的新生儿中，产程短者（〈6h）的发生率为39．0％（337／864），高于产程长者（≥6h）的34．6％（335／969）（X^2=4．055，P=O．044）；胎儿宫内窘迫者发生率为61．0％（100／1641，高于非胎儿宫内窘迫者新生儿视网膜出血的发生率（34．3％，572／1669）（X^2=45．856，P〈O．01）。而经阴道分娩组和剖宫产组新生儿性别、体重、产妇年龄、孕周差异无统计学意义。结论RetCamⅡ可以很好地记录新生儿视网膜出血。新生儿视网膜出血与分娩方式有关，经阴道产中与是否发生胎儿宫内窘迫及产程长短有关，而与新生儿性别、体重、产妇年龄、孕周无明显关系。

Occurrence condition and relative factors of neonatal retinal hemorrhage

Objective To determine the incidence of retinal hemorrhage in newborns with wide-field contact digital fundus camera （RetCam Ⅱ）, and also aimed to define risk factors of neonatal retinal hemorrhage. Methods In this cross-sectional study, 3646 neonates who were born between August 2010 and August 2011 in Kunming Maternal and Children＇s Hospital. Fundus examination was performed on these neonates within 3 days after birth using the RetCam II. Among the 3646 newborns, 1833 were born through vaginal delivery and 1813 through cesarean section. Demographic data was obtained including sex, birth weight, delivery process, fetal distress, puerpera age and gestational age for the analysis of risk factors. Data were analyzed with chi-square test. Results The incidence of neonatal retinal hemorrhage was 20.50%（747/3646）. Monocular retinal hemorrhage was detected on 6.80%（248/3646） neonates and binocular retinal hemorrhage was detected on 13.69% （499/3646） neonates. The retinal hemorrhage incidence in vaginal delivery group （36.66%） was much higher than cesarean delivery group （4.14%） （X^2=591.800, P〈0.01）. Among all neonates delivered through the vagina, neonates having short birth process （〈6 h） had higher incidence of retinal hemorrhage （39.0%, 337/864） than those had long birth process （≥6 h） （34.6%, 335/969） （X^2=4.055, P=0.044）. Neonates experiencing fetal distress had higher incidence of retinal hemorrhage （61.0%, 100/164） than neonates not experiencing fetal distress （34.3%, 572/1669） （X2=45.856, P〈0.01）.However, the neonatal sex, weight, puerpera age, and gestational age did not show great differences on retinal hemorrhage. Conclusion The RetCam provides excellent documentation of retinal hemorrhages. Delivery method is most likely the greatest risk factor for retinal hemorrhages, with fetal distress, short birth process also influencing risk to varying degrees.