早产儿视网膜病筛查及相关因素分析

目的:了解早产儿视网膜病(ROP)的发病率和相关危险因素,为预防提供相关依据。方法:对2004年7月~2006年6月在深圳市妇幼保健院NICU住院的胎龄<34周或体重<2 000 g的早产儿进行ROP筛查,同时对其全身情况进行记录,分析ROP发生的相关因素。结果:在符合ROP筛查标准并完成筛查的334例中,ROP患儿94例,占28.1%。94例ROP患儿中,达到阈值病变的需要进行眼底激光光凝治疗的26例,占筛查患儿的7.8%。ROP发生的相关因素分析显示,出生体重越低、出生孕周越小ROP发生率越高,需要接受治疗的ROP也越多。结论:该医院ROP总体发生率较高,出生体重低和胎龄小是ROP发生的重要危险因素。     

早产儿视网膜病变的危险因素分析

目的 分析患儿母亲孕产期因素与早产儿视网膜病变(ROP)发病情况的相关性,以期为ROP的防治提供科学依据。方法 选取2016年6月-2017年6月在湖南省妇幼保健院眼科门诊完成RetCam 3眼底检查的早产儿,记录早产儿眼底检查结果,同时收集早产儿胎龄、出生体重及其母亲孕期资料(孕期年龄、胎次、妊娠期相关疾病),进行回顾性分析。结果 1 956例早产儿中筛查出早产儿视网膜病变354例,检出率为18.10%。Logistic回归分析早产儿视网膜病变的高危因素有胎龄＜28周(OR=21.649,95%CI:18.485～24.327)、低出生体重(＜1 000 g)(OR=13.013,95%CI:10.861～16.233)、母亲孕期胎儿窘迫(OR=2.328,95%CI:1.269～3.156)、患有妊娠期高血压(OR=2.121,95%CI:1.072～3.571)、妊娠期糖尿病(OR=1.995,95%CI:1.008～2.929)。而孕期年龄、胎次及孕妇有无贫血与ROP的发生与否差异均无统计学意义(P＞0.05)。结论 早产儿的出生胎龄＜28周、低出生体重(＜1 000 g)、母亲孕期胎儿窘迫、患有妊娠期高血压、妊娠期糖尿病等与早产儿视网膜病变的发生密切相关。     

早产儿视网膜病变发生情况及其影响因素分析

目的 分析早产儿视网膜病变(ROP)发生情况及其影响因素。方法 选取2012年5月~2013年8月间在台州市立医院妇产科出生的103例早产儿作为研究对象,筛查ROP发生请况及影响因素。结果 在103例早产儿中,检出ROP12例,检出率为11.65%,根据多因素Logistic回归分析,结果显示胎龄、吸氧浓度、出生体重、机械通气、吸氧时间、贫血、颅内出血均为ROP的危险因素（P<0.05）。结论 低出生体重的早产儿在吸氧浓度等因素上都与ROP的发生有显著关系,因此给予适当浓度的氧疗和早期预防以及治疗都能减少ROP的致盲率和发生率。     

湖州地区784例早产儿视网膜病变的筛查结果与分析

目的 分析湖州地区早产儿视网膜病变(ROP)的发病情况及预后,以便早发现ROP患儿的高危因素,从中筛出严重ROP患儿使其得到及时干预。方法 回顾性分析胎龄<34周或出生体重≤2 000 g及34~37周合并有吸氧、窒息、宫内感染等高危因素的早产患儿784例,采用Ret Cam Ⅲ对眼底进行筛查。结果 784例早产儿中,ROP的发病率为11.23%,发生ROP患儿手术率13.48%。ROP的发病率与出生体重(F=58.78,P＜0.01)、出生胎龄(F=24.05,P＜0.01)及出生8周后体重增长率缓慢有关(F=3.605,P＜0.05)。严重ROP因素分析显示出生孕周与出生体重以及连续7 d以上的吸氧均是重要的影响因素,差异均有统计学意义(P＜0.05);出生后体重增长率缓慢,差异无统计学意义(P>0.05)。结论 ROP的发病率与出生体重、胎龄、长期吸氧及出生后体重增长缓慢有关,预后与出生后体重增长缓慢无关。应在眼科筛查中密切注意患儿全身的生长发育情况。     

超低出生体重儿及超早产儿输血治疗的相关危险因素分析

目的分析超低出生体重儿及超早产儿在不同时期进行输血治疗的相关危险因素,并探讨贫血的预防策略。方法回顾性分析空军军医大学唐都医院儿科2013年1月至2018年12月新生儿重症监护室(NICU)收治的出生体重<1 000g的超低出生体重儿及胎龄<28周的超早产儿,根据首次输血时间分为早期输血组(首次输血时间在出生2周内)和晚期输血组(首次输血时间在出生2周后),分析两组患儿一般情况、产时危险因素、输血前临床特征及输血后并发症等。结果共纳入患儿42例,其中早期输血组19例(45.24%),晚期输血组23例(54.76%)。与晚期输血组相比,早期输血组出生体重更低(t=2.04,P<0.05)、住院时间更长(t=2.05,P<0.05)。经单因素分析发现,早期输血组支气管肺发育不良(BPD)及早产儿视网膜病变(ROP)的发病率高于晚期输血组(χ~2值分别为4.40、4.50,均P <0.05)。结论超低出生体重儿及超早产儿早期输血与ROP及BPD的发生密切相关,该类患儿应尽量避免早期输血治疗。     

早产儿视网膜病变相关因素分析

目的研究早产儿视网膜病变的发病率,并分析其相关危险因素。方法对2007年9月～2010年8月新乡医学院第三附属医院新生儿科收治的体重〈2000g,胎龄〈34周的早产儿和低体重儿进行ROP筛查。于出生后2周始,由有经验的眼科医师进行间接检眼镜检查眼底,并记录完整的临床资料,调查ROP的发病率及分析相关危险因素。结果367例早产儿。ROP发病率为11．44％（42／367）。42例中ROPI期21例,Ⅱ期14例,Ⅲ期6例,Ⅳ期1例。激光手术9例（2．45％）。对367例早产儿相关因素分析提示,感染、贫血、窒息、吸氧时间〉7d、吸氧浓度〉40％、代谢性酸中毒、胎龄、呼吸暂停、输血与ROP的发生有相关性（P〈0．05）。Logistic回归分析提示,小胎龄、出生体重、吸氧时间〉7d、代谢性酸中毒、感染、输血、呼吸暂停是ROP发生的主要危险因素。结论防治早产儿的各种并发症的发生非常重要。感染、贫血、吸氧、酸中毒、窒息、胎龄与ROP相关;小胎龄、呼吸暂停、感染、输血、酸中毒是ROP发生的主要危险因素。     

2019年3所妇幼保健院早产儿视网膜病变筛查及随访分析

目的 调查妇幼保健院早产儿视网膜病变(ROP)的筛查及随访情况,为提高筛查和随访质量提供建议。方法 通过查阅住院病案、门诊登记及ROP管理档案,回顾性调查2019年1月1日—12月31日在某3个三级甲等妇幼保健院进行ROP筛查且符合筛查标准的3 579例早产儿的筛查、随访和干预情况。结果 ROP检出率为11.2%(400/3 579),1期为3.4%,2期为6.2%,3期及以上为1.6%。随着孕周、出生体重的降低,ROP检出率、重症ROP检出率升高。首次筛查矫正胎龄(周)为31～、32～组ROP检出率较高。ROP 1期、2期患儿干预率分别为1.6%、1.7%,低于3期的30.9%。干预方式主要采用玻璃体腔注射药物治疗(占91.3%)。全部阳性病例随访患儿的结案率为41.2%。1期、2期患儿结案率分别为51.7%、40.8%,高于3期的21.8%。结论 妇幼保健院应提升眼保健专科服务能力,加强ROP筛查,完善ROP患儿专案管理,做好筛查阳性病例的定期随访、干预、转诊工作,减少不良结局的发生。     

早产儿视网膜病变筛查结果分析

【目的】 对早产儿视网膜病变(retinopathy of prematurity,ROP)进行筛查,了解ROP的发病情况及其相关影响因素。 【方法】 对眼科门诊进行ROP筛查的早产儿及低体重儿进行回顾性调查,统计筛查情况。 【结果】 共计筛查239例早产儿、低体重儿,发现ROP患儿15例,发生率为6.28%。BW≤1 500 g、1 500 g2 000 g的ROP的发生率分别为20.59%、8.22%、1.52%,组间ROP发生率差异有统计学意义(χ²=17.47,P<0.005);胎龄≤31周、31<胎龄≤34周、胎龄>34周的ROP的发生率分别为29.17%、7.25%、2.06%,组间ROP发生率差异也有统计学意义(χ²=25.96,P<0.005)。分析显示ROP的发生与吸氧有一定的关系。 【结论】 筛查显示ROP的发生率为6.28%,不规范吸氧、出生体重低及胎龄小是ROP形成的相关因素,对于低胎龄或低体重的高危早产儿应定期进行眼底筛查。     

515例早产儿RetcamⅡ视网膜病变筛查分析

目的:研究早产儿视网膜病变的发生率及其危险因素。方法:对2008年5月~2009年7月在吉林大学第一医院儿科收治的胎龄<37周的早产儿应用RetcamⅡ进行眼底照相检查,根据1984年国际ROP会议制定的分类标准进行诊断和分析。结果:515例早产儿中患不同程度ROP者87例,ROP发生率16.89%;胎龄越小、出生体重越低ROP发生率越高。对可能影响ROP发生率的9种因素进行单因素分析,结果显示胎龄、出生体重、贫血、低血糖血症、吸氧、肺炎、输血与ROP发生率密切相关,性别、新生儿酸中毒与ROP发生率无相关性;进一步进行多因素logistic回归分析,结果显示出生体重与ROP发生率最相关,是ROP发生的高危因素。结论:胎龄越小,出生体重越低,具有新生儿贫血、低血糖血症、肺炎、吸氧史及输血史的早产儿ROP发生率越高,其中低出生体重是ROP的最高危因素,对具有以上危险因素的早产儿应早进行眼底筛查,早诊断,早治疗,预防ROP致盲。     

极低出生体重儿早产儿视网膜病的高危因素分析

目的 :探讨极低出生体重儿 ( VL BW)早产儿视网膜病 ( ROP)的患病率、高危因素。方法 :分别对 1997～ 2 0 0 0年期间 2 33例 VL BW和 1999～ 2 0 0 0年期间 12 1例 VL BW进行回顾性分析。结果 :2 33例 VL BW中有 5 6例 ROP,患病率为2 4 .0 % ,其中每年 ROP患病率在 2 2 .6 %～ 2 5 .5 % ,1例致盲。通过对 30余种高危因素与 12 1例 VL BW发生 ROP关系进行综合分析及应用逐步 L ogistic回归分析法发现 ,低出生体重、输血、低氧血症、低碳酸血症是造成 ROP的重要原因。结论 :预防 ROP的发生应首先减少低出生体重儿的发生率 ,减少输血 ,预防和及时纠正低氧血症、低碳酸血症。     

1 313例早产儿眼底疾病筛查结果及分析

目的 分析早产儿眼底疾病的患病率及患早产儿视网膜病变的高危因素,为临床诊治提供参考依据。方法 采用RetCam 3小儿视网膜成像系统对2015年3月-2016年3月出生的所有早产儿进行眼底疾病筛查,并结合患儿的一般临床资料对早产儿视网膜病变进行高危因素分析。结果 对1 313例早产儿进行筛查,一共筛查出301例眼底疾病患儿,其中早产儿视网膜病变208例,非特异性视网膜渗出性病变53例,视网膜出血33例,原始玻璃体动脉残留4例,视神经发育不全1例,永存原始玻璃体增生症1例,黄斑色素沉着1例。Logistic回归分析早产儿视网膜病变的高危因素有低胎龄、低出生体重、不规范吸氧史、多胎及输血史。结论 RetCam 3眼病筛查能在早产儿人群中筛查出眼底疾病;早产儿视网膜病变的高危因素有低胎龄、低出生体重、不规范吸氧史、多胎及输血史。     

A comparison of the childhood health status of normal birth weight and low birth weight infants

We analyzed previously unavailable data to describe the national health status in 1981 of noninstitutionalized children who were low birth weight infants. They were compared with normal birth weight children. All data contained in the analysis were based on weighted national estimates. Low birth weight children in general were found to have more chronic conditions, more hospitalizations, more days in bed because of illness, more limitations of activity, poorer health status as perceived by parents, and more school days lost because of illness. However, numbers of physician visits were not different even for low birth weight children younger than 2 years, which is inconsistent with the higher proportions of multiple hospitalizations, chronic conditions, and other illness measures. The proportions of children in the younger age groups at risk for health problems associated with low birth weight should be increasing. The proportion of very low birth weight children in the younger age groups with higher excessive morbidity measures tends to support the possibility. The increased survival of high-risk infants raises concern about their future requirements for special medical and educational services, and about the resulting stress on their families. Normal birth weight children were found to make a major contribution to the prevalence of morbidity. It is not the children identified as at risk as a result of low birth weight that comprise most of those with illnesses. The physical, social, and psychological environment after birth probably has the largest impact on the health status of our children. The attributable risk of excessive morbidity associated with low birth weight and very low birth weight reinforces the concept that while the overall impact is not large, the consistent pattern of poorer health for children born with low birth weight, compared to those of normal birth weight, shown in this analysis, is striking. The pattern reinforces concerns with the many factors associated with low birth weight and their effects on the present and future health of the population.     

Prevention and treatment of respiratory distress syndrome in premature infants using intratracheally administered surfactants]

OBJECTIVE. To study the effects of administration of surfactant immediately after birth (prophylactic) or after 6 hr (therapeutic) to 81 Dutch preterm infants from a multicentre trial. SETTING. University Hospital Leiden and Sint Joseph Hospital, Veldhoven. DESIGN. A randomized controlled trial with stratification for biochemical lung (im)maturity. The aims of the study were (I): to improve the TcPO2/FiO2 ratio by 40% and (2) to prevent the respiratory distress syndrome by 50% at 6 hours after birth. The secondary goal was to compare effects of prophylactic versus therapeutic use of exogenous surfactant (from 6 hours onwards) in surfactant-deficient infants. PATIENTS. The entrance criteria of the study were: (I) inborn children with a gestational age between 26 and 30 weeks, (2) elective intubation and (3) sampling of bronchotracheal or gastric aspirate. After randomization the children received surfactant within 10 minutes after birth prophylactically (n = 42) or 6 hours after birth if they needed more than 60% oxygen (13 of 39 control infants). A second dose of surfactant was given if, at 6 hours after the first dose, the FiO2 was still high (> or = 0.6). TREATMENT. We used a natural porcine surfactant preparation (Curosurf) in a dose of 200 mg/kg given through the endotracheal tube. RESULTS. The mean gestational age of the 81 infants was 28.2 weeks. The TcPO2/FiO2 ratios increased in the prophylactic group compared with the controls (38 versus 30 kPa; p < 0.05). RDS occurred less often and less severely in the prophylactic group (p < 0.05). Neonatal mortality was lower in the prophylactically treated infants (3/42) than in the control group (10/39; p < 0.05). Compared with the control infants with immature lungs, the immature prophylactically treated infants had six hours after birth higher TcPO2/FiO2 ratios (35 vs 13 kPa; p < 0.001), a 35% reduction of the incidence of RDS with a significant reduction of its severity (p < 0.05), and significantly lower mean airway pressures (0.87 versus 1.24 kPa; p < 0.005). The surfactant given 6 hours after birth to the immature controls resulted in an immediate improvement of the oxygenation. Nevertheless, these infants spent more time on the respirator and needed extra oxygen for longer periods than the immature infants prophylactically treated (p < 0.05). CONCLUSION. Surfactant, given either prophylactically or therapeutically, results in clinical improvement of children with biochemically immature lungs. A prophylactic treatment, moreover, results in reduced incidence and severity of RDS, in a significant shortening of the time spent on the respirator and in reduced need of extra oxygen compared with therapeutic treatment. We recommend to give surfactant prophylactically or at the first signs of RDS.     

空氧混合器给氧预防早产儿视网膜病及其影响因素分析

目的 探讨使用空气混合器预防早产儿视网膜病(retinopathy of prematurity,ROP)发生的效果和可行性。 方法 观察组117例早产儿,采用空氧混合器置中间,它的一端接中心供氧和空气气源,另一端接头、面罩、暖箱或改良鼻导管,并在供氧末端予氧浓度测定仪动态监测。在生后4~6周或矫正胎龄32周行眼底检查,1~2周酌情复查,并追踪随访3~6个月,与对照组95例未施行空氧混合仪供氧的早产儿比较,观察他们发生ROP的例数和程度。 结果 212例早产儿中共检出ROP 8例,男5例,女3例,发生率3.77%,其中观察组发生ROP 2例(1.71%),对照组发生ROP 6例(6.32%),两组ROP发生率差异有统计学意义(P<0.01)。患有呼吸暂停、窒息、肺透明膜病、反复低氧血症、败血症、肺出血、胎龄小、吸氧时间长及应用PS、机械通气的患儿ROP发生率均高于无此高危因素的患儿,其差异有统计学意义(P<0.01)。 结论 使用空氧混合器规范氧疗可降低ROP发生率,空氧混合器简便、价廉,适合基层医院应用,ROP发生与小胎龄、低出生体重、长时间和高浓度吸氧、反复低氧血症、严重感染等多种高危因素有关。     

未通过早产儿视网膜病变眼底筛查患儿远期眼部异常的跟踪与随访分析

目的:探讨未通过早产儿视网膜病变(ROP)眼底筛查新生儿的眼底及远期眼部异常随访的意义。方法:回顾性分析56例合并ROP患儿的围产期病史及远期眼部异常的发生情况。结果:视网膜完全血管化的时间ROP轻度组为生后(63.3±24.5)天;阈值前病变组为(52.0±12.4)天;ROP重度组为(55.0)±16.9天;ROP轻度组胎龄、出生体重、平均吸氧时间(F iO2>45.0%)与阈值前病变组及ROP重度组比较差异有显著性(P<0.05);阈值前病变组与ROP重度组比较,胎龄、平均吸氧时间(F iO2>45.0%)差异有显著性(P<0.05);6年后的随访早产儿的其他眼部异常的发生率与ROP的程度成正相关。结论:小胎龄、长时间高浓度的吸氧为ROP的预后的重要危险因素,阈值前病变及重度ROP早产儿远期其他眼部异常如屈光不正、弱视、斜视、的发生率较高。     

早产儿视网膜病变的筛查策略探讨

目的:根据早产儿出生体重和出生胎龄为指标,探讨早产儿视网膜病变的临床筛查标准和初次筛查时间。方法:收集2008年2月～2011年2月厦门市妇幼保健院NICU病区1 148例早产儿,使用双目间接眼底镜进行眼底检查,收集相关临床资料进行统计分析。结果:出生体重≤1 000 g、1 001～1 250 g、1 251～1 500 g、1 501～1 750 g、1 751～2 000 g、>2 000 g各组间阈值ROP发生率比较有统计学差异(χ2=201.54,P<0.001),其OR值为1.00、0.45、0.24、0.07、0.02、0.003,出生体重﹥1 500 g时阈值ROP发病率显著降低;ROC曲线示在出生体重为1 532.5g面积最大;出生胎龄﹤28周、28～30周、30～32周、32～34周、≥34周各组间阈值ROP发生率差异有统计学意义(χ2=213.14,P<0.001),其OR值为1.00、0.68、0.29、0.07、0.02,出生胎龄>32周时阈值ROP发病率明显降低;ROC曲线显示在出生胎龄32.07周面积最大;出现阈值ROP时的矫正胎龄﹤35周的8例早产儿,出生后周龄均在4～6周。结论:出生体重≤1 500 g和出生胎龄≤32周是ROP筛查指标;初次筛查时间在矫正胎龄≥35w或出生后4～6周。     

眼底镜检查及散瞳药应用对早产儿的影响

目的 探讨在早产儿视网膜病筛查过程中散瞳药以及眼底镜检查操作对患儿血氧饱和度、脉率的影响.方法 对2006年1月至2006年3月在广东省妇幼保健院出生的出生体重≤2 000g早产儿、低出生体重儿进行眼部检查,并记录检查过程中的血氧饱和度和脉率.结果 90例早产儿中有25例诊断为早产儿视网膜病(27.8%),早产儿视网膜病组平均孕周及出生体重均低于正常眼底组,两组间差异有统计学意义.研究所采用的复方托品酰胺眼药水不会影响患儿各项血氧饱和度和脉率,在进行眼底镜操作中,患儿经皮血氧饱和度明显降低,脉率出现增快.结论 在眼部使用局麻药,尽量减少使用开睑器的时间并注意操作轻柔、迅速,从而可减轻患儿的不适.     

Retinopathy of Prematurity and Ethnicity in Hawai‘i: A Retrospective Study (1996 – 2006) of Medical Records from Kapi‘olani Medical Center for Women and Children

The objective of this research was to identify risk factors for Retinopathy of Prematurity (ROP) in Hawai‘i''s ethnically unique population, with a focus on ethnicity. The study design focused on a 10-year retrospective chart review of neonates at Kapi‘olani Medical Center in Honolulu, Hawai‘i. Results showed that 23.3% of infants of Native Hawaiian and/or Pacific Islander ethnicity (NHPI) developed ROP. Necrotizing enterocolitis, intraventricular hemorrhage, and the severity of respiratory disease were significantly related (P < .001) to the incidence and severity of ROP. In a multiple logistic regression model, gestational age, birth weight, bronchopulmonary dysplasia, and postnatal steroids were significant predictors (P < .001) for presence of ROP. Significant predictors for severe ROP included gestational age (P < .001), birth weight (P = .001), postnatal steroids (P = .001), necrotizing enterocolitis (P = .025), and NHPI ethnicity (P = .004). Further research is recommended.     

Impact of birth weight at term on rates of emergency room visits and hospital admissions following vaccination at 2 months of age

Background

Birth weight of children born at term may theoretically be associated with risk of adverse events from immunization.

Methods

We analyzed data on children born between April 1st 2002 and March 31st 2009 in the province of Ontario. Using the self-controlled case series design, we examined the risk of the combined endpoint of emergency room visit and hospital admission in the immediate three days post vaccination at 2 months of age compared to a control period 9-18 days after vaccination. In term children, we conducted 4 comparisons of relative incidence (RI) of events: (1) 4 lower birth weight quintiles compared to the largest quintile (2) SGA10 infants compared to non SGA10 infants, (3) low birth weight infants (<2500 g) compared to non low birth weight infants and (4) SGA10 infants vaccinated before 60 days compared to those vaccinated after 60 days.

Results

There was a significant trend towards increasing relative incidence of the combined endpoint with decreasing birth weight quintile (p = 0.016). There was an increased relative incidence of events in SGA10 versus non SGA10 infants (RI 1.25 (95% CI 1.09-1.44)) and in SGA10 children vaccinated before 60 days of age compared to after 60 days of age (RI 1.57 (95% CI 1.14-2.18)). No significant effect was observed in low birth weight children. The impact of birth weight was primarily mediated through an increase in ER visits in the 24 h following vaccination.

Conclusion

Lower birth weight appears to be correlated with an increased risk of emergency room visits within 24 h of vaccination. The absolute risk is small and there was no impact on admissions or death.     

早产儿视网膜病危险因素分析

目的:探讨早产儿视网膜病变(ROP)的发生率及危险因素。方法:对孕周36周、出生体重2000g的244例早产儿生后4周行眼底检查,根据ROP国际诊断分期法进行诊断分期,分析ROP与孕周、出生体重、窒息、吸氧、母亲妊娠并发症、感染及贫血等因素的关系。结果:244例早产儿中患有不同程度ROP者49例(其中ROPⅠ期37例、ROPⅡ期10例、ROPⅢ期2例),ROP发生率为20.08%。ROP病儿中住院期间有8例自愈,1例成功进行手术治疗,而大部分病例需出院后继续定期进行眼底检查。孕周、出生体重、吸氧、母亲妊娠并发症、酸中毒、呼吸暂停、PO2的变化、机械通气及感染与ROP的发生有关。且孕周越短、出生体重越小,ROP发生率越高。结论:早产儿ROP的发生率较高。ROP的发生与孕周、出生体重、吸氧、母亲妊娠并发症、酸中毒、呼吸暂停、PO2变化及感染、机械通气等因素有关。孕周、出生体重、吸氧、呼吸暂停是ROP的独立危险因素。