NICU新生儿眼底筛查结果分析

新生儿眼病是新生儿期较为常见的疾病,如果诊断及治疗不及时,可以影响小儿的视功能,甚至造成视力严重缺失。研究资料表明有围产期病史的幼儿常存在严重的视功能紊乱,并认为有围产期病史的幼儿将是眼病的高危人群。为此,我们对入住 NICU的新生儿进行眼底筛查,旨在早期发现高危新生儿眼底疾病,现将筛查结果报告如下。     

早产儿86例眼底筛查结果分析

目的 探讨早产儿视网膜病(ROP)及其他常见眼科疾病的发病情况.方法 早产儿86例根据胎龄分为2组:<32周胎龄组(n=38)和≥32周胎龄组(n=48),并由眼科医师使用间接眼底镜进行眼底筛查,以后检查眼底1次/周.检出眼底异常的早产儿均予维生素E胶丸、小施尔康滴剂口服.分析二组早产儿ROP、玻璃体混浊及视网膜出血等眼科疾病的发病情况.结果 86例早产儿中共检出5例POP(5.81%).其中Ⅰ期ROP 4例,Ⅱ期ROP 1例,未见阈值ROP发生.玻璃体混浊24例(27.9%),其中2例并视网膜出血.视网膜出血、色素异常各4例.胎龄＜32周组的早产儿发生玻璃体混浊的几率明显高于≥32周组(χ2＝6.822 P<0.05),二组发生早产儿ROP、视网膜出血及色素异常的几率无显著性差异(Pa>0.05).结论 ROP发病率有下降的趋势,玻璃体混浊成为早产儿眼底筛查中最常见的问题,胎龄越小,其发病率越高,维生素E对各种眼底异常有一定的疗效.     

72小时内新生儿眼底检查400例结果分析

我院新生儿科和眼科合作，于1996年1至6月底，对本院出生后72小时以内的400例新生儿进行了随机眼底检查，检查对象中男194例、女206例，男：女=0．94：1；孕周28～36周22例、37～42周370例，＞42周8例；体重<2500克16例，＞2500克364例、＞4000克20例；分娩方式中，自然分娩230例，剖宫产130例，产钳助娩34例，臀牵引6例；初产妇344例，经产妇56例，产母年龄<25岁78例，25～30岁288例，>30岁34例；汉族376例，少数民族24例。检查方法及结果：双眼各点复方托品酰胺眼药水一滴（北京制药工业研究所实验药厂生产），点药后压迫泪囊一分钟，20～…     

2061例新生儿听力筛查及听力障碍高危因素的分析

听力障碍是常见的出生缺陷,正常新生儿中双侧听力障碍的发生率约为0．1％～0．3％,其中重度至极重度听力障碍的发生率约为0．1％。1994年美国婴幼儿听力联合会（Joint Committee of Infant Heating）列出了新生儿听力减退的10个危险因素旧0,其中宫内感染、高胆红素血症、极低体重儿、Apgar评分1min0～4分或5min0～6分、机械通气5d以上等因素常见于NICU住院患儿中。     

早产儿视网膜病变筛查及相关因素分析

目的：分析我院早产儿视网膜病变( retinopathy of prematurity,ROP)的发病情况,探讨其相关因素。方法回顾性分析2013年9月至2014年9月我院新生儿科住院的182例早产儿(出生体重<2000 g或胎龄<37周)的临床资料。于生后第4~6周或纠正胎龄32周进行ROP筛查,并定期随访。结果182例早产儿中筛查出不同程度ROP患儿32例,占17.6％,其中单眼10例,双眼22例。ROP患儿平均出生胎龄为(29.3±1.5)周,平均出生体重为(1280±240)g,其中ROP 1期11例,2期5例,3期16例,附加病变5例,住院期间18例患儿行视网膜激光光凝手术,2例行Lucentis球内注射。ROP组患儿与非ROP组在出生体重、胎龄、吸氧、肺表面活性物质应用、感染、窒息、输血方面比较,差异有统计学意义(P<0.05)。 Logistic回归分析显示胎龄、吸氧、机械通气、肺表面活性物质应用对ROP的发生有明显影响( P<0.05)。结论胎龄、出生体重、吸氧、呼吸暂停、感染等因素与ROP的发生有关,出生体重及胎龄越低,ROP发病率越高。     

新生儿听力筛查1988例分析

听力障碍是常见的出生缺陷。新生儿中双侧听力障碍的发生率约在0.1%~0.3%[1]。我国聋人口基数大,每年新产生聋儿较多。其中重者导致聋哑,轻者导致语言障碍、社会适应能力低下、注意力缺陷和学习困难等心理行为问题,给整个社会造成了沉重的负担。然而目前的各种治疗方法,其疗效的保证都需依赖于听力障碍的早期发现。据美国婴幼儿听力联合委员会的报告,接受新生儿听力筛查的婴幼儿,其听损伤可以在3个月以内确诊[2],对及早制定治疗和康复计划非常有利。因此,及早发现小儿的听力障碍,并进行早期干预,对保障和提高儿童健康水平具有非常重要的意义…     

数字化视网膜照相术在早产儿视网膜病筛查中的应用

目的：评估数字化视网膜照相术（RetCam）进行眼底检查的实用性及对ROP诊断的有效率。方法：对2007年6月至2008年3月间我科收治的112例早产儿运用间接眼底镜和RetCam同时进行眼底检查,以间接眼底检查诊断ROP的结果为“金标准”,记录RetCam检查眼底结果并进行统计学分析。结果：应用RetCam共检出各期ROP 46眼,其中间接眼底镜检查证实有ROP 43眼,RetCam诊断ROP的敏感度为97.7%,特异度为98.3%,阳性预测值为93.5%,阴性预测值为99.4%,1例ROPⅠ期漏诊,RetCam与间接眼底镜对ROP诊断的一致率为97.3%。结论：RetCam是一种有效的ROP的诊断新方法,可推广应用。［中国当代儿科杂志,2010,12（10）：774-776］     

新生儿尸检779例分析

目的　分析新生儿尸检资料 ,总结新生儿的常见死亡原因及死因与日龄、胎龄的关系。方法　分析整理779例新生儿尸检的尸体解剖记录、尸检结果和相关病历资料。结果　新生儿的常见死亡原因依次为窒息性因素、感染、出血性疾病、畸形及产科因素 ,不同日龄与胎龄的新生儿死因排序略有差异。而随着医疗技术水平的提高 ,感染性疾病和畸形在死因中的比例有下降趋势。将临床和病理诊断结果比较 ,误诊率为 15 % ,以窒息性因素最多见。结论　加强产后护理、预防感染、积极防治早产、强化产前检查及孕期保护是降低新生儿死亡率的有效手段。     

早产儿视网膜病1082例筛查报告及诊治分析

目的 探讨早产儿视网膜病(ROP)的早期诊治方法,分析其筛查结果.方法 由眼底病专科医生应用双目间接眼底镜对本院新生儿科2004年7月至2009年6月收治的胎龄＜34周或出生体质量＜2000 g的住院早产儿进行ROP筛查.首次筛查时间为纠正胎龄32～34周或生后4～6周,对检出的阈值期或阈值前期1型ROP(重症)患儿全部给予眼底激光光凝术,对视网膜血管未发育成熟、1～2期或阈值前期2型(轻度)ROP患儿进行密切随访,直至视网膜血管发育至锯齿缘或发展成为重症.对所有的临床资料进行回顾性分析.结果 5年共收治早产儿2 295例,符合筛查标准的早产儿1 082例,占47.14%;检出ROP总阳性病例154例,占筛查对象的14.23%(154/1082);其轻度ROP86例,占7.94%(86/1 082);重症ROP 68例,占6.28%(68/1 082).68例重症ROP患儿中,有6例出院后随访期间发现进展为重症ROP而再入院,有2例放弃治疗1年后证实全部失明.66例(132只眼)接受各种治疗,其中63例单用光凝术治疗;3例急进性后极ROP中2例采用玻璃体腔内注入血管内皮生长因子拮抗剂(Avastin)联合光凝术治疗,1例单用光凝术治疗者治疗后仍出现部分视网膜脱离,经玻璃体视网膜手术后仍失明;随访结果65例成功的保存了视力,成功率98.48%(65/66).在观察期间未达到光凝治疗条件,因原发病恶化死亡10例,经光凝治疗后的患儿未出现死亡.结论 ROP筛查是防止ROP病情发展的有效措施,对重症ROP及时给予光凝术治疗是安全有效的方法,对急进性后极ROP可用玻璃体腔内注入血管内皮生长因子拮抗剂联合光凝术治疗抢救视力.     

Maternal and neonatal factors associated with poor early weight gain and later retinopathy of prematurity

Aim: To identify factors associated with poor early weight gain as reflected in an alarm system, WINROP, and risk of later proliferative retinopathy of prematurity (ROP) in infants with gestational age (GA) < 28 weeks. Methods: Infants with a WINROP alarm and proliferative ROP, the ‘alarm group’ (n = 23), were matched to GA and gender to a ‘no alarm group’ (n = 23) with no WINROP alarm and no or mild ROP. Retrospectively maternal variables, birth characteristics and neonatal factors, during the first three postnatal weeks, were compared. Results: The ‘alarm group’ had lower birth weight (BW) and BW standard deviation score, longer stay in ventilator, more insulin and corticosteroid treatments, and lower white blood cell count. In a logistic regression model, BW standard deviation score, insulin, low white blood cell count, absence of both elevated C‐reactive protein and premature rupture of membranes were associated with proliferative ROP and WINROP alarm (p = 0.000, r² = 0.704). Conclusions: This study shows that prenatal factors resulting in low BW have persisting effects on early postnatal growth, metabolism and inflammatory response. Future prospective studies will focus on the link between these factors and pathological retinal vessel development in the early postnatal period to find possible preventive strategies.     

Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS)

Aims: The aim of this study was to determine the incidence of neonatal morbidity in extremely preterm infants and to identify associated risk factors. Methods: Population based study of infants born before 27 gestational weeks and admitted for neonatal intensive care in Sweden during 2004–2007. Results: Of 638 admitted infants, 141 died. Among these, life support was withdrawn in 55 infants because of anticipation of poor long‐term outcome. Of 497 surviving infants, 10% developed severe intraventricular haemorrhage (IVH), 5.7% cystic periventricular leucomalacia (cPVL), 41% septicaemia and 5.8% necrotizing enterocolitis (NEC); 61% had patent ductus arteriosus (PDA) and 34% developed retinopathy of prematurity (ROP) stage ≥3. Eighty‐five per cent needed mechanical ventilation and 25% developed severe bronchopulmonary dysplasia (BPD). Forty‐seven per cent survived to one year of age without any severe IVH, cPVL, severe ROP, severe BPD or NEC. Tocolysis increased and prolonged mechanical ventilation decreased the chances of survival without these morbidities. Maternal smoking and higher gestational duration were associated with lower risk of severe ROP, whereas PDA and poor growth increased this risk. Conclusion: Half of the infants surviving extremely preterm birth suffered from severe neonatal morbidities. Studies on how to reduce these morbidities and on the long‐term health of survivors are warranted.     

携带血管生成素1基因的骨髓间充质干细胞对早产儿视网膜病模型小鼠的干预研究

目的探讨携带血管生成素1(Ang-1)基因的骨髓间充质干细胞(BMSCs)对氧诱导视网膜病模型小鼠视网膜新生血管的作用。方法将出生7天的昆明小鼠随机分成空气对照组和高氧模型组(其中包括注射Ang-1+BMSCs组、单纯BMSCs组及高氧PBS组),每个亚组12只。除空气对照组之外,其余组均放入氧分压65%±5%的氧箱内饲养5天后取出。将携带Ang-1的BMSCs和不携带Ang-1的BMSCs各2 ml(内含细胞总数为1×105)在鼠龄第7、12、17日分别腹腔注入高氧模型组中的Ang-1+BMSCs组和单纯BMSCs组小鼠体内,空气对照组和高氧PBS组注入相同剂量的PBS缓冲液。于鼠龄17天时取小鼠眼球做标本固定,分别用免疫组织化学法检测Ang-1蛋白、qRT-PCR法检测Ang-1蛋白mRNA、计数突破视网膜内界膜的血管内皮细胞数及明胶墨汁灌注眼底视网膜血管,比较小鼠视网膜新生血管情况。结果高氧模型各组每只眼球均可见突出内界膜的新生血管内皮细胞。其中Ang-1+BMSCs组、单纯BMSCs组与高氧PBS组相比较,突破视网膜内界膜的血管内皮细胞核明显减少,差异有统计学意义(P<0.05);与高氧PBS组比较,Ang-1+BMSCs组及单纯BMSCs组血管走形较直,Ang-1蛋白表达量增加,免疫组织化学染色被黄染的胞浆较丰富;Ang-1+BMSCs组与单纯BMSCs组相比,前者血管走行较直,周边新生血管覆盖率降低,突破内界膜新生血管细胞数目减少,Ang-1蛋白的表达量增多。结论高氧能诱导新生鼠视网膜新生血管生成;Ang-1基因与BMSCs结合与单纯应用BMSCs相比,前者能更有效地改善视网膜新生血管的增生状况。     

早产儿视网膜病的筛查及其高危因素分析

目的 分析早产儿视网膜病(ROP)的危险因素,为合理防治ROP提供理论依据.方法回顾分析2006年7月至2008年5月,我院NICU住院的胎龄≤36周、出生体重≤2500 g行ROP筛查的1675例早产儿临床资料.记录早产儿的性别、胎数、孕周、出生体重、用氧情况、患全身疾病情况及孕母情况.同时用单因素χ~2检验和多因素Logistic回归分析筛选和判定早产儿ROP发生的危险因素.结果 1675例早产儿中,发生ROP 195例,ROP患病率为11.6%.195例ROP患儿中,达到阈值前病变Ⅰ型或阈值病变者35例,占筛查早产儿的2.1%.ROP发生的相关因素分析发现,出生体重越低、胎龄越小、氧疗时间越长,ROP患病率越高.Logistic回归分析结果 表明,低出生体重、小胎龄、窒息、呼吸暂停、氧疗是ROP发生的高危因素(OR值分别为0.957、1.052、1.186、5.314、1.881).结论 低出生体重、小胎龄、窒息、呼吸暂停、氧疗是ROP发生的高危因素,建议对具有高危因素的所有早产儿均进行ROP筛查.     

一所地市级医院NICU中新生儿肺出血的高危因素分析

目的探讨某地市级医院NICU中发生新生儿肺出血(NPH)高危因素,为地市级医院救治NPH提供早期识别依据。方法某地市级医院NICU确诊的112例NPH患儿作为病例组,按巢式病例配对法选取同期住院、予呼吸机辅助呼吸但未并发生肺出血的224例新生儿为对照组,采用单因素分析和非条件logistic回归分析法对NPH的高危因素进行统计学分析。结果单因素分析结果显示:病例组母妊娠期糖尿病及胆汁淤积症,患儿剖腹产出生,胎龄34周,5 min Apgar评分≤5分,体重2 500 g,NPH前出现心力衰竭、弥漫性血管内凝血(DIC)、PaO_2/FiO_2(氧合指数,OI)≤100及平均血小板体积减小的发生比率明显高于对照组。Logistic回归多因素分析显示:DIC、心力衰竭、OI≤100是NPH的独立危险因素(OR分别为33.975、3.975、1.818;P0.05)。结论心力衰竭、OI≤100、DIC是地市级医院NICU发生NPH高危因素,应针对这些因素开展积极的原发病治疗和病情监测。     

促红细胞生成素在新生儿相关疾病中的研究进展

促红细胞生成素(Epo)是一种糖蛋白激素,在促红细胞生成和神经保护中具有重要作用,目前认为Epo在新生儿高氧肺损伤、早产儿视网膜病及新生儿坏死性小肠结肠炎中也有一定的保护效应。重组人促红细胞生成素（rhEpo）作为其基因克隆物已广泛应用于新生儿领域。     

Low gestational age and chronic lung disease are synergistic risk factors for retinopathy of prematurity

Aims

This retrospective, population based study was designed to investigate risk factors for development of retinopathy of prematurity (ROP) and their possible interrelationships, in neonates of gestational age (GA) < 32 weeks born in a well-defined geographical region.

Study design—subjects

The study population included all preterm infants born alive with GA 24–32 weeks in Northwestern Greece during a 9-year period and hospitalised in the regional neonatal intensive care unit (NICU).

Outcome measurements

The association was assessed of the presence of ROP with maternal factors: age, pathology of pregnancy, in-vitro fertilisation, multiple gestation, mode of delivery, perinatal factors: gender, antenatal steroids, transportation, resuscitation, GA, birth weight (BW), small for GA status and postnatal morbidity: chronic lung disease (CLD), intraventricular haemorrhage (IVH), necrotizing enterocolitis (NEC), respiratory distress syndrome (RDS), maximum O₂ needs, hypoxic/hyperoxic episodes, patent ductus arteriosus (PDA), sepsis, using multiple logistic regression analysis.

Results

Of 189 infants without congenital anomalies born at GA 24–32 weeks ROP was diagnosed in 24 (12.7%) (> grade 2: 6). Logistic regression analysis showed ROP to be strongly associated with GA, odds ratio (OR) 2.1, confidence interval (CI) 1.3–3.3, p < 0.01 and CLD, OR 10.2, CI 2.3–44, p < 0.01, respectively, independent of confounding factors. By estimating interaction on an additive scale it was shown that the combined risk effect of GA and CLD was larger than the sum of the individual risk effects, implying synergistic effect.

Conclusions

ROP was closely and independently related to both low GA and the diagnosis of CLD, which were interrelated in the development of ROP.     

Retinopathy of prematurity: Recommendations for screening

Retinopathy of prematurity (ROP) is a disorder of the developing retinal blood vessels of the preterm infant. New recommendations for screening and treatment of ROP have been published in the past few years. Current evidence suggests that screening infants with gestational ages of 30 6/7 weeks or less (regardless of birth weight) and birth weights of 1250 g or less is a strategy with a very small likelihood that an unscreened baby would have treatable ROP. Individual centres may choose to extend birth weight screening criteria to 1500 g. Initial screening should be performed at 31 weeks' postmenstrual age in infants with gestational ages of 26 6/7 weeks or less at birth, and at four weeks' chronological age in infants with gestational ages of 27 weeks or more at birth by an ophthalmologist skilled in the detection of ROP. Follow-up examinations are conducted according to the ophthalmologist's recommendation. Infants with high-risk prethreshold ROP and threshold ROP are referred for retinal ablative therapy. Developing processes for ROP screening, documenting results and communicating results to parents as well as health professionals involved in the infant's care are important responsibilities for all nurseries providing care for preterm infants.