Retinal and Optic Nerve Hemorrhages in the Newborn Infant: One-Year Results of the Newborn Eye Screen Test Study.
Retinal and Optic Nerve Hemorrhages in the Newborn Infant: One-Year Results of the Newborn Eye Screen Test Study.
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DOI：
10.1016/j.ophtha.2016.01.004
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发表时间：
2016-05
期刊：
影响因子：
13.7
通讯作者：
Moshfeghi DM
中科院分区：
文献类型：
--
作者：
Callaway NF;Ludwig CA;Blumenkranz MS;Jones JM;Fredrick DR;Moshfeghi DM
目的报告新生儿出生时视网膜和视神经眼底出血(FH)的发生率、危险因素、特点和部位。斯坦福大学医学院的前瞻性队列研究。所有年龄在月经后37周或以上且被儿科医生认为稳定的婴儿都有资格进行筛查。无眼科或已知或怀疑有感染性结膜炎的婴儿被排除在外。在新生儿眼屏测试(Nest)研究中，2013年7月25日至2014年7月25日在Lucile Packard儿童医院(LPCH)出生的婴儿通过广角数字视网膜摄影进行了普遍的新生儿筛查。产妇、产科和新生儿因素是通过在出院前查阅医院记录获得的。FH的位置、视网膜层和偏侧性由一位儿科玻璃体视网膜专家记录。FH的出生患病率。次要结果包括不良事件发生率、FH的危险因素、出血特征和不良事件。本研究中FH的出生患病率为20.3%(41/202)。95%的FHs累及周边，83%累及黄斑，71%累及多层视网膜。15%的FH病例累及中心凹(出生率为3.0%)。未发现双侧黄斑中心凹出血病例。眼底出血在左眼比右眼更常见。眼底出血最常见的是视神经火焰出血(48%)和白色中心视网膜出血(30%)。视网膜出血在所有四个象限都是最常见的(35%)，而且更多的是多发性的，而不是单发性的。黄斑出血最常见的是视网膜内(40%)。在这项研究中考察的危险因素中，阴道分娩与剖腹产相比(优势比[OR]，9.34；95%可信区间[CI]，2.57-33.97)与FH的相关性最高。自认为是西班牙裔或拉丁裔的种族显示出保护作用(OR，0.43；95%CI，0.20-0.94)。其他研究因素均不显著。眼底出血在新生儿中很常见。它们通常累及视网膜的多个区域和多层。在这项研究中，阴道分娩与FH的风险显著增加有关，而自我认同的西班牙裔或拉丁裔种族对FH具有保护作用。FH对视觉发育的长期影响尚不清楚。
To report the birth prevalence, risk factors, characteristics and location of fundus hemorrhages (FH) of the retina and optic nerve present in newborns at birth. Prospective cohort study at Stanford University School of Medicine. All infants who were 37 weeks postmenstrual age or older and were deemed stable by their pediatrician were eligible for screening. Infants who were anophthalmic or had known or suspected infectious conjunctivitis were excluded. Infants born at Lucile Packard Children's Hospital (LPCH) from July 25, 2013 through July 25, 2014 were offered universal newborn screening via wide-angle digital retinal photography in the Newborn Eye Screen Test (NEST) study. Maternal, obstetric, and neonatal factors were obtained by reviewing hospital records prior to discharge. The location, retinal layer, and laterality of FH were recorded by one pediatric vitreoretinal specialist. Birth prevalence of FH. Secondary outcomes included rate of adverse events, risk factors for FH, hemorrhage characteristics and adverse events. The birth prevalence of FH in this study was 20.3% (41/202 infants). Ninety-five percent of FHs involved the periphery, 83% involved the macula, and 71% involved multiple layers of the retina. The fovea was involved in 15% of FH cases (birth prevalence, 3.0%). No cases of bilateral foveal hemorrhage were found. Fundus hemorrhages were more common in the left eye than the right. Fundus hemorrhages were most commonly optic nerve flame hemorrhages (48%) and white-centered retinal hemorrhages (30%). Retinal hemorrhages were found most frequently in all 4 quadrants (35%) and more often were multiple than solitary. Macular hemorrhages most often were intraretinal (40%). Among the risk factors examined in this study, vaginal delivery compared with cesarean section (odds ratio [OR], 9.34; 95% confidence interval [CI], 2.57-33.97) showed the greatest level of association with FH. Self-identified ethnicity as Hispanic or Latino showed a protective effect (OR, 0.43; 95% CI, 0.20-0.94). Other study factors were not significant. Fundus hemorrhages are common among newborns. They often involve multiple areas and layers of the retina. Vaginal delivery was associated with a significantly increased risk of FH, whereas self-identified Hispanic or Latino ethnicity was protective against FH in this study. The long-term consequences of FH on visual development remain unknown.