ObjectiveTo investigate the related factors of the retina1 hemorrhage in newborns.
Methods9558 newborns included in this observation between March of 2012 and July of 2013 in our hospital. The fundus was examined by the fully-integrated wide-field digital imaging system RetCamⅢat 0-4 days after born. According to the literature, retinal hemorrhage was classified into degreeⅠ, ⅡandⅢ. The condition for baby and the mother during pregnancy were correlatively analyzed. The other factors were analyzed including twins, premature delivery, big baby, mode of delivery, fetal birth, forceps delivery, suction delivery, asphyxia, jaundice, ABO hemolytic, cranial hematoma, intracranial hemorrhage, maternal age, first-time mom, the maternal previous mode of production, emergency delivery, the first stage of labor prolonged, the second stage of labor prolonged, the third stage of labor prolonged, pregnancy-induced hypertension, gestational diabetes, oxytocin, prenatal body mass index (BMI). Multivariate logistic regression analysis was used.
ResultsIn 9558 cases of newborns, retinal hemorrhages were found in 2753 infants (28.8%), including 1137 degreeⅠ(41.3%), 895 degreeⅡ(32.5%) and 721 degreeⅢ(26.2%). Multivariate logistic regression analysis showed that the mode of delivery, asphyxia, jaundice, advanced maternal age, maternal previous birth, prenatal BMI is a risk factor for neonatal values retinal hemorrhage (r=0.146, 5.841, 1.847, 0.071, 0.246, 0.965;P < 0.05). The degree of fundus hemorrhage was not related to birth weight and BMI (P > 0.05).
ConclusionsThe neonatal retinal hemorrhage rate was 28.8%. Mode of delivery, asphyxia, neonatal jaundice, maternal age, the previous mode of delivery of mothers with more than one previous birth, prenatal BMI values may be risk factors lead to retinal hemorrhage.
ObjectiveTo observe the effect of breastfeeding on the incidence of retinopathy of prematurity (ROP).MethodsA retrospective clinical study. From June 2017 to December 2019, 1256 eyes of 628 premature infants who were born in Ningbo Women and Children's Hospital and were screened for ROP were included in the study. Among them, there were in 325 males (650 eyes) and 303 females (606 eyes). According to the feeding situation, premature infants were divided into breastfeeding (research) group and formula feeding (control) group, with 390 cases of 780 eyes and 238 cases of 476 eyes, respectively. The changes in the retina of the fundus of the two groups of premature infants during the observation period were compared. The qualitative data comparison between groups was performed by the χ2 test; the quantitative data comparison was performed by the two independent sample t test.ResultsThe sex ratio of premature infants in the study group and control group (χ2=0.217), birth weight (t=0.728), gestational age at birth (t=0.351), Apgar score at birth (t=0.816), oxygen inhalation time (t=0.427), were compared with the length of stay in the neonatal intensive care unit (t=1.580), the difference was not statistically significant (P＞0.05). Among the 390 cases in the study group, 108 cases (27.7%, 108/390) and 282 cases (72.3%, 282/390) were with or without ROP, respectively; in the 238 cases in the control group, 86 (36.1%, 86/238) were with ROP, 152 (63.9%, 152/238) cases were without ROP. There was a statistically significant difference in the incidence of ROP between the two groups (χ2=4.934, P=0.026). Among the 108 cases of ROP in the study group, 50 (12.8%, 50/108), 35 (9.0%, 35/108), 23 (5.9%, 23/108) cases were in stage 1, 2 and 3, respectively. Among the 86 ROP cases in the control group, stages 1, 2 and 3 were 25 (10.5%, 25/86), 40 (16.8%, 40/86), and 21 (8.8%, 21/86), respectively. In the comparison of ROP staging between the two groups, the difference in stage 1 was not statistically significant (χ2=0.754, P＞0.05), and the difference in stage 2 and above was statistically significant (χ2=11.400, P＜0.05).ConclusionBreastfeeding may reduce the incidence and severity of ROP.
Objective To observe the retinal function of infa nts with retinopat hy of prematurity (ROP). Methods A total of 78 infants (156 ey es) aged from 4-5 months underwent full-field flash electroretinogram (ERG) examination. The am p litude and implicit time of a-and b-wave of ERG were detected to evaluate the i nfants' retinal function. Seventy-eight infants (156 eyes) included 33 healthy a nd full-term infants (66 eyes), 25 healthy premature children (50 eyes), and 20 infants (40 eyes) with ROP. Results Obvious ERG waveforms were recorded in all the fullterm and healthy premature children. Amplitude of combined b-wave wa s 388.7 mu;V in full-term infants and 336.7 mu;V in healthy premature children, whi c h was 64.4% and 55.6% of that of the healthy adults respectively. In infants wit h ROP, ERG was nonrecordable in 20 eyes (50％); amplitude of combined b-wave was 183.8 mu;V in the other 20, whose implicit time delayed obviously compared with that of fullterm infants. The amplitude of ERG of healthy premature infants de c reased significantly compared with that of the full-term infants. Conclusions Retina keeps growing after birth. ERG of healthy full-term chi ldren is not as developed as those of adults. The progress of retinal maturation in infants with ROP is slower than that in the full-term infants. ERG examination is an effecti ve method in evaluating retinal function of infants with ROP.
ObjectiveTo observe the macular morphological development and thickness of retinal layers in infants.
MethodsFifty-eight infants (86 eyes) were randomly selected from neonatal intensive care unit. They were divided into 4 groups according to the corrected gestational age, including <32 weeks group (10 cases, 14 eyes), 33 to 36 weeks group (26 cases, 39 eyes), 37 to 41 weeks group (12 patients, 18 eyes) and ≥42 weeks group (10 cases,15 eyes). Twelve health adults (22 eyes) were randomly selected as adult group. All infants and adults underwent a portable optical coherence tomography (OCT) examination, focus on the macular morphology. The thickness of 9 retinal layers at fovea and parafovea (750 μm, 1500 μm from central fovea) were measured, including retinal neurepithelium layer, the inner retina, the outer retina, nerve fiber layer, ganglion cell layer, inner plexiform layer, inner nuclear layer, outer plexiform layer and inner nuclear layer. The correlation between retinal thickness and corrected gestational age was analyzed.
ResultsMacular fovea was shallow in early infancy, and then form a mature macular fovea finally with corrected gestational age. The outer retina structure was more mature than the inner retina of infants. With the increase of the corrected gestational age, the following structures gradually developed including the outer limiting membrane (OLM), the junction of inner and outer segment of photoreceptor (IS/OS), the outer segment of photoreceptor/retinal pigment epithelium layer (OS/RPE). The earliest corrected gestational age to detect the OLM, IS/OS, OS/RPE was 32+6, 35, 47+6 weeks respectively. The RPE and choroid layer became thicker gradually. There were no statistical differences between infants group and adults group (P>0.01) for the following thickness measurements, including inner retina at 750 μm parafovea, nerve fiber layer at 1500 μm parafovea, ganglion cell layer at central fovea and parafovea (750 μm, 1500 μm). The thickness of other retinal layers was different between different sites, between different corrected gestational ages, and between infants and adults groups (P<0.01). Correlation analysis found that, except of retinal ganglion cell layer, the thickness of other retinal layers was correlated with the corrected gestational age (P<0.05).
ConclusionsMacular fovea is shallow in early infancy, and then form a mature macular fovea finally with corrected gestational age. At infant's early stage, the outer retina of macular is gradually thickening, of which the most obvious variation are the inner nuclear layer and outer nuclear layer. But the development speed of all layers is inconformity.
Objective To observe the characteristics of images of ocular fundus obtained by computer-assisted imaging system of binocular indirect ophthalmosco p y (CABIO) in the healthy premature infants and the ones with retinopathy of prem aturity(ROP), and evaluate the value of the clinical practice of CABIO in ROP s creening. Methods From January, 2006 to December, 2006, we exa mined 150 prematur e infants in ROP screening procedure by using the computerassisted imaging sys t em of binocular indirect ophthalmoscope, beginning at the infantsprime;age of postn a tal 4-6 weeks or the corrected age above 32 weeks. The follow-up duration was co nfirmed according to the first examination results. The procedure of the operati on was recorded and the typical pictures were shot to obtain the images of the o cular fundus of the healthy premature infants and the ones with ROP. The charact eristics of the images were retrospectively analyzed and compared. Resu lts The typical images of normal ocular fundus and that with ROP in the 150 premature i nfants were successfully obtained by indirect ophthalmoscope. In normal fundus o f infants, the color of optic disc was pale, peripheral retina was not completel y vascularized and presented gray-tone in color;while all stages of ROP present ed dif ferent appearances under the indirect ophthalmoscope. Conclusions Computer-ass isted imaging system of the binocular indirect ophthalmoscopy can clearly observ e the characteristics of normal ocular fundus of premature infants and the ocula r fundus with ROP, and can save the objective examination results, which may pro vide significant references in screening and treating ROP.
ObjectiveTo evaluate the potential risk factors with incidence and degree of retinopathy of prematurity (ROP) in infants with very low birth weight.MethodsThe clinical data of 130 premature infants with birth weight ≤1500 g recorded in Peking University People′s Hospital from July 2002 to April 2004 were retrospectively analyzed.ResultsThere were 60 infants in ROP group and 70 infants in control group. The mean birth weight and gestational age was (1256.3±196.8) g and (29.583 3±1.543 6) weeks in ROP group, and (1337.8±146) g and (31.217 4±2.430 6) weeks in control group, respectively. In 39 ecdemic infants, 32 were found with ROP (82.1%, 1 with mild and 31 with severe ROP) while in 91 local infants, 28 were found with ROP (30.8%, 15 with mild and 13 with severe ROP). The time of the first examination in infants with mild ROP was (36.062 5±2.909 0) weeks, which was significantly earlier than (59.477 3±33.604 0) weeks in the ones with severe ROP. The time of the first examination and surgery was earlier in non vitrectomy group than in nonvitrectomy group.ConclusionLow birth weight is the high risk factor in ROP. Incidence of ROP is higher in ecdemic infants. The severity of ROP correlates with time of first examination, and the way of surgery is relative to time of the first examination and surgery.(Chin J Ocul Fundus Dis,2005,21:275-277)
ObjectiveTo measure and analyze the tortuosity of retinal veins in neonatal and premature infants quantitatively.
MethodsA retrospective clinical study. The fundus images of the left eyes were selected from 30 healthy neonates and 30 premature infants without retinopathy of prematurity underwent RetCam screening. There were 16 premature infants with a history of oxygen inspiration. The tortuosity of superior temporal veins, inferior temporal veins, superior nasal veins, inferior nasal veins was measured separately using a self-developed computer program. Pearson correlation analysis was used to analyze the relationship between tortuosity of retinal veins and birth weight, gestational age and correct gestational age.
ResultsIn full-term neonatal infants, the vascular tortuosity of the nasal veins was significantly higher than the temporal veins (t=5.73, P < 0.01), while the superior veins and inferior veins showed no significant difference (t=0.39, P > 0.05). There was no correlation between vascular tortuosity of temporal (r=0.179, -0.175) or nasal veins (r=0.055, 0.345) with birth weight or gestational age (P > 0.05). In premature infants, the vascular tortuosity of the nasal veins was also significantly higher than the temporal veins (t=5.00, P < 0.01), no significant difference was found between the superior veins and inferior veins (t=0.39, P > 0.05). The vascular tortuosity of temporal veins of premature infants was negatively correlated with birth weight (r=-0.375, P < 0.05); however, no significant correlation was found with gestational age (r=-0.296, P > 0.05). The vascular tortuosity of the temporal retinal veins of premature infants with a history of oxygen inspiration was significantly higher than premature infants without a history of oxygen inspiration (t=2.517, P < 0.05), though no significant difference was found between the nasal veins (t=-0.261, P > 0.05). The vascular tortuosity of the temporal and nasal retinal veins of premature infants was both higher than neonate, but was not statistically significant (t=0.88, 1.50; P > 0.05).
ConclusionsThe vascular tortuosity of the temporal veins was greater than the nasal veins in both full-term and premature infants, though no significant difference was found between superior and inferior veins. The vascular tortuosity of temporal veins of premature infants increased as birth weight decreased. The vascular tortuosity of the temporal retinal veins of premature infants with a history of oxygen inspiration was higher than premature infants without a history of oxygen inspiration.
Objective To investigate the related factors of the retinal hemorrhage in high-risk infants (HRI). Methods Eight hundred and sixty HRI with histories of high-risk pregnancy and/or neonatal asphyxia after 1-5 days of birth were enrolled in this study.In 860 cases of HRI, 498 infants were vaginal delivery and 362 infants were delivered through cesarean sections. Among 498 vaginal delivered infants, 407 infants were eutocia and 91 infants were with forceps delivery; 298 infants were born following normal labor, 102 infants experienced prolonged labor, and 98 infants were urgent birth. The retinal hemorrhages were observed and conditions were graded into three degrees of Ⅰ, Ⅱ, and Ⅲ. Conditions of neonatal asphyxia were evaluated based on criteria of Apgar score. The incidence of retinal hemorrhage in the different types of deliveries and labor processes were compared, and the relationship between degree of retinal hemorrhage and grade of neonatal asphyxia were analyzed. Results In 860 cases of HRI, retinal hemorrhages were found in 202 infants (23.5%). Within these 202 infants, 75 infants (37.1%) were Ⅰ degree retinal hemorrhage, 75 infants (37.1%) were Ⅱ degree retinal hemorrhage, and 52 infants (25.8%) were Ⅲ degree retinal hemorrhage. In these 202 infants of retinal hemorrhage, 172 infants (85.1%) had histories of asphyxia; 119 infants (69.2%) were graded as mild asphyxia-risk, and 53 infants (30.8%) were graded as severe asphyxiarisk. There was a statistical difference of the degree of the retinal hemorrhage between the mild and severe asphyxia-risk infants (chi;2=34.61,P＜0.01). The incidence of retinal hemorrhage after vaginal delivery was higher than cesarean section delivery with significant statistical difference (chi;2=30.73,P＜0.01). The incidence of retinal hemorrhage after forceps delivery was significantly higher than eutocia with statistical difference (chi;2=62.78,P＜0.01). Both prolonged and urgent childbirth had statistically significant higher incidences of retinal hemorrhage compared to normal labor in the process of vaginal delivery (chi;2=45.86, 71.51; P＜0.01). Asphyxia, types of delivery, prolonged and urgent labors were risk factors of retinal hemorrhage for HRI (r=7.46,4.87,15.03,6.47;P＜0.01). Conclusions The incidence of retinal hemorrhage in high-risk infant was 23.5%. And, asphyxia, types of delivery, prolonged and urgent labors may play roles of risk factor in retinal hemorrhage of HRI.
Kangaroo mother care has reduced mortality and morbidity in preterm and low birth weight infants and has many benefits, such as promoting breastfeeding. Based on the current evidence in China and internationally, we developed clinical practice guidelines for kangaroo mother care in preterm and low birth weight infants using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE), and proposed 34 recommendations for 20 key questions. Our goal is to promote the appropriate implementation of kangaroo mother care in clinical practice.
Objective To investigate the degree of retinal developmen t in pret erm infants and compare the electroretinograms between preterm and fullterm in fants.
Methods Flash electroretinogram (ERG) were obtained wit h contact lens el ectrodes in one eye from ten preterm infants (10 eyes) and twenty full-term inf a nts (20 eyes) in seven days after birth. The rod cell, cone cell, maximal combi nation, oscillatory potentials, and 30 Hz flicker responses were recorded.
Results Compared with the full-term infants, the implicit time of rod cell respon s e (t=3.216，P=0.003) was longer and the amplitudes were lower (t=6.0 50，P=0.000) in the preterm infants; the difference of implicit time of maximal response was not significant (t=0.465，P=0.650; t=1.068，P=0.295), while th e amplitudes dec reased (t=6.584, P=0.000; t=6.649, P=0.000). The a- and b-wav e implicit time of cone response was not differed much between the two groups (t=0.077, P=0.939; t=0.935,P=0.358); the amplitudes was obvious lower in preterm group (t =3 .417，P=0.002；t=6.310，P=0.000); the difference of implicit t ime of 30 Hz flic ker betw een the two groups was not significant (t=3.745，P=0.001). The difference of b/a value of maximal combination response was not obvious between the two groups ( t=0.215, P=0.831).
Conclusions The development of retinal function is slower in preterm infants than that in full-term ones．
