Fundus Screening And Perinatal Risk Factors Of Retinal Hemorrhage In 2689 Healthy Full-term Newborns In Jilin Province

Objective:The objective of this study was to analyze the fundus screening results of 2689 healthy full-term neonates in Jilin Province,and to investigate the perinatal risk factors of retinal hemorrhage(RH),so as to provide a certain clinical basis for early screening and treatment of neonatal eye disease.Method:This study is a retrospective study.Healthy full-term newborns(gestational age≥37 weeks)who underwent fundus screening in Jilin Provincial Maternal and Child Health Hospital from December 2020 to December 2021 were selected as subjects.According to inclusion and exclusion criteria,a total of 2689 patients(5378 eyes in total)were enrolled.All subjects undenwent RetCam iii fundus examination within 7 days after birth,and perinatal factors of all included neonates were recorded.The detection of fundus diseases in full-term neonates was analyzed.The children were divided into retinal hemorrhage group and normal fundus group.In neonatous RH,according to the new domestic grading method,the neonatous RH was divided into mild RH group and moderate and severe RH group,and according to the involved macular hemorrhage,it was divided into macular hemorrhage group and non-macular hemorrhage group.To analyze the risk factors of retinal hemorrhage,moderate and severe retinal hemorrhage and macular hemorrhage.IBM SPSS 25.0 statistical software was used for data analysis,t test and χ2 test was used for univariate analysis,and stepwise binary Logistic regression was used for multivariate analysis.P<0.05 was considered statistically significant.Results:(1)A total of 2689 patients were included,of which 1321(49.12%)is normal,and 1368(50.88%)had fundus abnormalities(either left or right eye).The total detection rate of fundus abnormalities was about 50.88%.There were 1608(59.79%)cases of normal left eye and 1081(40.21%)cases of abnormal fundus.There were 1669(62.06%)cases of normal right eye and 1020(37.94%)cases of abnormal fundus.Retinal hemorrhage is a common ocular fundus disease in neonates.Others include peripheral white lesions,incomplete retinal development,pigmentation,ROP,FEVR,PHPV.(2)Retinal hemorrhage(RH)was detected in 606 cases(22.53%)of newborns,with a total detection rate of 22.53%.RH was detected in 429 cases(39.69%)of left eye and 420 cases(41.18%)of right eye.There were 465 cases(76.73%)with degree i RH,60 cases(9.90%)with degree ii RH,81 cases(13.37%)with degree iii RH,and 18 cases(2.90%)with macular hemorrhage.(3)Perinatal risk factors of RH:Univariate analysis showed that there were statistically significant differences in birth weight,delivery mode,number of fetuses,gestational hypertension,umbilical cord winding and oligohydramnios between normal fundus group and retinal hemorrhage group(P<0.05).Multivariate logistic analysis showed that umbilical cord winding(OR=1.611,95%CI:1.279-2.029,P<0.01)and vaginal delivery(OR=8.347,95%CI:8.131,9.055,P<0.01)were risk factors of RH.(4)Perinatal risk factors of moderate and severe RH:Univariate analysis showed that there were significantly differences in gestational age,delivery mode,birth weight,umbilical cord winding and amniotic fluid meconium contamination between the mild RH group and the moderate and severe RH group(P<0.05).Multivariate logistic analysis showed that vaginal delivery(OR=3.423,95%CI:2.214-2.593,P<0.01)and meconium-stained amniotic fluid(OR=1.556,95%CI:1.225-1.975,P<0.01)were risk factors for moderate and severe RH.(5)Perinatal risk factors of macular hemorrhage:There was no significantly differences in gestational anemia,screening time,delivery mode,gestational diabetes,gestational hypertension,number of fetuses,premature rupture of membrane,fetal distress and fetal gestational age,sex,birth weight,placental abruption,umbilical cord winding,oligohydramnios,meconium-stained amniotic fluid,asphyxia between macular hemorrhage group and non-macular hemorrhage group(P>0.05).Conclusion:(1)Retinal hemorrhage is a common fundus disease in newborns.Others abnormal fundus diseases include peripheral white lesions,incomplete retinal development,pigmentation,ROP,FEVR,PHPV.(2)Umbilical cord winding and vaginal delivery are perinatal risk factors for RH in full-term newborns;(3)Vaginal delivery and meconium-stained amniotic fluid are perinatal risk factors for moderate and severe RH in full-term newborns.