Should Ocular Hemorrhage Screening Be Conducted in Newborns with Acidosis?

IF 1.5 4区医学 Q3 OBSTETRICS & GYNECOLOGY

American journal of perinatology Pub Date : 2024-10-01 Epub Date: 2024-02-16 DOI:10.1055/s-0044-1780512

Sezin Unal, Caner Kara, Nihal Demirel, Seza Petriçli, Sumru Kavurt, Elif Uzlu, Mehtap Durukan, Ahmet Yagmur Bas

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引用次数: 0

Abstract

Objective: Ocular hemorrhages (OHs) may cause visual disturbances and incidence vary from 18 to 39% in newborns. Precipitated/instrumental delivery and perinatal asphyxia were predefined risk factors. Acidosis can interfere with coagulation and disrupt the pressure of ocular capillaries and put infants with moderate acidosis with or without hypoxic-ischemic encephalopathy at risk for OH. We aimed to evaluate the OH in neonates with fetal acidosis.

Study design: Neonates >34 weeks are included if pH < 7.10 and BE < -12 mmol/L within the first hour. Ophthalmologic examinations for retinal (RH), vitreous, and anterior chamber (hyphema) hemorrhage were done within the third day. RH was staged according to Egge's classification. Follow-up of the patients was continued until the age of 2. Clinical characteristics of newborns were analyzed.

Results: Sixty-two neonates (38 ± 2.3 weeks, 2,971 ± 612 g) were included. pH = 6.91 ± 0.16, BE = - 17.2 ± 5.3 mmol/L. OH was found in 22 (36.7%) neonates (hyphema n = 2, vitreous n = 2, RH n = 21). Thirty-eight eyes with RH were staged (Stage 3: n = 15 [39.5%]; Stage 2: n =11 [28.9%]; Stage 1: n = 12 [31.6%]). Vaginal delivery (OR: 4.9, 95% CI [1.4-17.8]) and advanced resuscitation at the delivery room (OR: 8.8; 95% CI [1.9-41.7]) were found to increase the risk of RH.

Conclusion: Approximately one-third of neonates with moderate to severe acidosis exhibited RH when examined on the third day. Contrary to previous studies that reported mild RH in otherwise healthy neonates, our findings revealed that neonates with moderate to severe acidosis predominantly presented with Stage 3 RH. While the higher incidence of RH in vaginally delivered infants is consistent with previous studies, the identification of advanced resuscitation as a risk factor is a new addition to the literature. The findings in our study highlight the importance of retinal examination in neonates with acidosis in the presence of intubation during resuscitation.

Key points: · One-third of neonates with moderate to severe acidosis exhibited RH.. · Stage 3 RH was identified as the most prevalent.. · Advanced resuscitation was identified as an independent risk factor for RH..

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是否应对酸中毒新生儿进行眼底出血筛查？

目的：眼底出血（OHs）可导致视力障碍，在新生儿中的发病率从 18% 到 39% 不等。预产/工具性分娩和围产期窒息是预先确定的危险因素。酸中毒会干扰凝血功能，破坏眼部毛细血管的压力，使患有中度酸中毒并伴有或不伴有缺氧缺血性脑病的婴儿面临发生OH的风险。我们旨在评估胎儿酸中毒新生儿的OH：研究设计：如果 pH 值大于 34 周，则纳入新生儿：pH = 6.91 ± 0.16，BE = - 17.2 ± 5.3 mmol/L。22名（36.7%）新生儿（红斑下n = 2，玻璃体n = 2，RH n = 21）发现OH。38只患有RH的眼睛被分期（3期：n = 15 [39.5%]；2期：n = 11 [28.9%]；1期：n = 12 [31.6%]）。阴道分娩（OR：4.9，95% CI [1.4-17.8]）和产房高级复苏（OR：8.8；95% CI [1.9-41.7]）会增加发生 RH 的风险：结论：大约三分之一患有中度至重度酸中毒的新生儿在第三天接受检查时表现出RH。以往的研究报告称，健康的新生儿会出现轻度 RH，而我们的研究结果却显示，中度至重度酸中毒的新生儿主要表现为三期 RH。虽然阴道分娩婴儿的 RH 发生率较高与之前的研究结果一致，但将晚期复苏确定为风险因素是文献中新增加的内容。我们的研究结果强调了在复苏过程中插管时对酸中毒新生儿进行视网膜检查的重要性：- 要点：三分之一患有中度至重度酸中毒的新生儿表现出RH。- 第三期RH被认为是最常见的。- 晚期复苏是RH的独立风险因素

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来源期刊

American journal of perinatology 医学-妇产科学

CiteScore

5.90

自引率

0.00%

发文量

302

审稿时长

4-8 weeks

期刊介绍： The American Journal of Perinatology is an international, peer-reviewed, and indexed journal publishing 14 issues a year dealing with original research and topical reviews. It is the definitive forum for specialists in obstetrics, neonatology, perinatology, and maternal/fetal medicine, with emphasis on bridging the different fields. The focus is primarily on clinical and translational research, clinical and technical advances in diagnosis, monitoring, and treatment as well as evidence-based reviews. Topics of interest include epidemiology, diagnosis, prevention, and management of maternal, fetal, and neonatal diseases. Manuscripts on new technology, NICU set-ups, and nursing topics are published to provide a broad survey of important issues in this field. All articles undergo rigorous peer review, with web-based submission, expedited turn-around, and availability of electronic publication. The American Journal of Perinatology is accompanied by AJP Reports - an Open Access journal for case reports in neonatology and maternal/fetal medicine.