Objective To observe the rate of iris vessels exposure and analyze its relevant factors in normal full-term neonates. Methods A retrospective study. 1855 normal full term neonates, including 947 boys and 908 girls, were enrolled. The mean gestational age (GA) was (38.84±1.10) weeks and mean birth weight (BW) was (3 396.52±402.08) g. There were 1235 neonates from normal term vaginal delivery, 402 cases of cesarean delivery and 218 cases of forceps delivery. All neonates were examined with hand-held portable slit lamp biomicroscopy within 1 to 3 days after birth by two trained ophthalmologist respectively. Iris vessels exposure was defined as radial red blood vessels along iris fibers. Infants were divided into iris vessels exposure group and iris vessels unexposed group according to the findings of slit lamp biomicroscopy. 78 infants with iris vessels exposure were followed up for 42 days after birth till the iris vessels can’t be seen under microscope. The differences between the two groups were compared for gender, mode of delivery (MOD), GA, BW and body length (BL). Multiple logistic regressions were used to determine the factors related to iris vessels exposure. Results There were 298 neonates with iris vessels exposure among 1855 neonates and the rate was 16.1%. 1557 neonates (83.9%) had unexposed iris vessels. There were no different in gender (χ2=0.551) and MOD (χ2=3.036) between iris vessels exposure group and unexposed group (P>0.05), while the differences in GA (χ2=47.216), BW (t=4.603) and BL (t=3.936) between the two groups were statistically significant (P=0.000). Multiple logistic regression analysis revealed that only GA (β=?0.291, odds ratio=0.747, 95% confidence interval: 0.656 - 0.851, P=0.000) was correlated to iris vessels exposure significantly. The iris vessels couldn’t be seen in 77 of 78 infants with iris vessels exposure when followed up to 42 days. Conclusions The iris vessels exposure in normal full-term neonates is frequently observed. There is a significant inverse correlation between GA and iris vessels exposure.
Objective To observe the fundus characteristics and associated factors of retinal hemorrhage (RH) in newborns. Methods A total of 293 healthy newborns (586 eyes) were enrolled in this study. A digital wide-angle retinal imaging device (RetCam Ⅲ) was used to examine the subjects at about 2 days after birth (2.7plusmn;0.9) days. The images of posterior pole, temporal quadrant, superior quadrant, nasal quadrant and inferior quadrant of the fundus of each eye were taken sequentially. Every newborn completed the examination and the mean duration of the procedure was (2.62plusmn;0.55) minutes. Newborns with RH were reexamined after one month. RH was classified according to the location and size of the hemorrhages based on guidelines in the literature. The location and degree of RH was determined in each newborn. The incidence of RH by gender, parity, birth weight, maternal age and delivery method was compared and analyzed. Results RH was present in 87 eyes (14.8%) of 58 newborns (19.8%) and of the 58 newborns with RH, half (29 eyes) had hemorrhages in both eyes, and half (29 eyes) had hemorrhages in only one eye. The site of the hemorrhage was all on the superficial retina. Of the 87 eyes with RH, 72 eyes (82.8%) had hemorrhage in zone Ⅰ, 86 eyes (98.9%) had hemorrhage in zone Ⅱ, and 36 eyes (41.4%) had hemorrhage in zone Ⅲ. Thirty-eight eyes (43.7%) had hemorrhage in zone Ⅰand Ⅱ. Three eyes (3.4%) had hemorrhage in zone Ⅱ and Ⅲ. Thirtythree eyes (37.9%) had hemorrhage in zone Ⅰ, Ⅱ and Ⅲ. One eye (0.4%) had hemorrhage in zoneⅠonly. Twelve eyes (13.8%) had hemorrhage in zone Ⅱ only. None had hemorrhage in zone Ⅲ only. The severity of RH was grade Ⅰ in 13 of 87 eyes (14.9%), grade Ⅱ in 33 of 87eyes (37.9%), and grade Ⅲ in 41 of 87 eyes (47.1%). Fourteen of 58 newborns with RH (24.1%) were lost to follow-up. Forty-four of 58 newborns with RH (75.9%) were reexamined one month after birth and all the RH disappeared entirely. There were no statistically significant differences among the incidences of RH of the different gender (chi;2=0.018,P=0.893), parity（chi;2=0.772,P=0.380）, birth weight（chi;2=1.611,P=0.447）and maternal age (chi;2=0.915,P=0.339). The incidence of RH was higher for vaginal delivery than that for cesarean section delivery (chi;2=3.073,P＜0.05). Conclusions The RH in newborn is located in the superficial retina, mostly located in zone Ⅰor zone Ⅱ, and resolves itself within one month after birth. The RH in newborns is related to the mode of delivery, but not related to gender, parity, birth weight or maternal age.
Objective To investigate the incidence and risk factors associated with the development of retinopathy of prematurity (ROP) in Hubei province. MethodsFrom July 2009 to May 2011, 313 premature infants (626 eyes) with gestational age less than 37 weeks were examined by indirect ophthalmoscopy and RetCamⅡ as part of ROP screening.Two hundred infants were male and 113 were female. Their birth weight was from 890 to 3500 grams, with a mean of (1977.37±497.03) grams. Their gestational age was from 26 to 37 weeks, with a mean of (33.13±2.44) week. The infants were divided into ROP group and non-ROP group according to the results of screening. All infants were followed up until retinopathy was stable or received laser therapy as the requirements of prevention and control guidelines of ROP. The sex, gestational age, birth weight, delivery mode, IVF baby, multiple pregnancy, oxygen therapy, intrauterine hypoxia, eclampsia, threatened abortion, oxygen history of infants, respiratory distress syndrome, hypoxicischemic encephalopathy, jaundice, and blueray radiation therapy in two groups were statistically analyzed. ResultsIn 313 infants (626 eyes), ROP developed in 52 infants (16.61%) and 87 eyes (13.90%), which including 2 eyes suffering from AP-ROP, 38 eyes from stage 1, 36 eyes from stage 2, 11 eyes from stage 3. There were 261 infants (83.39%) and 539 eyes (8610%) in nonROP group. Eleven infants (20 eyes) received laser therapy. The results of statistical analysis showed that gestation age(t=-4.348), birth weight (t=-3.966), oxygen therapy (χ2=9.05;OR=3.403, 95%CI=1.475 - 7.854) were significantly related to ROP (P＜0.05).ConclusionThe incidence of ROP in Hubei province is 16.61%. The gestation age, birth weight and oxygen therapy are closely related to the occurrence of ROP.
ObjectiveTo systematically review the accuracy of T-cell receptor excision circles (TRECs) in screening newborns for severe combined immunodeficiency (SCID). MethodsThe PubMed, EMbase, Cochrane Library, Web of Science, CBM, WanFang Data and CNKI databases were electronically searched to collect the diagnostic accuracy studies related to the objects from inception to October 26, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies using the QUADAS-2 scale. Meta-analysis was performed using Stata 15.0 and Meta-Disc 1.4 software. ResultsA total of 18 studies involving 6 243 718 neonates were included. The results of meta-analysis showed that the pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnosis odds ratio (DOR) were 0.97 (95%CI 0.92 to 0.99), 1.00 (95%CI 1.00 to 1.00), 1447.05 (95%CI 528.49 to 3962.11), 0.13 (95%CI 0.08 to 0.22) and 11698.21 (95%CI 2853.44 to 47958.98), respectively. The area under the summary receiver operating characteristic curve (SROC) was 0.97. ConclusionThe application of TRECs in screening neonatal SCID has high accuracy, which is helpful for early diagnosis of SCID. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
Medical device-related pressure injury (MDRPI) is a kind of pressure injury that occurs in the course of diagnosis and treatment, and its appearance is similar to that of medical device. Neonatal intensive care unit (NICU) infants are more likely to develop MDRPI than children and adults because of the physiological characteristics of skin and the influence of disease. At present, the occurrence of MDRPI in NICU infants is attracting worldwide attention. Its treatment and nursing consume a large amount of medical resources, which not only affect the outcome of the disease, but also increase the economic burden of the family and society. This article summarizes the MDRPI from three aspects: summary, influencing factors, and evaluation tools. It is expected that NICU nurses will carry out large sample clinical investigation of MDRPI in the future, so as to provide a reference for risk prediction model and risk assessment tools to identify high-risk infants and take effective measures in advance to reduce the incidence of MDRPI.
ObjectiveTo observe the clinical features of retinopathy of prematurity (ROP) in multiple fetuses.MethodsRetrospective clinical study. From December 2009 to June 2018, 758 premature or low-weight multiple fetuses (multiple fetuses group) and 2363 simultaneous single fetuses (single fetuses group) who were admitted to the Department of Ophthalmology and Neonatal Department of Dongguan People’s Hospital and underwent ROP screening were included in the study. Among the multiple pregnancy group, there were 735 twins and 23 triplets; 441 males and 317 females. The mean gestational age was 32.22±2.14 weeks, and the mean body weight was 1.69±0.43 kg. There were 202 of natural births and 556 of cesarean sections. A total of 750 cases have a history of oxygen. Among the singleton group, 1421 were males and 942 were females. The mean gestational age was 32.06±2.52 weeks, and the mean body weight was 1.70±0.46 kg. There were 1146 of natural births and 1217 of cesarean sections. A total of 2333 cases have a history of oxygen. The detection rate of multiple ROP, gestational age, birth weight, sex composition ratio, mode of birth, time of first ROP diagnosis, and severity of ROP were observed. χ2 test was used to compare the rate between groups, and t test was used to compare the mean between groups.ResultsAmong the multiple pregnancy group, there were 68 cases (8.97%) of ROP. Among them, 64 twins (8.71%, 64/735), 4 triplets (17.39%, 4/23). Among the singleton group, there were 187 cases (7.91%) of ROP. With the increase of fetal number, the detection rate of ROP increased, but there was no significant difference (χ2=3.097, P=0.213). There was no significant difference in the detection rate of ROP between multiple fetuses and single fetuses (χ2=0.855, P=0.355). There was no significant difference in sex ratio (χ2=0.069), mode of production (χ2=1.900), birth weight (t=0.139), gestational age (t=－0.478), and time of first ROP diagnosis (t=0.371) between ROP cases of multiple fetuses and single fetuses (P=0.793, 0.168, 0.889, 0.633, 0.371). There was no significant difference in the constituent ratio of severity of ROP lesions between multiple fetuses and single fetuses (χ2=3.003, P=0.223).ConclusionThere is no significant difference in ROP incidence, gestational age, birth weight, diagnosis time and severity of ROP between multiple fetuses and single fetuses under the same conditions.
ObjectiveTo systematically review the efficacy of promoting neonatal resuscitation technique in treatment of neonatal asphyxia in China. MethodsElectronical databases including WanFang Data, CNKI, VIP, Jiangsu Engineering and Technology Literature Information Center, PubMed and The Cochrane Library (Issue 5, 2016) were searched to collect studies of neonatal resuscitation technique in treatment of neonatal asphyxia up to June 1st, 2016. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies, and then meta-analysis was performed by using RevMan 5.2 software. ResultsA total of eighteen observational studies were included, involving 28 144 cases of neonatal asphyxia and 32 636 cases of control, 2 148 death cases of neonatal asphyxia and 1 679 cases of controls. The results of meta-analysis showed that neonatal resuscitation technique could reduce newborn suffocation rate compared with the control group in hospital surveys (RR=0.59, 95%CI 0.55 to 0.63, P<0.000 01) and in regional project surveys (RR=0.72, 95%CI 0.69 to 0.75, P<0.000 01). Neonatal resuscitation could also reduce neonatal asphyxia mortality rate in hospital surveys (RR=0.26, 95%CI 0.16 to 0.42, P<0.000 01) and in regional surveys (RR=0.65, 95%CI 0.55 to 0.77, P<0.000 01). ConclusionThe existing evidence shows that neonatal resuscitation technology could effectively reduce the incidence of neonatal asphyxia and mortality rate in China. Due to the limitations of the quantity and quality of present studies, we need to carry out prospective multicenter cohort studies to verify the current results.
ObjectiveTo evaluate the efficacy and safety of heated humidified high-flow nasal cannula (HHHFNC) vs. nasal continuous positive airway pressure (NCPAP) in the treatment of neonatal respiratory distress syndrome (NRDS). MethodsThe PubMed, EMbase, The Cochrane Library (Issue 3, 2017), CBM, VIP, WanFang Data and CNKI were searched up to March 27th, 2017 to collect randomized controlled trials (RCTs) of HHHFNC vs. NCPAP for NRDS. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 11 RCTs involving 1 104 patients were included. The results of meta-analysis showed that: 1) The HHHFNC group reduced the rate of reintubation (OR=0.56, 95%CI 0.32 to 0.98, P=0.04), shortened the time of assisted ventilation (MD=–11.12, 95%CI –13.31 to –8.93, P<0.000 01), hospitalization time (MD=–2.99, 95%CI –3.54 to –2.44, P<0.000 01) and neonatal aspiration of milk (MD=–17.82, 95%CI –21.19 to –14.45, P<0.000 01), shortened partial pressure of carbon dioxide at 48 hours (MD=–4.86, 95%CI –5.94 to –3.78, P<0.000 01), reduced the rate of frequent hemorrhoid (OR=0.32, 95%CI 0.12 to 0.90, P=0.03), the rate of abdominal distension (OR=0.17, 95%CI 0.09 to 0.30, P<0.000 01), the rate of injury of nose (OR=0.08, 95%CI 0.03 to 0.20, P<0.000 01), and the rate of head shape change (OR=0.03, 95%CI 0.00 to 0.23, P=0.000 7). 2) There were no significant differences between two groups in mortality rate, nosocomial infection rate, oxygen exposure time, arterial oxygen pressure and oxygen saturation at 48 hours, intraventricular hemorrhage, patent ductus arteriosus, retinopathy of prematurity, bronchopulmonary dysplasia and neonatal necrotizing enterocolitis, respectively. ConclusionCurrent evidence indicates that HHHFNC can reduce the rate of reintubation, shorten the time of assisted ventilation, length of hospital day and neonatal aspiration of milk, reduce the rate of frequent hemorrhoid, abdominal distension, injury of nose, head shape change. Due to the limitation of quantity and quality of included studies, the long-term follow-up results of HHHFNC for NRDS are needed to analyze with large-scale and multicenter RCTs.
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.
Neonates represent a unique population with distinct physiological characteristics. The application of Enhanced Recovery After Surgery (ERAS) principles in neonatal care remains in its early developmental stages. In 2024, the ERAS Society published evidence-based perioperative care recommendations tailored for neonates undergoing non-cardiac surgical procedures. These recommendations are intended to be implemented within the Neonatal Intensive Care Units (NICUs). This article provides an interpretation of the guideline, aiming to establish a reference framework for implementing ERAS in neonatal surgical care .