Objective To explore changes in the fundus in the newborns with subarachnoid hemorrhage (SAH) and relevant factors and to guide clinical therapy.Methods 325 asphyxia newborns were included in this study.57 were diagnosed with SAH by head CT.Fundus were examined in these SAH newborns with wide-field digital imaging system RetCam Ⅱ at 24~72 hours after birth.Presence or absence of optic papilledema, retinal angiospasm and retinal hemorrhage were studied.According to the literature, retinal hemorrhage was classified into grades Ⅰ~Ⅳ.Another 20 age-matched normal infants were included as control.Results 1) Abnormal changes in the fundus was found in 48 of 57 (84.2%) infants with SAH.These changes included optic papilledemas in 18 (37.5%), retinal hemorrhages in 27 (56.3%) and retinal angiospasm in 3 (6.2%) infants.The abnormality rate was 5.0% in the controls (1 case of optic papilledema;χ2=12.350,P=0.001).Degree of retinal hemorrhage varied in SAH patients, with 10 of grade I (37.1%), 7 of grade Ⅱ (25.9%), 6 of grade Ⅲ (22.2%) and 4 of grade Ⅳ (14.8%).2) Retinal hemorrhage was positively correlated with the severity of SAH (r=0.632,P<0.05).Conclusions The incidence of retinal hemorrhage in the newborns with SAH was 56.3%.It may be helpful to evaluate and monitor the severity and prognosis of retinal hemorrhage and guide treatment for SAH using the RetCam Ⅱ.It was convenient, direct and safe.%目的 了解新生儿蛛网膜下腔出血(SAH)的眼底改变及其影响因素,从而指导临床诊治.方法 选择325名出生后窒息新生儿经颅脑CT检查确诊的57例SAH患儿纳入观察对象.采用第二代广角数码儿童视网膜成像系统(RetCam Ⅱ)于生后24~72 h内行眼底检查,观察SAH患儿眼底特点及视乳头水肿、视网膜出血的发生情况.眼底出血程度分Ⅰ、Ⅱ、Ⅲ、Ⅳ级.设正常足月适于胎龄儿20例为对照组.结果 ①57例SAH患儿中,眼底异常改变阳性率为84.2%(48/57),主要表现为视乳头水肿18例(37.5%)、视网膜出血27例(56.3%)和血管痉挛3例(6.2%),对照组眼底异常改变阳性率为5.0%(1/20),仅表现为视乳头水肿.两组比较差异有统计学意义(χ2=12.350,P=0.001).出血程度Ⅰ级者10例(37.1%)、Ⅱ级者7例(25.9%)、Ⅲ级者6例(22.2%)和Ⅳ级者4例(14.8%).②新生儿视网膜出血的严重程度与SAH程度呈正相关(r=0.632,P<0.05).结论 ①新生儿蛛网膜下腔出血视网膜出血发生率为56.3%;②动态用RetCamⅡ监测SAH患儿视网膜出血情况可能有助于SAH患儿颅内病变的早期判断和预后,并客观指导临床治疗,其方法方便、直观、安全.
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