视网膜出血的特殊表现：早产儿Roth斑1例

Special Presentation of Retinal Hemorrhage: A Case Report of Roth Spots in a Preterm Infant

摘要: 本文报告一例无早产儿视网膜病变(ROP)的早产儿出现大量Roth斑并自发吸收的病例，探讨其可能原因与临床意义。患儿，男，胎龄36周，出生体重3160克。其母患有妊娠期糖尿病。出生时有脐带绕颈及水肿。生后出现生理性黄疸，心脏超声提示卵圆孔未闭(1.9 mm)及动脉导管未闭(1.5 mm)。生后24小时内行广域眼底成像(RetCam III)筛查，未见ROP体征，但发现双眼眼底四个象限散布大量Roth斑(约20~25处)，主要位于后极部，最大出血灶直径约1.5 PD。患儿仅接受常规支持治疗及蓝光照射。生后2周随访，视网膜出血完全吸收。生后2月余复查心脏超声，提示PFO与PDA均已自然闭合。结论：本例早产儿在无ROP及其他严重全身性疾病的情况下，出现大量Roth斑，并随血流动力学不显著的心脏分流自然闭合而完全吸收。提示对于病情稳定的早产儿，孤立的Roth斑可能是一种良性、自限性的表现。尽管如此，全面的筛查与随访对于排除潜在病理性原因仍然至关重要。

Abstract: This article reports a case of a preterm infant with numerous Roth spots that spontaneously resolved in the absence of retinopathy of prematurity (ROP), and explores its potential etiology and clinical significance. The patient was a male infant born at 36 weeks of gestation with a birth weight of 3160 grams. His mother had gestational diabetes mellitus. At birth, a nuchal cord and cord edema were noted. The infant developed physiological jaundice postpartum. Cardiac ultrasound revealed a patent foramen ovale (1.9 mm) and a patent ductus arteriosus (1.5 mm). Within 24 hours after birth, wide-field retinal imaging (RetCam III) screening was performed. No signs of ROP were observed; however, numerous Roth spots (approximately 20~25 in total) were identified, scattered across all four quadrants of both eyes, predominantly in the posterior pole. The largest hemorrhage measured about 1.5 disc diameters. The infant received only routine supportive care and phototherapy. At the 2-week follow-up, complete absorption of the retinal hemorrhages was confirmed. A repeat cardiac ultrasound performed over two months later indicated spontaneous closure of both the PFO and PDA. Conclusion: In this preterm infant, a large number of Roth spots appeared in the absence of ROP or other severe systemic diseases and resolved completely alongside the spontaneous closure of hemodynamically insignificant cardiac shunts. This suggests that in clinically stable preterm infants, isolated Roth spots may represent a benign and self-limiting condition. Nevertheless, comprehensive screening and follow-up remain essential to exclude underlying pathological causes.