Advertisement

Clinical features of premature twin babies with intersibling asymmetry of retinopathy of prematurity severity

      Abstract

      Objective

      To report the clinical features of premature twin babies showing intersibling asymmetry in their severity of retinopathy of prematurity (ROP) and analyze risk factors associated with development of severe ROP between twin siblings with discordant ROP severity.

      Methods

      A retrospective study of records of 105 premature twin pairs was conducted. The criteria for discordant ROP with an intersibling difference in ROP severity were as follows: (i) two or more stages of difference in ROP between siblings, (ii) one sibling having treatment-requiring ROP and the other having no ROP or ROP that regressed spontaneously, or (iii) one sibling having aggressive posterior ROP and the other having staged or no ROP. Twin siblings were classified into two groups according to the severity of ROP (no or less ROP and more severe ROP). We examined ocular features in twins having intersibling asymmetry of ROP and analyzed perinatal risk factors for ROP.

      Results

      Of 105 twin pairs, 32 pairs (30.5%) showed intersibling asymmetry of ROP severity, and 15 pairs (14.3%) showed ROP asymmetry in terms of need for ROP treatment. The development of more severe ROP was associated with longer duration of oxygen supplementation and greater frequency of total blood and packed red blood cell transfusion (p = 0.020, p = 0.045, and p = 0.036, respectively). Longer duration of oxygen supplementation remained a statistically independent risk factor of severe ROP using multivariate logistic regression analysis.

      Conclusions

      Ophthalmologists caring for premature infants should be aware of the variable courses and progressions of ROP between twin babies. Longer duration of oxygen supplementation and greater frequency of blood transfusions were associated with higher ROP severity in twins.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Ophthalmology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Steinkuller PG
        • Du L
        • Gilbert C
        • Foster A
        • Collins ML
        • Coats DK.
        Childhood blindness.
        J AAPOS. 1999; 3: 26-32
        • Good WV
        • Hardy RJ
        • Dobson V
        • et al.
        Early Treatment for Retinopathy of Prematurity Cooperative Group. The incidence and course of retinopathy of prematurity: findings from the Early Treatment for Retinopathy of Prematurity study.
        Pediatrics. 2005; 116: 15-23
        • Schaffer DB
        • Palmer EA
        • Plotsky DF
        • et al.
        Prognostic factors in the natural course of retinopathy of prematurity. The Cryotherapy for Retinopathy of Prematurity Cooperative Group.
        Ophthalmology. 1993; 100: 230-237
        • Campbell PB
        • Bull MJ
        • Ellis FD
        • Bryson CQ
        • Lemons JA
        • Schreiner RL.
        Incidence of retinopathy of prematurity in a tertiary newborn intensive care unit.
        Arch Ophthalmol. 1983; 101: 1686-1688
        • Rothberg AD
        • Maisels MJ
        • Bagnato S
        • et al.
        Outcome for survivors of mechanical ventilation weighing less than 1,250 gm at birth.
        J Pediatr. 1981; 98: 106-111
        • Binenbaum G.
        Algorithms for the prediction of retinopathy of prematurity based on postnatal weight gain.
        Clin Perinatol. 2013; 40: 261-270
        • Kim SJ
        • Port AD
        • Swan R
        • Campbell JP
        • Chan RVP
        • Chiang MF.
        Retinopathy of prematurity: a review of risk factors and their clinical significance.
        Surv Ophthalmol. 2018; 63: 618-637
        • Section on Ophthalmology, American Academy of Pediatrics; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus
        Screening examination of premature infants for retinopathy of prematurity.
        Pediatrics. 2006; 117: 572-576
        • Early Treatment for Retinopathy of Prematurity Cooperative Group
        Revised indications for the treatment of retinopathy of prematurity: results of the Early Treatment for Retinopathy of Prematurity randomized trial.
        Arch Ophthalmol. 2003; 121: 1684-1694
        • Sanghi G
        • Dogra MR
        • Dutta S
        • Katoch D
        • Gupta A.
        Intersibling variability of retinopathy of prematurity in twins and its risk factors.
        Int Ophthalmol. 2012; 32: 113-117
        • Binenbaum G
        • Tomlinson LA.
        Postnatal Growth and Retinopathy of Prematurity Study: rationale, design, and subject characteristics.
        Ophthalmic Epidemiol. 2017; 24: 36-47
        • Darlow BA
        • Vento M
        • Beltempo M
        • et al.
        on behalf of the International Network for Evaluating Outcomes (iNeo) of Neonates. Variations in oxygen saturation targeting and retinopathy of prematurity screening and treatment criteria in neonatal intensive care units: an international survey.
        Neonatology. 2018; 114: 323-331
        • Fellows RR
        • McGregor ML
        • Bremer DL
        • Rogers GL
        • Miller D.
        Retinopathy of prematurity in discordant twins.
        J Pediatr Ophthalmol Strabismus. 1995; 32: 86-88
        • Aydemir O
        • Sarikabadayi YU
        • Aydemir C
        • et al.
        Adjusted poor weight gain for birth weight and gestational age as a predictor of severe ROP in VLBW infants.
        Eye (Lond). 2011; 25: 725-729
        • Friling R
        • Rosen SD
        • Monos T
        • Karplus M
        • Yassur Y.
        Retinopathy of prematurity in multiple-gestation, very low birth weight infants.
        J Pediatr Ophthalmol Strabismus. 1997; 34: 96-100
        • Blumenfeld LC
        • Siatkowski RM
        • Johnson RA
        • Feuer WJ
        • Flynn JT.
        Retinopathy of prematurity in multiple-gestation pregnancies.
        Am J Ophthalmol. 1998; 125: 197-203
        • Holmström G
        • Broberger U
        • Thomassen P.
        Neonatal risk factors for retinopathy of prematurity: a population-based study.
        Acta Ophthalmol Scand. 1998; 76: 204-207
        • Azad R
        • Chandra P
        • Patwardhan SD
        • Gupta A.
        Profile of asymmetrical retinopathy of prematurity in twins.
        Indian J Ophthalmol. 2010; 58: 209-211
        • Dos Santos Motta MM
        • Fortes Filho JB
        • Coblentz J
        • Fiorot CA
        Multiple pregnancies and its relationship with the development of retinopathy of prematurity (ROP).
        Clin Ophthalmol. 2011; 5: 1783-1787
        • Woo SJ
        • Park KH
        • Ahn J
        • et al.
        A co-twin study of the relative effect of birth weight and gestational age on retinopathy of prematurity.
        Eye (Lond). 2011; 25: 1478-1483
        • Sood V
        • Chellani H
        • Arya S
        • Guliani BP.
        Changing spectrum of retinopathy of prematurity (ROP) and variations among siblings of multiple gestation.
        Indian J Pediatr. 2012; 79: 905-910
        • Yau GS
        • Lee JW
        • Tam VT
        • et al.
        Incidence and risk factors for retinopathy of prematurity in multiple gestations: a Chinese population study.
        Medicine (Baltimore). 2015; 94: e867
        • Higgins RD.
        Oxygen saturation and retinopathy of prematurity.
        Clin Perinatol. 2019; 46: 593-599
        • Enomoto H
        • Miki A
        • Matsumiya W
        • Honda S.
        Evaluation of oxygen supplementation status as a risk factor associated with the development of severe retinopathy of prematurity.
        Ophthalmologica. 2015; 234: 135-138
        • Cooke RW
        • Clark D
        • Hickey-Dwyer M
        • Weindling AM.
        The apparent role of blood transfusions in the development of retinopathy of prematurity.
        Eur J Pediatr. 1993; 152: 833-836
        • Englert JA
        • Saunders RA
        • Purohit D
        • Hulsey TC
        • Ebeling M.
        The effect of anemia on retinopathy of prematurity in extremely low birth weight infants.
        J Perinatol. 2001; 21: 21-26
        • Hesse L
        • Eberl W
        • Schlaud M
        • Poets CF.
        Blood transfusion: iron load and retinopathy of prematurity.
        Eur J Pediatr. 1997; 156: 465-470
        • Stutchfield CJ
        • Jain A
        • Odd D
        • Williams C
        • Markham R.
        Foetal haemoglobin, blood transfusion, and retinopathy of prematurity in very preterm infants: a pilot prospective cohort study.
        Eye (Lond). 2017; 31: 1451-1455
        • Hirano K
        • Morinobu T
        • Kim H
        • et al.
        Blood transfusion increases radical promoting non-transferrin bound iron in preterm infants.
        Arch Dis Child Fetal Neonatal Ed. 2001; 84: F188-F193
        • Zhu Z
        • Hua X
        • Yu Y
        • Zhu P
        • Hong K
        • Ke Y.
        Effect of red blood cell transfusion on the development of retinopathy of prematurity: a systematic review and meta-analysis.
        PLoS ONE. 2020; 15e0234266
        • Biniwale M
        • Weiner A
        • Sardesai S
        • Cayabyab R
        • Barton L
        • Ramanathan R.
        Early postnatal weight gain as a predictor for the development of retinopathy of prematurity.
        J Matern Fetal Neonatal Med. 2019; 32: 429-433
        • Lin L
        • Binenbaum G.
        Postnatal weight gain and retinopathy of prematurity.
        Semin Perinatol. 2019; 43: 352-359
        • Binenbaum G
        • Ying GS
        • Quinn GE
        • et al.
        The CHOP postnatal weight gain, birth weight, and gestational age retinopathy of prematurity risk model.
        Arch Ophthalmol. 2012; 130: 1560-1565
        • Cao JH
        • Wagner BD
        • McCourt EA
        • et al.
        The Colorado Retinopathy of Prematurity (CO-ROP) model: postnatal weight gain screening algorithm.
        J AAPOS. 2016; 20: 19-24
        • Binenbaum G
        • Bell EF
        • Donohue P
        • G-ROP Study Group
        Development of modified screening criteria for retinopathy of prematurity: primary results from the postnatal growth and retinopathy of prematurity study.
        JAMA Ophthalmol. 2018; 136: 1034-1040