Risk factors of retinopathy of prematurity in children born from multiple pregnancies

    Abstract

    Risk factors of retinopathy of prematurity in children born from multiple pregnancies

    I.E. Panova, I.A. Chervonyak, E.P. Tagieva

    The S. Fyodorov Eye Microsurgery Federal State Institution, the St.-Petersburg Branch, Saint-Petersburg
The Chelyabinsk Regional Pediatric Clinical Hospital, Chelyabinsk

    Purpose. To identify significant risk factors for the «threshold» retinopathy of prematurity (ROP) in children born from multiple pregnancies.

    Material and methods. The paper is based on a retrospective analysis of case histories of premature infants with a gestational age (GA) at birth ≤34 weeks and weighing ≤2000 grams. The study group comprised 174 children born from multiple pregnancies, a control group included 130 children from a single pregnancy, the groups were comparable in average GA and birth weight (p>0.05). Taking into account the morbidity and severity of ROP, there was analyzed the significance of the sequence of birth (first, second), the type of conception (natural pregnancy and pregnancy as a result of in vitro fertilization), the type of placentation (mono- and bichorial), the presence of severe intrapartum asphyxia, artificial ventilation lung for more than 7 days, total oxygen therapy for more than 21 days, intraventricular hemorrhages of grade III-IV, hemodynamically significant heart defects, neonatal sepsis, early anemia of prematurity (hemoglobin<100 g/l), transfusions of blood components, hyperbilirubinemia, bronchopulmonary dysplasia. The role of heredity in the development of ROP was studied using the twin study method.

    Results. It was found that the twins had an increased frequency of development of threshold ROP stages compared with the children of the control group (35.0% and 24.4%, respectively, p<0.05), as well as the posterior aggressive form of the disease (5.2% and 2.3% respectively, p<0.05). Significant risk factors for «threshold» retinopathy in twins were early anemia of prematurity, transfusion of blood components, duration of mechanical ventilation for more than 7 days and oxygen therapy for more than 21 days, in vitro fertilization, bronchopulmonary dysplasia, the order of birth (the second of twins), severe intra-natal asphyxia. Infants born the second of twins, as well as a result of in vitro fertilization, had increased risks of development of severe stages of ROP due to greater immaturity and somatic complications. Hereditary conditionality in the development of the disease is not established.

    Conclusion. The most significant risk factors in the development of the «threshold» stages of ROP in twins are an early anemia of prematurity, blood transfusions, mechanical ventilation for more than 7 days, in vitro fertilization, duration of total oxygen therapy for more than 21 days, bronchopulmonary dysplasia, severe intra-natal asphyxia, the order of birth (the second of twins).

    Key words: retinopathy of prematurity; multiple pregnancy; risk factors; in vitro fertilization.