Population based retrospective cohort study on risk of retinopathy of prematurity in twins

Twin infants are likely at great risk for ROP, but studies reported conflicting findings and population studies examining the risk of retinopathy of prematurity (ROP) in twins is limited. We aimed to evaluate the ROP risk in the cohort of one of twins, comparing to singletons.

Using insurance claims data of a half of children in Taiwan ages 18 and less, we established a twin cohort (N = 27830) born in 1998-2009 and a randomly selected singleton cohort (N = 111080) frequency matched by sex, birth year, residential area and parental occupation and followed up to 2012 years.

The overall incidence rate of ROP was 13.6-fold greater in the twin cohort than in the singleton cohort (35.1 vs. 2.58 per 10,000 person-years; adjusted HR = 13.4, 95% CI = 11.7-15.3; p <0.0001). The ROP incidence was slightly higher in boys than in girls, higher in children in more urbanized areas and born to mothers without works. The incident ROP increased with decreasing birthweight. For children with birthweight <1000 grams, the ROP incidence was 1.2-fold greater in the twin cohort than in the singleton cohort (1243.2 vs. 1016.3 per 10,000 person-years). The use of mechanical ventilation was associated with increased ROP risk for both cohorts, particularly for infants who were under invasive treatment.

Infants who were born as twins or born with low birthweight were at an elevated risk of developing ROP. Extreme cautious and close monitor are required for new born with low birthweight and have undergone with mechanical ventilation.