Very-Low-Birthweight Neonates: Do Outcomes Differ in Multiple Compared with Singleton Gestations?

ABSTRACT

The purpose of this study is to determine if outcomes for very-low-birthweight (VLBW) neonates differ in multiple versus singleton gestations. This is a retrospective cohort study of neonates weighing less than 1500 g admitted to a neonatal intensive care unit from 1993 to 2004. Outcome variables were necrotizing enterocolitis, death, and/or severe intraventricular hemorrhage (IVH). Statistical analysis included univariate and multivariate analysis. During the study period, 1769 VLBW infants including 465 multiples and 1304 singletons were identified. Gestational age and birthweight were similar; conversely white race (68% multiples versus 43% singletons), maternal age (28.7 ± 5.7 versus 26.1 ± 6.5 years), born at facility (95% versus 86%), antenatal steroids (74% versus 58%), preeclampsia (14% versus 24%), and preterm labor (74% versus 62%) were significantly different. Correcting for these, VLBW multiples had a higher odds ratio (OR) of death and/or severe IVH, OR 1.4 (1.03-1.95). In our population, VLBW multiple gestations were at elevated odds for death and/or severe IVH compared with VLBW singletons.

KEYWORDS

Very low birthweight - multiple gestations - twins - intraventricular hemorrhage

REFERENCES

• 1 Martin J A, Hamilton B E, Sutton P D, Ventura S J, Menacker F, Munson M L. Births: final data for 2002.  Natl Vital Stat Rep. 2003;  52 1-113
• 2 Benirschke K, Kim C K. Multiple pregnancy. 1.  N Engl J Med. 1973;  288 1276-1284
• 3 PeriStats: Your online source for perinatal statistics. http://Available at: www.MarchofDimes.com/peristats Accessed August 1, 2006
• 4 Magee B D. Role of multiple births in very low birth weight and infant mortality.  J Reprod Med. 2004;  49 812-816
• 5 Petterson B, Nelson K B, Watson L, Stanley F. Twins, triplets, and cerebral palsy in births in Western Australia in the 1980s.  BMJ. 1993;  307 1239-1243
• 6 Wen S W, Demissie K, Yang Q, Walker M C. Maternal morbidity and obstetric complications in triplet pregnancies and higher-order multiple pregnancies.  Am J Obstet Gynecol. 2004;  191 254-258
• 7 Papile L A, Munsick-Bruno G, Schaefer A. Relationship of cerebral intraventricular hemorrhage and early childhood handicaps.  J Pediatr. 1983;  103 273-277
• 8 Bell M J, Ternberg J L, Feigin R D et al.. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging.  Ann Surg. 1978;  187 1-7
• 9 Spellacy W N, Handler A, Ferre C D. A case-control study of 1253 twin pregnancies from 1982-1987 perinatal data base.  Obstet Gynecol. 1990;  75 168-171
• 10 Friedman S A, Schiff E, Kao L, Kuint J, Sibai B M. Do twins mature earlier than singletons? Results from a matched cohort study.  Am J Obstet Gynecol. 1997;  176 1193-1199
• 11 Garite T J, Clark R H, Elliott J P, Thorp J A. Twins and triplets: the effect of plurality and growth on neonatal outcome compared with singleton infants.  Am J Obstet Gynecol. 2004;  191 700-707
• 12 Nielsen H C, Harvey-Wilkes K, MacKinnon B, Hung S. Neonatal outcome of very premature infants from multiple and singleton gestations.  Am J Obstet Gynecol. 1997;  177 653-659
• 13 Linder N, Haskin O, Levit O et al.. Risk factors for intraventricular hemorrhage in very low birth weight premature infants: a retrospective case-control study.  Pediatrics. 2003;  111(5 Pt 1) e590-e595
• 14 Jobe A H. Antenatal steroids in twins. [letter].  Am J Obstet Gynecol. 2003;  188 856
• 15 Murphy D J, Caukwell S, Joels L A, Wardle P. Cohort study of the neonatal outcome of twin pregnancies that were treated with prophylactic or rescue antenatal corticosteroids.  Am J Obstet Gynecol. 2002;  187 483-488