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Am J Perinatol 2008; 25(6): 373-380
DOI: 10.1055/s-2008-1078762
© Thieme Medical Publishers

Triplet Infants with Birthweight ≤ 1250 Grams: How Well Do They Compare with Twin and Singleton Infants at 36 to 48 Months of Age?

Wendy H. Yee1 , Matt Hicks1 , Sophie Chen4 , Heather Christianson2 , Reg Sauve3
  • 1Department of Pediatrics, University of Calgary, Calgary Alberta, Canada
  • 2Department of Community Health Sciences, University of Calgary, Calgary Alberta, Canada
  • 3Department of Pediatrics and Department of Community Health Sciences, University of Calgary, Calgary Alberta, Canada
  • 4Primary Health Care and Public Health Directorate, Health Canada
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Publication History

Publication Date:
02 June 2008 (online)

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ABSTRACT

The purpose of this study was to determine if triplet infants with birthweight ≤ 1250 g were at increased risk of long-term disability compared with similar birthweight and gestational age singletons and twins. This was a retrospective cohort study of ≤ 1250-g infants admitted to a regional neonatal intensive care unit from 1986 to 2001 with follow-up to 36 to 48 months corrected gestational age. Outcomes studied were cognitive ability, cerebral palsy, and neurosensory impairment at 36 to 48 months. Enrollment was 1717 infants: 59 triplets, 402 twins, and 1256 singletons. Triplet infants differed from twin or singleton infants because they were more likely to have older, married mothers (relative risk [RR] 3.62, 95% CI 1.31, 5.94), be products of assisted reproductive technology pregnancies (RR 29.59, 95% CI 13.97, 62.68), be exposed to antenatal steroids (RR 1.55, 95% CI 1.38, 1.75), and were all delivered by cesarean section. Triplet infants had lower risk of having intraventricular hemorrhage (RR 0.19, 95% CI 0.05, 0.75). The risk of cerebral palsy, cognitive delay, total major disability, or chronic lung disease was similar in triplet and twin infants compared with singleton infants. The lower risk of having intraventricular hemorrhage in triplet infants may have been due to the use of antenatal corticosteroids and cesarean section delivery.

KEYWORDS

Preterm triplets - long-term follow-up - neurodevelopment outcome

REFERENCES

  • 1 Jewell S E, Yip R. Increasing trends in plural births in the United States.  Obstet Gynecol. 1995;  85(2) 229-232
    Google Scholar
  • 2 Joseph K S, Marcoux S, Ohlsson A et al.. Preterm birth, stillbirth and infant mortality among triplet births in Canada, 1985-96.  Paediatr Perinat Epidemiol. 2002;  16(2) 141-148
    PubMedGoogle Scholar
  • 3 Wilcox L S, Kiely J L, Melvin C L, Martin M C. Assisted reproductive technologies: estimates of their contribution to multiple births and newborn hospital days in the United States.  Fertil Steril. 1996;  65(2) 361-366
    CrossrefPubMedGoogle Scholar
  • 4 Blickstein I, Keith L G. The decreased rates of triplet births: temporal trends and biologic speculations.  Am J Obstet Gynecol. 2005;  193(2) 327-331
    CrossrefPubMedGoogle Scholar
  • 5 Gunby J, Daya S. Assisted reproductive technologies (ART) in Canada: 2001 results from the Canadian ART Register.  Fertil Steril. 2005;  84(3) 590-599
    CrossrefPubMedGoogle Scholar
  • 6 Blickstein I. How and why are triplets disadvantaged compared to twins?.  Best Pract Res Clin Obstet Gynaecol. 2004;  18(4) 631-644
    CrossrefPubMedGoogle Scholar
  • 7 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(6914) 1239-1243
    CrossrefPubMedGoogle Scholar
  • 8 Pharoah P O, Cooke T. Cerebral palsy and multiple births.  Arch Dis Child Fetal Neonatal Ed. 1996;  75(3) F174-F177
    CrossrefPubMedGoogle Scholar
  • 9 Yokoyama Y, Shimizu T, Hayakawa K. Prevalence of cerebral palsy in twins, triplets and quadruplets.  Int J Epidemiol. 1995;  24(5) 943-948
    CrossrefPubMedGoogle Scholar
  • 10 Ballabh P, Kumari J, AlKouatly H B et al.. Neonatal outcome of triplet versus twin and singleton pregnancies: a matched case control study.  Eur J Obstet Gynecol Reprod Biol. 2003;  107(1) 28-36
    CrossrefPubMedGoogle Scholar
  • 11 Barr S, Poggi S, Keszler M. Triplet morbidity and mortality in a large case series.  J Perinatol. 2003;  23(5) 368-371
    CrossrefPubMedGoogle Scholar
  • 12 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(3) 700-707
    CrossrefPubMedGoogle Scholar
  • 13 Kaufman G E, Malone F D, Harvey-Wilkes K B, Chelmow D, Penzias A S, D'Alton M E. Neonatal morbidity and mortality associated with triplet pregnancy.  Obstet Gynecol. 1998;  91(3) 342-348
    CrossrefPubMedGoogle Scholar
  • 14 Maayan-Metzger A, Naor N, Sirota L. Comparative outcome study between triplet and singleton preterm newborns.  Acta Paediatr. 2002;  91(11) 1208-1211
    CrossrefPubMedGoogle Scholar
  • 15 Shinwell E S, Blickstein I, Lusky A, Reichman B. Excess risk of mortality in very low birthweight triplets: a national, population based study.  Arch Dis Child Fetal Neonatal Ed. 2003;  88(1) F36-F40
    CrossrefPubMedGoogle Scholar
  • 16 Ziadeh S M. Perinatal outcome in 41 sets of triplets.  Gynecol Obstet Invest. 2000;  50(3) 162-165
    CrossrefPubMedGoogle Scholar
  • 17 Luke B, Brown M B, Hediger M L, Misiunas R B, Anderson E. Perinatal and early childhood outcomes of twins versus triplets.  Twin Res Hum Genet. 2006;  9(1) 81-88
    CrossrefPubMedGoogle Scholar
  • 18 Feldman R, Eidelman A I. Does a triplet birth pose a special risk for infant development? Assessing cognitive development in relation to intrauterine growth and mother-infant interaction across the first 2 years.  Pediatrics. 2005;  115(2) 443-452
    CrossrefPubMedGoogle Scholar
  • 19 Bax M C. Terminology and classification of cerebral palsy.  Dev Med Child Neurol. 1964;  11 295-297
    PubMedGoogle Scholar
  • 20 Blishen B R, Carroll W K, Moore C. The 1981 socioeconomic index for occupations in Canada.  Can Rev Sociol Anthropol. 1986;  24 465-488
    PubMedGoogle Scholar
  • 21 Salihu H M, Bekan B, Aliyu M H, Rouse D J, Kirby R S, Alexander G R. Perinatal mortality associated with abruptio placenta in singletons and multiples.  Am J Obstet Gynecol. 2005;  193(1) 198-203
    CrossrefPubMedGoogle Scholar
  • 22 Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Consensus Development Panel on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes.  JAMA. 1995;  273(5) 413-418
    CrossrefPubMedGoogle Scholar
  • 23 Garite T J, Rumney P J, Briggs G G et al.. A randomized, placebo-controlled trial of betamethasone for the prevention of respiratory distress syndrome at 24 to 28 weeks' gestation.  Am J Obstet Gynecol. 1992;  166(2) 646-651
    CrossrefPubMedGoogle Scholar
  • 24 Leviton A, Kuban K C, Pagano M, Allred E N, Van M L. Antenatal corticosteroids appear to reduce the risk of postnatal germinal matrix hemorrhage in intubated low birth weight newborns.  Pediatrics. 1993;  91(6) 1083-1088
    PubMedGoogle Scholar
  • 25 Shankaran S, Bauer C R, Bain R, Wright L L, Zachary J. Relationship between antenatal steroid administration and grades III and IV intracranial hemorrhage in low birth weight infants. The NICHD Neonatal Research Network.  Am J Obstet Gynecol. 1995;  173(1) 305-312
    CrossrefPubMedGoogle Scholar
  • 26 Ment L R, Oh W, Ehrenkranz R A, Philip A G, Duncan C C, Makuch R W. Antenatal steroids, delivery mode, and intraventricular hemorrhage in preterm infants.  Am J Obstet Gynecol. 1995;  172(3) 795-800
    CrossrefPubMedGoogle Scholar
  • 27 Blickstein I, Reichman B, Lusky A, Shinwell E S. Plurality-dependent risk of severe intraventricular hemorrhage among very low birth weight infants and antepartum corticosteroid treatment.  Am J Obstet Gynecol. 2006;  194(5) 1329-1333
    CrossrefPubMedGoogle Scholar
  • 28 Salihu H M, Aliyu M H, Rouse D J, Kirby R S, Alexander G R. The association of parity with mortality outcomes among triplets.  Am J Obstet Gynecol. 2004;  190(3) 784-789
    CrossrefPubMedGoogle Scholar
  • 29 Topp M, Huusom L D, Langhoff-Roos J, Delhumeau C, Hutton J L, Dolk H. Multiple birth and cerebral palsy in Europe: a multicenter study.  Acta Obstet Gynecol Scand. 2004;  83(6) 548-553
    CrossrefPubMedGoogle Scholar
  • 30 Adegbite A L, Ward S B, Bajoria R. Perinatal outcome of spontaneously conceived triplet pregnancies in relation to chorionicity.  Am J Obstet Gynecol. 2005;  193(4) 1463-1471
    CrossrefPubMedGoogle Scholar
  • 31 Bajoria R, Ward S B, Adegbite A L. Comparative study of perinatal outcome of dichorionic and trichorionic iatrogenic triplets.  Am J Obstet Gynecol. 2006;  194(2) 415-424
    CrossrefPubMedGoogle Scholar
  • 32 Blickstein I, Keith L G. Neonatal mortality rates among growth-discordant twins, classified according to the birth weight of the smaller twin.  Am J Obstet Gynecol. 2004;  190(1) 170-174
    CrossrefPubMedGoogle Scholar
  • 33 Glinianaia S V, Pharoah P O, Wright C, Rankin J M. Fetal or infant death in twin pregnancy: neurodevelopmental consequence for the survivor.  Arch Dis Child Fetal Neonatal Ed. 2002;  86(1) F9-F15
    CrossrefPubMedGoogle Scholar
  • 34 Shinwell E S. Neonatal morbidity of very low birth weight infants from multiple pregnancies.  Obstet Gynecol Clin North Am. 2005;  32(1) 29-38 viii
    CrossrefPubMedGoogle Scholar
  • 35 Adegbite A L, Castille S, Ward S, Bajoria R. Neuromorbidity in preterm twins in relation to chorionicity and discordant birth weight.  Am J Obstet Gynecol. 2004;  190(1) 156-163
    CrossrefPubMedGoogle Scholar
  • 36 Hvidtjorn D, Grove J, Schendel D E et al.. Cerebral palsy among children born after in vitro fertilization: the role of preterm delivery-a population-based, cohort study.  Pediatrics. 2006;  118(2) 475-482
    CrossrefPubMedGoogle Scholar
  • 37 Ito A, Honma Y, Inamori E, Yada Y, Momoi M Y, Nakamura Y. Developmental outcome of very low birth weight twins conceived by assisted reproduction techniques.  J Perinatol. 2006;  26(2) 130-133
    CrossrefPubMedGoogle Scholar
  • 38 Schieve L A, Rasmussen S A, Buck G M, Schendel D E, Reynolds M A, Wright V C. Are children born after assisted reproductive technology at increased risk for adverse health outcomes?.  Obstet Gynecol. 2004;  103(6) 1154-1163
    PubMedGoogle Scholar
  • 39 Laptook A R, O'Shea T M, Shankaran S, Bhaskar B. Adverse neurodevelopmental outcomes among extremely low birth weight infants with a normal head ultrasound: prevalence and antecedents.  Pediatrics. 2005;  115(3) 673-680
    CrossrefPubMedGoogle Scholar
  • 40 Anderson P J, Doyle L W. Executive functioning in school-aged children who were born very preterm or with extremely low birth weight in the 1990s.  Pediatrics. 2004;  114(1) 50-57
    CrossrefPubMedGoogle Scholar
  • 41 Hack M, Taylor H G, Drotar D et al.. Chronic conditions, functional limitations, and special health care needs of school-aged children born with extremely low-birth-weight in the 1990s.  JAMA. 2005;  294(3) 318-325
    CrossrefPubMedGoogle Scholar
  • 42 Marlow N, Wolke D, Bracewell M A, Samara M. Neurologic and developmental disability at six years of age after extremely preterm birth.  N Engl J Med. 2005;  352(1) 9-19
    CrossrefPubMedGoogle Scholar

Wendy H YeeM.D. M.Sc. 

Department of Pediatrics, University of Calgary

Unit 63, 7007 14th Street SW, Calgary, Alberta, T2V 1P9 Canada