Neonatal outcome of growth discordant twin gestations

Abstract

The aim of the study was to compare a variety of neonatal outcome variables of growth concordant twin gestations (CT) to that of growth discordant twins (DT). Maternal and neonatal charts of live, non-anomalous twins > 25 weeks' gestation from 1984-2000 with no evidence of twin-twin transfusion syndrome were reviewed for several variables. DT occurred in (N = 81) 11.9% of all twin pregnancies. In 61.7% of DT, twin B was the smaller of the twins. There was no difference in maternal age, admission indications, or antepartum complications between both groups. DT had a significantly higher incidence of growth restriction compared to CT (88.9% vs 43.5%, p < 0.001). More mothers of DT required oxytocin (37.0% vs 26.3%, p = 0.024); however, cesarean delivery rate and indications were similar in both groups. A similar percentage of infants had AS < 4 at 1 min and AS < 7 at 5 min in both groups. There was no difference between the 2 groups in neonatal complications including: trauma, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, pneumonia, seizures, or neonatal mortality. However, DT had a significantly higher incidence of hyperbilirubinemia, need for mechanical ventilation and a longer nursery stay. The neonatal outcome of growth discordant twins is worse than that of concordant twins even in pregnancies uncomplicated by twin-twin transfusion syndrome or congenital anomalies.

Does birth weight discordance in preterm twins affect neonatal outcome?

“…In another study, it was found that discordant twins had a significantly higher incidence of SGA status than concordants but there was no difference for neonatal complications. 24 In our study, while the incidence of hypoglycemia was significantly higher in discordant twins, sepsis was significantly more frequent in concordant twins. The increased incidence of sepsis in our series could not be attributed to LBW or lower gestational ages of the babies, since these parameters were similar in both groups.…”

Reappraisal of twinning: epidemiology and outcome in the early neonatal period

“…(6,7) Hollier et al have shown that higher BWD was a risk factor for HMD, (26) although Nassar et al did not find any such association. (25) HMD was observed in about 12% of twin infants in our study, and only prematurity and lower birth weight were identified as independent risk factors.…”

“…(6) Nassar et al reported a 1% incidence of neonatal seizures in twins, (25) and Hollier et al found higher BWD to be a risk factor for neonatal seizures. (26) In our study, seizures were seen in about 4% of twin infants, and the most common aetiology was hypoglycaemia, followed by HIE and hypocalcaemia.…”

“…(6)(7)(8)25) Respiratory morbidities other than HMD, such as TTNB and MAS, are also strikingly elevated in twins. (6) Male gender is known to be associated with a higher risk of HMD, (27) although some studies disagree.…”

“…Studies suggest that pathological NNH occurs in nearly one-third of twin infants, (9,25) although this increased risk of NNH in twins is mainly attributed to prematurity rather than twinning per se. (7,28) The risk of NNH in the first and second twins is reported to be comparable.…”