Neurodevelopmental Outcomes of Twins Compared With Singleton Children: A Systematic Review

Babatunde, Oluwole Adeyemi; Adebamowo, Sally N.; Ajayi, IkeOluwapo O.; Adebamowo, Clement

doi:10.1017/thg.2018.3

Cited by 12 publications

(8 citation statements)

References 39 publications

(102 reference statements)

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“…There is limited literature on the outcomes in periviable births regarding differences in between multiples and singletons which warrants further investigation. 14 Our study demonstrated that self-reported maternal Black race was associated with increased risk for g-tube placement in periviable infants that survived to discharge, a finding that has not been previously reported in literature. The composite outcome of death or g-tube placement was not significant.…”

Section: Discussionsupporting

confidence: 44%

Need for Gastrostomy Tube in Periviable Infants

ElSeed Peterson,

Roeckner,

Deall

et al. 2024

Am J Perinatol

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Objective We sought to identify clinical and demographic factors associated with gastrostomy tube (g-tube) placement in periviable infants. Study Design We conducted a single-center retrospective cohort study of live-born infants between 22 and 25 weeks' gestation. Infants not actively resuscitated and those with congenital anomalies were excluded from analysis. Results Of the 243 infants included, 158 survived until discharge. Of those that survived to discharge, 35 required g-tube prior to discharge. Maternal race/ethnicity (p = 0.006), intraventricular hemorrhage (p = 0.013), periventricular leukomalacia (p = 0.003), bronchopulmonary dysplasia (BPD; p ≤ 0.001), and singleton gestation (p = 0.009) were associated with need for gastrostomy. In a multivariable logistic regression, maternal Black race (Odds Ratio [OR] 2.88; 95% confidence interval [CI] 1.11–7.47; p = 0.029), singleton gestation (OR 3.99; 95% CI 1.28–12.4; p = 0.017) and BPD (zero g-tube placement in the no BPD arm; p ≤ 0.001) were associated with need for g-tube. Conclusion A high percentage of periviable infants surviving until discharge require g-tube at our institution. In this single-center retrospective study, we noted that maternal Black race, singleton gestation, and BPD were associated with increased risk for g-tube placement in infants born between 22 and 25 weeks' gestation. The finding of increased risk with maternal Black race is consistent with previous reports of racial/ethnic disparities in preterm morbidities. Additional studies examining factors associated with successful achievement of oral feedings in preterm infants are necessary and will inform future efforts to advance equity in newborn health. Key Points

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Section: Discussionsupporting

confidence: 44%

Need for Gastrostomy Tube in Periviable Infants

ElSeed Peterson,

Roeckner,

Deall

et al. 2024

Am J Perinatol

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“…Within this framework, twin gestation has been traditionally associated with an increased risk of perinatal mortality and morbidity ( 15 , 16 ). Moreover, it has been suggested that twins are at greater risk of adverse long-term neurodevelopmental outcomes than singletons, but the evidence is inconsistent ( 17 ). Moreover, longitudinal studies examining the neurodevelopmental outcomes among preterm twins and higher-order multiples are limited, and few of those studies had long follow-up durations.…”

Section: Introductionmentioning

confidence: 99%

To be born twin: effects on long-term neurodevelopment of very preterm infants—a cohort study

Fontana,

Schiavolin,

Ardemani

et al. 2023

Front. Pediatr.

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ObjectiveTo examine the effect of twin birth on long-term neurodevelopmental outcomes in a cohort of Italian preterm infants with very low birth weight.Study designWe performed a retrospective cohort study on children born in a tertiary care centre. We included children born between 1 January 2007 and 31 December 2013 with a gestational age (GA) of ≤32 weeks and birth weight of <1,500 g. The infants born from twin pregnancies complicated by twin-to-twin transfusion syndrome and from higher-order multiple pregnancies were excluded. The children were evaluated both at 2 years corrected age and 5 years chronological age with Griffiths mental development scales revised (GMDS-R). The linear mixed effects models were used to study the effect of being a twin vs. being a singleton on GMDS-R scores, adjusting for GA, being born small for gestational age, sex, length of NICU stay, socio-economic status, and comorbidity score (CS) calculated as the sum of the weights associated with each of the major morbidities of the infants.ResultsA total of 301 children were included in the study, of which 189 (62.8%) were singletons and 112 (37.2%) were twins; 23 out of 112 twins were monochorionic (MC). No statistically significant differences were observed between twins and singletons in terms of mean general quotient and subscales at both 2 and 5 years. No effect of chorionicity was found when comparing scores of MC and dichorionic twins vs. singletons; however, after adjusting for the CS, the MC twins showed lower scores in the hearing and language and performance subscales at 5 years.ConclusionOverall, in our cohort of children born very preterm, twin infants were not at higher risk of neurodevelopmental impairment compared with singletons at pre-school age.

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“…29,32 Nevertheless, when evaluating early child neurodevelopment, few or no significant differences in sequelae have been found between preterm-born multiples and singletons. [33][34][35] While there are many antenatal and intrapartum factors impacting twin gestations, zygosity and birth order are the two core factors for consideration when examining childhood sequelae. Zygosity is used to evaluate heritability, commonly determined by the concordance of outcomes.…”

Section: Introductionmentioning

confidence: 99%

Within- and between-twin comparisons of risk for childhood behavioral difficulties after preterm birth

et al. 2023

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Background Preterm birth and multiple gestation are independently associated with adverse neurodevelopmental outcomes. The objective of this study was to describe risks of screening positive for attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and anxiety in preterm-born twin children by zygosity (monozygotic, dizygotic) and birth order (first-born, second-born). Methods Caregivers of 349 preterm-born twin pairs (42% monozygotic) aged 3–18 years reported child behavioral outcomes on Strengths and Weaknesses of ADHD Symptoms and Normal Behavior; Social Responsiveness Scale, Second Edition; and Preschool Anxiety Scale or Screen for Child Anxiety and Related Emotional Disorders. Results Concordance for behavioral outcomes in twin pairs ranged from 80.06 to 89.31% for ADHD, 61.01 to 84.23% for ASD, and 64.76 to 73.35% for anxiety. Monozygotic twins had a greater risk than dizygotic of screening positive for inattention (risk ratio = 2.91, 95% CI = 1.48–5.72) and social anxiety (1.79, 1.23–2.61). Relative to first-born, second-born twins had a greater risk of screening positive for hyperactivity/impulsivity (1.51, 1.06–2.16); overall ASD (2.38, 1.62–3.49); difficulties with social awareness (2.68, 1.94–3.71), social cognition (4.45, 3.06–6.46), and social communication (2.36, 1.56–3.57); restricted/repetitive behavior (1.91, 1.30–2.81); overall anxiety (1.34, 1.10–1.64); generalized anxiety (1.34, 1.11–1.60); and social anxiety (1.32, 1.06–1.64). Conclusion The current findings emphasize considering zygosity and birth order in preterm and multiple birth outcomes research, and highlight clinical implications for discharge planning, neurodevelopmental surveillance, and facilitating parenting and family support. Impact Zygosity and birth order are important determinants of behavioral and socioemotional outcomes in preterm-born twins. Among 349 preterm-born twin pairs aged 3–18 years (42% monozygotic), 61–89% demonstrated concordance for behavioral and socioemotional outcomes. Monozygosity had greater risks than dizygosity for positive screening of inattention and social anxiety. Second-born twins had greater risks than first-born for hyperactivity/impulsivity, social difficulties (awareness, cognition, communication), restricted/repetitive behavior, and anxiety (generalized, social). These findings have implications for discharge planning, neurodevelopmental surveillance, and facilitating parenting and family support.

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Neurodevelopmental Outcomes of Twins Compared With Singleton Children: A Systematic Review

Cited by 12 publications

References 39 publications

Need for Gastrostomy Tube in Periviable Infants

Need for Gastrostomy Tube in Periviable Infants

To be born twin: effects on long-term neurodevelopment of very preterm infants—a cohort study

Within- and between-twin comparisons of risk for childhood behavioral difficulties after preterm birth

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