Prematurity and twinning

Abstract

Aim of the study: Newborns from multiple pregnancies are increasing in number and demonstrate a higher perinatal morbidity and mortality compared to singletons. Prematurity is the main reason for most neonatal diseases in twins, but other variables may play a role and their prenatal evaluation may improve the overall outcome. Main findings: Prematurity is six times more frequent in twins and therefore birth weight is significantly lower compared to singletons. Thus, twins are more exposed to prematurity related diseases (respiratory, cardiovascular, infectious, etc.) and to long-term complications (especially neurological disabilities). Results: It is very difficult to estimate the increased risk of neonatal morbidity related to twinning independently to the increased risk of prematurity and therefore to interpret data on morbidity rates, in particular regarding the neurodevelopmental outcome. Conclusion: Prevention of preterm birth is a primary goal in managing multiple pregnancies, together with prophylaxis with corticosteroids in order to improve foetal lung maturity. Accurate risk assessment strategies and adequate obstetrical-neonatological management of multiple pregnancies may reduce the increasing need for neonatal intensive care and for health resources in the long-term follow-up that has been observed over the last decades.

Epidemiology of Toxoplasma and CMV serology and of GBS colonization in pregnancy and neonatal outcome in a Sicilian population

“…Despite the increasing role of horizontally transmitted nosocomial infections [5,6], especially in infants who require prolonged hospitalization because of underlining risk factors (prematurity, IUGR, congenital malformations) [7,8], vertically transmitted perinatal infections are still frequent and responsible for short and long term sequelae. Neonatal Units must therefore pay attention both to evaluate and limit the circulation of outbreaks of nosocomial pathogens [9] and also to identify the risk of mother to fetus/newborn transmission of well known dangerous pathogens, such as Toxoplasma, CMV and Group B Streptococcus.…”

Oxidative stress markers at birth: Analyses of a neonatal population

“…Newborns, especially if preterm, are particularly prone to the action of free radicals, which is due to various reasons: structural and functional immaturity of organs, increase of tissue mass with aerobic metabolism accompanied by a rapidly growing energy demand, reduced ability to induce efficient homeostatic mechanisms (Cipolla et al, 2011), and lack of antioxidant systems that come to maturity only during the first year of life (Giuffre et al, 2012). There are also other predisposing conditions such as (a) the neonatal relative deficiency of antioxidant systems in plasma and erythrocytes (e.g., low enzymatic activities of glutathione peroxidase and superoxide dismutase and low content of vitamin E and ascorbic acid); (b) increased susceptibility to oxidative stress as indicated by an increase of the following: release of transitional metals such as free iron, production of superoxide radicals, content of fatty acids, and membrane peroxidation; and (c) an increased removal rate of erythrocytes (i.e., increase in senescent antigen production) (Mutinati et al, 2014).…”

Language Development of Three- to Twelve-Year-Old Twins Compared to Singletons

“…Some monozygotic twins share a monochorionic placenta, which can result in a transfusion effect of the blood from one twin to the other [7]. The risk for a preterm birth is 6 times higher in twins compared to singletons [8]. Many twins are born preterm and are of a low birth weight and, therefore, have more risk for respiratory, cardiovascular and neurological problems.…”