Document Detail

Twins and triplets: the effect of plurality and growth on neonatal outcome compared with singleton infants.
MedLine Citation:
PMID:  15467528     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Information on outcome by gestational age from large numbers of twins and triplets is limited and is important for counseling and decision-making in obstetric practice. We reviewed one of the largest available neonatal databases to describe mortality and morbidity rates and growth in newborn infants from multiple gestations and compared these data with data for singletons. STUDY DESIGN: Data from a large prospectively recorded neonatal database that incorporated neonatal records from January 1997 to July 2002 were reviewed. We evaluated birth weight and neonatal mortality and morbidity rates that affected long-term outcome for each week of gestational age from 23 to 35 weeks of gestation for all nonanomolous inborn twins and triplets who were admitted to the neonatal intensive care unit and compared these data to all singletons who met similar criteria during the same time period. RESULTS: There were 12,302 twin and 2155 triplet births that met the entry criteria. The data for these newborn infants were compared with 36,931 singletons. Average birth weights at each gestational week were similar for all gestational ages until 29 weeks of gestation for triplets and 32 weeks of gestation for twins. After these gestational ages, the entire difference between twins and singletons was due to the weight of the smaller twin; the larger twins' mean weights were similar to singletons at all weeks that were studied. Birth order at each week also did not affect neonatal mortality rates, even when corrected for route of delivery and antenatal steroids. Neonatal morbidities associated with adverse long-term outcomes (intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis) were also not different between multiple infants and singletons. Intrauterine growth restriction (IUGR) was associated with increased mortality rates at all gestational ages, but in the absences of IUGR, discordance was not. CONCLUSION: Data on a large number of twins and triplets provide reassurance that neonatal outcome at all viable premature weeks of gestation are similar to singletons. Intrauterine growth restriction and prematurity are therefore the principal issues that drive neonatal mortality and morbidity rates in multiple gestations. These data are important for obstetric decision-making and patient counseling.
Thomas J Garite; Reese H Clark; John P Elliott; James A Thorp
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  191     ISSN:  0002-9378     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2004 Sep 
Date Detail:
Created Date:  2004-10-06     Completed Date:  2004-11-06     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  700-7     Citation Subset:  AIM; IM    
Department of Obstetrics and Gynecology, University of California, Irvine, Calif, USA.
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MeSH Terms
Birth Weight
Embryonic and Fetal Development*
Fetal Growth Retardation / mortality
Gestational Age*
Infant Mortality
Infant, Newborn
Infant, Premature
Intensive Care, Neonatal
Pregnancy Outcome*
Pregnancy, Multiple
Erratum In:
Am J Obstet Gynecol. 2004 Dec;191(6):2184

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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