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Morbidity and Mortality of Preterm Twins and Higher-Order Multiple Births

Journal of Perinatology volume 21, pages 293–299 (2001)Cite this article

Abstract

OBJECTIVE: To determine if preterm infants of higher-order multiple (HOM) gestations have a significantly worse outcome during hospital stay when compared with preterm twins.

STUDY DESIGN: Retrospective cohort analysis.

METHODS: Perinatal outcome variables including gestational age (GA), birthweight, prenatal steroid use, cesarean section delivery rate, Apgar scores, and growth retardation were analyzed for 106 preterm HOM births (triplets and quadruplets) versus 328 preterm twins admitted to a single tertiary level neonatal intensive care unit. A comparison of the mortality and major neonatal morbidities such as respiratory distress syndrome, patent ductus arteriosus, intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity was made for these two groups. In addition, the duration of respiratory support including surfactant therapy, nasal continuous positive airway pressure, and mechanical ventilation, as well as the length of hospitalization, was analyzed.

RESULTS: There were no significant differences in major morbidities between the infants of HOM and twin births of similar GA. There was no statistically significant difference in mortality, but the data showed a trend for lesser mortality in HOM. There was a highly significant increase in antenatal steroid use as well as the use of cesarean section for delivery in the HOM when compared with twin gestations. The infants of HOM gestations were of significantly lower birthweight than the twins and had a longer hospitalization.

CONCLUSION: Although premature infants of HOM had lower birthweight and needed a longer hospital stay, their mortality and morbidity at hospital discharge were not worse than that for preterm twins.

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References

  1. Loucopoulos A, Jewelewicz R Management of multifetal pregnancies: sixteen years' experience at the Sloan Hospital for Women Am J Obstet Gynecol 1982 143 902–5

    Article  CAS  Google Scholar 

  2. Ron-El R, Caspi E, Schreyer P, Weinraub Z, Arieli S, Goldberg MD Triplet and quadruplet pregnancies and management Obstet Gynecol 1981 57 458–63

    CAS  PubMed  Google Scholar 

  3. Martin JA, MacDorman MF, Mathews TJ Triplet births: trends and outcomes 1971–94 Vital Health Stat 1997 21 1–20

    Google Scholar 

  4. Luke B, Keith LG The contribution of singletons, twins and triplets to low birth weight, infant mortality and handicap in the United States J Reprod Med 1992 37 661–6

    CAS  PubMed  Google Scholar 

  5. Holcberg G, Biale Y, Lewenthal H, Insler V Outcome of pregnancy in 31 triplet gestations Obstet Gynecol 1982 59 472–6

    CAS  PubMed  Google Scholar 

  6. Olofsson P Triplet and quadruplet pregnancies — a forthcoming challenge also for the “general” obstetrician Eur J Obstet Gynecol Reprod Biol 1990 35 159–71

    Article  CAS  Google Scholar 

  7. Melgar CA, Rosenfeld DL, Rawlinson K, Greenberg M Perinatal outcome after multifetal reduction to twins compared with nonreduced multiple gestations Obstet Gynecol 1991 78 763–7

    CAS  PubMed  Google Scholar 

  8. Boulot P, Hedon B, Pelliccia G, et al Obstetrical results after embryonic reductions performed on 34 multiple pregnancies Hum Reprod 1990 5 1009–13

    Article  CAS  Google Scholar 

  9. Angel JL, Kalter CS, Morales WJ, Rasmussen C, Caron L Aggressive perinatal care for high-order multiple gestations: does good perinatal outcome justify aggressive assisted reproductive techniques? Am J Obstet Gynecol 1999 181 253–9

    Article  CAS  Google Scholar 

  10. Skrablin S, Kuvacic I, Pavicic D, Kalafatic D, Goluza T Maternal neonatal outcome in quadruplet and quintuplet versus triplet gestations Eur J Obstet Gynecol Reprod Biol 2000 88 147–52

    Article  CAS  Google Scholar 

  11. Wolf EJ, Vintzileos AM, Rosenkrantz TS, Rodis JF, Lettieri L, Mallozzi A A comparison of pre-discharge survival and morbidity in singleton and twin very-low-birth-weight infants Obstet Gynecol 1992 80 436–9

    CAS  PubMed  Google Scholar 

  12. Sassoon DA, Castro L, Davis J, Hobel CJ Perinatal outcome in triplet versus twin gestations Obstet Gynecol 1990 75 817–20

    CAS  PubMed  Google Scholar 

  13. Ballard JL, Novak KK, Driver M A simplified score for assessment of fetal maturation of newly born infants J Pediatr 1979 95 769–74

    Article  CAS  Google Scholar 

  14. Kattner E, Metze B, Waiss E, Obladen M Accelerated lung maturation following maternal steroid treatment in infants born before 30 weeks gestation J Perinat Med 1992 20 449–57

    Article  CAS  Google Scholar 

  15. Lubchenco LO, Hansman C, Boyd E Intrauterine growth in length and head circumference as estimated from live births at gestational ages from 26 to 42 weeks Pediatrics 1966 37 403–8

    CAS  PubMed  Google Scholar 

  16. Boyle RJ, Oh W Respiratory distress syndrome Clin Perinatol 1978 5 283–97

    Article  CAS  Google Scholar 

  17. Friedman WF, Fitzpatrick KM, Merritt TA, Feldman BH The patent ductus arteriosus Clin Perinatol 1978 5 411–36

    Article  CAS  Google Scholar 

  18. Papile LA, Burstein J, Burstein R, Koffler H Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm J Pediatr 1978 92 529–34

    Article  CAS  Google Scholar 

  19. Banker BQ, Larroche J-C Periventricular leukomalacia of infancy: a form of neonatal anoxic encephalopathy Arch Neurol 1962 7 386–410

    Article  CAS  Google Scholar 

  20. Volpe JJ Hypoxic–ischemic encephalopathy: neuropathology and pathogenesis Neurology of the Newborn 3rd ed Philadelphia: W.B. Saunders 1987

    Google Scholar 

  21. Anonymous An international classification for retinopathy of prematurity. The Committee for the Classification of Retinopathy of Prematurity Arch Ophthal 1984 102 1130

    Article  Google Scholar 

  22. Northway WH Jr, Rosan RC, Porter DY Pulmonary disease following respirator therapy of hyaline membrane disease. Bronchopulmonary dysplasia N Engl J Med 1967 276 357–68

    Article  Google Scholar 

  23. Shennan AT, Dunn MS, Ohlsson A, Lennox K, Hoskins EM Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period Pediatrics 1988 82 527–32

    CAS  PubMed  Google Scholar 

  24. Luke B The changing pattern of multiple births in the United States: maternal and infant characteristics, 1973 and 1990 Obstet Gynecol 1994 84 101–6

    CAS  PubMed  Google Scholar 

  25. Porreco RP, Burke MS, Hendrix ML Multifetal reduction of triplets and pregnancy outcome Obstet Gynecol 1991 78 335–9

    CAS  PubMed  Google Scholar 

  26. Lipitz S, Reichman B, Paret G, et al The improving outcome of triplet pregnancies Am J Obstet Gynecol 1989 161 1279–84

    Article  CAS  Google Scholar 

  27. Albrecht JL, Tomich PG The maternal and neonatal outcome of triplet gestations Am J Obstet Gynecol 1996 174 1551–6

    Article  CAS  Google Scholar 

  28. Papiernik E, Grange G, Zeitlin J Should multifetal pregnancy reduction be used for prevention of preterm deliveries in triplet or higher-order multiple pregnancies? J Perinat Med 1998 26 365–70

    Article  CAS  Google Scholar 

  29. Elster AD, Bleyl JL, Craven TE Birth weight standards for triplets under modern obstetric care in the United States, 1984–1989 Obstet Gynecol 1991 77 387–93

    CAS  PubMed  Google Scholar 

  30. Boulot P, Hedon B, Pelliccia G, Peray P, Laffargue F, Viala JL Effects of selective reduction in triplet gestation: a comparative study of 80 cases managed with or without this procedure Fertil Steril 1993 60 497–503

    Article  CAS  Google Scholar 

  31. Syrop CH, Varner MW Triplet gestation: maternal and neonatal implications Acta Genet Med Gemellol 1985 34 81–8

    Article  CAS  Google Scholar 

  32. Collins MS, Bleyl JA Seventy-one quadruplet pregnancies: management and outcome Am J Obstet Gynecol 1990 162 1384–91 discussion 1391–2

    Article  CAS  Google Scholar 

  33. Newman RB, Hamer C, Miller MC Outpatient triplet management: a contemporary review Am J Obstet Gynecol 1989 161 547–53 discussion 553–5

    Article  CAS  Google Scholar 

  34. Gonen R, Heyman E, Asztalos EV, et al The outcome of triplet, quadruplet, and quintuplet pregnancies managed in a perinatal unit: obstetric, neonatal, and follow-up data [see comments] Am J Obstet Gynecol 1990 162 454–9

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank Marlene Holman, RN, Paula Gendreau, RN, Marta Baker, RN, and Barbara Westman, Administrative Program Assistant, for their invaluable help with data collection and maintenance of our neonatal database.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, University of Connecticut School of Medicine, Farmington, CT

    Kirin Suri MD, Ted S Rosenkrantz MD & Naveed Hussain MBBS, DCH

  2. Department of Pediatrics, Division of Neonatology, Albert Einstein Medical Center, Philadelphia, PA

    Vineet Bhandari MD, DM

  3. Office of Research, Connecticut Children's Medical Center, Hartford, CT

    Trudy Lerer MS

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  1. Kirin Suri MD
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  2. Vineet Bhandari MD, DM
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  3. Trudy Lerer MS
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  4. Ted S Rosenkrantz MD
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  5. Naveed Hussain MBBS, DCH
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Suri, K., Bhandari, V., Lerer, T. et al. Morbidity and Mortality of Preterm Twins and Higher-Order Multiple Births. J Perinatol 21, 293–299 (2001). https://doi.org/10.1038/sj.jp.7200492

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