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Delayed-interval delivery in multiple gestation pregnancies: neonatal mortality, morbidity, and development

Journal of Perinatology volume 42, pages 1607–1614 (2022)Cite this article

Subjects

Abstract

Objective

Delayed-interval delivery (DID) is the delivery of the first fetus in a multiple gestation pregnancy without prompt delivery of the remaining fetus(es). We aimed to assess infant outcomes of DID.

Study design

We performed a retrospective cohort study of infants born 22–28 weeks’ gestation or weighing 401–1500 g. DID was defined as a passage of >24 h between the birth of firstborn and retained infants. Rates of mortality, morbidity, and developmental outcomes were compared within DID multiples, to other multiples not born by DID, and all infants in the Generic Database and follow-up datasets (excluding DID-born).

Results

DID-born multiples were younger and smaller than other multiples. Retained infants had no significantly different rates of mortality and morbidities compared to their firstborn counterparts, apart from less bronchopulmonary dysplasia.

Conclusions

DID showed no evidence of harm and a potential benefit of decreased bronchopulmonary dysplasia mediated by increased gestational age and birthweight.

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Fig. 1: Participant flowchart.

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Data availability

ClinicalTrials.gov ID. Generic Database: NCT00063063. Data reported in this paper may be requested through a data use agreement. Further details are available at https://neonatal.rti.org/index.cfm?fuseaction=DataRequest.Home.

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Acknowledgements

While NICHD staff had input into the study design, conduct, analysis, and manuscript drafting, the comments and views of the authors do not necessarily represent the views of NICHD, the National Institutes of Health, the Department of Health and Human Services, or the U.S. Government. Participating NRN sites collected data and transmitted it to RTI International, the data coordinating center (DCC) for the network, which stored, managed and analyzed the data for this study. On behalf of the NRN, RTI International had full access to all of the data in the study, and with the NRN Center Principal Investigators, takes responsibility for the integrity of the data and accuracy of the data analysis. We are indebted to our medical and nursing colleagues and the infants and their parents who agreed to take part in this study. The following investigators, in addition to those listed as authors, participated in this study: NRN Steering Committee Chairs: Alan H. Jobe, MD PhD, University of Cincinnati (2003-2006); Michael S. Caplan, MD, University of Chicago, Pritzker School of Medicine (2006-2011); Richard A. Polin, MD, Division of Neonatology, College of Physicians and Surgeons, Columbia University, (2011-present). Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island (UG1 HD27904) – Abbot R. Laptook, MD; Martin Keszler, MD; Betty R. Vohr, MD; Angelita M. Hensman, PhD RNC-NIC; Barbara Alksninis, RNC PNP; Carmena Bishop; Robert T. Burke, MD MPH; Melinda Caskey, MD; Laurie Hoffman, MD; Katharine Johnson, MD; Mary Lenore Keszler, MD; Andrea M. Knoll; Vita Lamberson, MD; Teresa M. Leach, MEd CAES; Emilee Little, BSN RN; Elisabeth C. McGowan, MD; Bonnie E. Stephens, MD; Elisa Vieira, BSN RN; Lucille St. Pierre BS; Suzy Ventura; Victoria E. Watson, MS CAS. Case Western Reserve University, Rainbow Babies & Children’s Hospital (UG1 HD21364, K24 HL143291) – Nancy S. Newman, RN; Monika Bhola, MD; Allison H. Payne, MD MS; Bonnie S. Siner, RN; Gulgun Yalcinkaya, MD. Children’s Mercy Hospital, University of Missouri Kansas City School of Medicine (UG1 HD68284) – William E. Truog, MD; Eugenia K. Pallotto, MD MSCE; Howard W. Kilbride, MD; Cheri Gauldin, RN BS CCRC; Anne Holmes, RN MSN MBA-HCM CCRC; Kathy Johnson, RN CCRC; Allison Scott, RNC-NIC BSN CCRC; Prabhu S. Parimi, MD; Lisa Gaetano, RN MSN. Cincinnati Children’s Hospital Medical Center, University Hospital, and Good Samaritan Hospital (UG1 HD27853, UL1 TR77) – Brenda B. Poindexter, MD MS; Kurt Schibler, MD; Suhas G. Kallapur, MD; Edward F. Donovan, MD; Stephanie Merhar, MD MS; Cathy Grisby, BSN CCRC; Kimberly Yolton, PhD; Barbara Alexander, RN; Traci Beiersdorfer, RN BSN; Kate Bridges, MD; Tanya E. Cahill, RN BSN; Juanita Dudley, RN BSN; Estelle E. Fischer, MHSA MBA; Teresa L. Gratton, PA; Devan Hayes, BS; Jody Hessling, RN; Lenora D. Jackson, CRC; Kristin Kirker, CRC; Holly L. Mincey, RN BSN; Greg Muthig, BS; Sara Stacey, BA; Jean J. Steichen, MD; Stacey Tepe, BS; Julia Thompson, RN BSN; Sandra Wuertz, RN BSN CLC. Duke University School of Medicine, University Hospital, University of North Carolina, Duke Regional Hospital, and WakeMed Health and Hospitals (UG1 HD40492, UL1 TR1117, UL1 TR1111) – C. Michael Cotten, MD MHS; Ronald N. Goldberg, MD; Ricki F. Goldstein, MD; William F. Malcolm, MD; Joanne Finkle, RN JD; Patricia L. Ashley, MD PhD; Kathy J. Auten, MSHS; Kimberley A. Fisher, PhD FNP-BC IBCLC; Sandra Grimes, RN BSN; Kathryn E. Gustafson, PhD; Melody B. Lohmeyer, RN MSN; Matthew M. Laughon, MD MPH; Carl L. Bose, MD; Janice Bernhardt, MS RN; Gennie Bose, RN; Cindy Clark, RN; Linda Manor, RPh; Diane Warner, MD MPH; Janice Wereszczak, CPNP-AC/PC; Stephen D. Kicklighter, MD; Ginger Rhodes-Ryan, ARNP MSN NNP-BC; Donna White, BSN RN-BC. Emory University, Children’s Healthcare of Atlanta, Grady Memorial Hospital, and Emory University Hospital Midtown (UG1 HD27851, UL1 TR454) – Ravi M. Patel, MD MSc; David P. Carlton, MD; Barbara J. Stoll, MD; Ira Adams-Chapman, MD (deceased); Ellen C. Hale, RN BS CCRC; Yvonne C. Loggins, RN BSN; Ann Blackwelder, RN MN; Diane I. Bottcher, RN MSN; Sheena L. Carter, PhD; Salathiel Kendrick-Allwood, MD; Judith Laursen, RN; Maureen Mulligan LaRossa, RN; Colleen Mackie, BS RT; Amy Sanders, PsyD; Irma Seabrook, RRT; Gloria Smikle, PNP MSN; Lynn C. Wineski, RN MS. Eunice Kennedy Shriver National Institute of Child Health and Human Development – Rosemary D. Higgins, MD; Andrew A. Bremer, MD PhD; Stephanie Wilson Archer, MA. Indiana University, University Hospital, Methodist Hospital, Riley Hospital for Children, and Wishard Health Services (UG1 HD27856, UL1 TR6) – Gregory M. Sokol, MD; Brenda B. Poindexter, MD MS; Anna M. Dusick, MD FAAP (deceased); Lu Ann Papile, MD; Susan Gunn, NNP CCRC; Faithe Hamer, BS; Heidi M. Harmon, MD MS; Dianne E. Herron, RN CCRC; Abbey C. Hines, PsyD; Carolyn Lytle, MD MPH; Lucy C. Miller, RN BSN CCRC; Heike M. Minnich, PsyD HSPP; Leslie Richard, RN; Lucy Smiley, CCRC; Leslie Dawn Wilson, BSN CCRC. McGovern Medical School at The University of Texas Health Science Center at Houston, Children’s Memorial Hermann Hospital, Memorial Hermann Southwest Hospital, and Lyndon Baines Johnson General Hospital/Harris County Hospital District (UG1 HD87229, U10 HD21373) – Jon E. Tyson, MD MPH; Kathleen A. Kennedy, MD MPH; Amir M. Khan, MD; Barbara J. Stoll, MD; Emily K. Stephens, BSN RNC-NIC; Georgia E. McDavid, RN; Nora I. Alaniz, BS; Elizabeth Allain, MS; Julie Arldt-McAlister, RN BSN; Katrina Burson, RN BSN; Allison G. Dempsey, PhD; Susan E. Dieterich, PhD; Andrea F. Duncan, MD; Elizabeth Eason, MD; Patricia W. Evans, MD; Claudia I. Franco, RNC MSN; Carmen Garcia, RN CCRP; Charles Green, PhD; Donna Hall, RN; Beverly Foley Harris, RN BSN; Margarita Jiminez, MD MPH; Janice John, CPNP; Patrick M. Jones, MD MA; M. Layne Lillie, RN BSN; Anna E. Lis, RN BSN; Karen Martin, RN; Sara C. Martin, RN BSN; Carrie M. Mason, MA LPA; Shannon McKee, EdS; Brenda H. Morris, MD; Patricia Ann Orekoya, RN BSN; Claudia Pedrozza, PhD; Shawna Rodgers, RN BSN; Saba Khan Siddiki, MD; Maegan C. Simmons, RN; Daniel Sperry, RN; Emily K. Stephens, RN BSN; Patti L. Pierce Tate, RCP; Sharon L. Wright, MT (ASCP). Nationwide Children’s Hospital, The Research Institute at Nationwide Children’s Hospital, The Ohio State University Wexner Medical Center, The Ohio State College of Medicine, Center for Perinatal Research (U10 HD68278) – Pablo J. Sánchez, MD; Leif D. Nelin, MD; Sudarshan R. Jadcherla, MD; Patricia Luzader, RN; Gail E. Besner, MD; Erna Clark, BA; Christine A. Fortney, PhD RN; Julie Gutentag, RN; Nathalie L. Maitre, MD PhD; Courtney Park, RN; Nehal A. Parikh, MD; Julie Shadd, BA; Margaret Sullivan, BA; Melanie Stein, BBA, RRT. RTI International (UG1 HD36790) – Abhik Das, PhD; Marie G. Gantz, PhD; Carla M. Bann, PhD; Dennis Wallace, PhD; Margaret M. Crawford, BS CCRP; Jenna Gabrio, MPH CCRP; David Leblond, BS; Jamie E. Newman, PhD MPH; Carolyn M. Petrie Huitema, MS CCRP; Jeanette O’Donnell Auman, BS; W. Kenneth Poole, PhD (deceased); Kristin M. Zaterka-Baxter, RN BSN CCRP. Stanford University, Dominican Hospital, El Camino Hospital, and Lucile Packard Children’s Hospital (UG1 HD27880, UL1 TR93) – Krisa P. Van Meurs, MD; Valerie Y. Chock, MD MS Epi; David K. Stevenson, MD; Susan R. Hintz, MD MS Epi; Marian M. Adams, MD; Dona Bahmani, MD; M. Bethany Ball, BS CCRC; Barbara Bentley, PhD; Elizabeth Bruno, PhD; Alexis S. Davis, MD MS Epi; Maria Elena DeAnda, PhD; Anne M. DeBattista, RN PNP-C PhD; Lynne C. Huffman, MD; Magdy Ismael, MD MPH; Jean G. Kohn, MD MPH; Casey Krueger, PhD; Julie C. Lee-Ancajas, PhD; Janice Lowe, MD; Ryan E. Lucash, PhD; Andrew W. Palmquist, RN BSN; Jessica Patel, PhD; Melinda S. Proud, RCP; Elizabeth N. Reichert, MA CCRC; Nicholas H. St. John, PhD; Dharshi Sivakumar, MD; Heather L. Taylor, PhD; Natalie Wager, PsyD; R. Jordan Williams, BA; Hali Weiss, MD. Tufts Medical Center, Floating Hospital for Children (U10 HD53119) – Ivan D. Frantz III, MD; John M. Fiascone, MD; Elisabeth C. McGowan, MD; Brenda L. MacKinnon, RNC; Anne Furey, MPH; Ellen Nylen, RN BSN; Paige T. Church, MD; Cecelia E. Sibley, MHA PT; Ana K. Brussa MS OTR/L. University of Alabama at Birmingham Health System and Children’s Hospital of Alabama (UG1 HD34216) – Waldemar A. Carlo, MD; Namasivayam Ambalavanan, MD; Myriam Peralta-Carcelen, MD MPH; Kathleen G. Nelson, MD; Kirstin J. Bailey, PhD; Fred J. Biasini, PhD; Stephanie A. Chopko, PhD; Monica V. Collins, RN BSN MaEd; Shirley S. Cosby, RN BSN; Fred J. Biasini, PhD; Kristen C. Johnston, MSN CRNP; Mary Beth Moses, PT MS PCS; Kathleen G. Nelson, MD; Cryshelle S. Patterson, PhD; Vivien A. Phillips, RN BSN; Julie Preskitt, MSOT MPH; Richard V. Rector, PhD; Sally Whitley, MA OTR-L FAOTA. University of California - Los Angeles, Mattel Children’s Hospital, Santa Monica Hospital, Los Robles Hospital and Medical Center, and Olive View Medical Center (UG1 HD68270) – Uday Devaskar, MD; Meena Garg, MD; Isabell B. Purdy, PhD CPNP; Teresa Chanlaw, MPH; Rachel Geller, RN BSN. University of California – San Diego Medical Center and Sharp Mary Birch Hospital for Women and Newborns (U10 HD40461) – Neil N. Finer, MD; Yvonne E. Vaucher, MD MPH; David Kaegi, MD; Maynard R. Rasmussen, MD; Kathy Arnell, RNC; Clarence Demetrio, RN; Martha G. Fuller, PhD RN MSN; Wade Rich, BSHS RRT. University of Iowa, Sanford Health, and Mercy Medical Center (UG1 HD53109, UL1 TR442) – Edward F. Bell, MD; Tarah T. Colaizy, MD MPH; John A. Widness, MD; Jane E. Brumbaugh, MD; Michael J. Acarregui, MD MBA; Jonathan M. Klein, MD; John M. Dagle, MD PhD; Karen J. Johnson, RN BSN; Diane L. Eastman, RN CPNP MA; Claire A. Goeke, RN; Mendi L. Schmelzel, MSN RN; Jacky R. Walker, RN; Michelle L. Baack, MD; Laurie A. Hogden, MD; Megan Broadbent, RN BSN; Chelsey Elenkiwich, RN BSN; Megan M. Henning, RN; Dan L. Ellsbury, MD; Donia B. Campbell, RNC-NIC; Tracy L. Tud, RN. University of Miami, Holtz Children’s Hospital (U10 HD21397, M01 RR16587) – Shahnaz Duara, MD; Charles R. Bauer, MD; Ruth Everett-Thomas, RN MSN; Sylvia Fajardo-Hiriart, MD; Arielle Rigaud, MD; Maria Calejo, MS; Silvia M. Frade Eguaras, MA; Michelle Harwood Berkowits, PhD; Andrea Garcia, MS; Helina Pierre, BA; Alexandra Stoerger, BA. University of New Mexico Health Sciences Center (UG1 HD53089, UL1 TR41) – Kristi L. Watterberg, MD; Janell Fuller, MD; Robin K. Ohls, MD; Sandra Sundquist Beauman, MSN RNC-NIC; Conra Backstrom Lacy, RN; Andrea F. Duncan, MD MScr; Mary Hanson, RN BSN; Carol Hartenberger, MPH RN; Elizabeth Kuan, RN BSN; Jean R. Lowe, PhD; Rebecca A. Thomson, RN BSN. University of Pennsylvania, Hospital of the University of Pennsylvania, Pennsylvania Hospital, and Children’s Hospital of Philadelphia (UG1 HD68244) – Barbara Schmidt, MD MSc; Haresh Kirpalani, MB MSc; Eric C. Eichenwald, MD; Sara B. DeMauro, MD MSCE; Aasma S. Chaudhary, BS RRT; Soraya Abbasi, MD; Toni Mancini, RN BSN CCRC; Christine Catts, CRNP; Noah Cook, MD; Dara M. Cucinotta, RN; Judy C. Bernbaum, MD; Marsha Gerdes, PhD; Sarvin Ghavam, MD; Hallam Hurt, MD; Jonathan Snyder, RN BSN RN; Saritha Vangala, RN MSN; Kristina Ziolkowski, CMA(AAMA) CCRP. University of Rochester Medical Center, Golisano Children’s Hospital, and the University at Buffalo Women’s and Children’s Hospital of Buffalo (UG1 HD68263, U10 HD40521, UL1 TR42) – Carl T. D’Angio, MD; Dale L. Phelps, MD; Ronnie Guillet, MD PhD; Gary J. Myers, MD; Michelle Andrews-Hartley, MD; Julie Babish Johnson, MSW; Kyle Binion, BS; Melissa Bowman, RN NP; Erica Burnell, RN; Cait Fallone, MA; Osman Farooq, MD; Cassandra A. Horihan, MS; Julianne Hunn, BS; Diane Hust, MS RN CS; Rosemary L. Jensen; Emily Kushner, MA; Deanna Maffett, RN; Joan Merzbach, LMSW; Gary J. Myers, MD; Constance Orme; Diane Prinzing; Linda J. Reubens, RN CCRC; Daisy Rochez, BS MHA; Mary Rowan, RN; Premini Sabaratnam, MPH; Ann Marie Scorsone, MS CCRC; Holly I.M. Wadkins, MA; Kelley Yost, PhD; Lauren Zwetsch, RN MS PNP; Satyan Lakshminrusimha, MD; Anne Marie Reynolds, MD MPH; Michael G. Sacilowski, MAT CCRC; Stephanie Guilford, BS; Ashley Williams, MSEd; Karen Wynn, RN; William A. Zorn, PhD. University of Texas Southwestern Medical Center at Dallas, Parkland Health & Hospital System, and Children’s Medical Center Dallas (UG1 HD40689) – Luc P. Brion, MD; Pablo J. Sánchez, MD; Walid A. Salhab, MD; Charles R. Rosenfeld, MD; Roy J. Heyne, MD; Diana M. Vasil, MSN BSN RNC-NIC; Sally S. Adams, MS RN CPNP; Lijun Chen, PhD RN; Maria M. De Leon, RN BSN; Francis Eubanks, RN BSN; Alicia Guzman; Gaynelle Hensley, RN; Elizabeth T. Heyne, MS MA PA-C PsyD; Lizette E. Lee, RN; Melissa H. Leps, RN; Linda A. Madden, BSN RN CPNP; E. Rebecca McDougald, MSN APRN CPNP-PC/AC; Nancy A. Miller, RN; Janet S. Morgan, RN; Lara Pavageau, MD; Pollieanna Sepulveda, RN; Cathy Twell Boatman, MS CIMI; Jillian Waterbury DNP RN CPAP-PC. University of Utah University Hospital, Intermountain Medical Center, McKay-Dee Hospital, Utah Valley Hospital, LDS Hospital, and Primary Children’s Medical Center (UG1 HD87226, U10 HD53124, UL1 RR25764) – Bradley A. Yoder, MD; Mariana Baserga, MD MSCI; Roger G. Faix, MD; Sarah Winter, MD; Stephen D. Minton, MD; Mark J. Sheffield, MD; Carrie A. Rau, RN BSN CCRC; Shawna Baker, RN; Karie Bird, RN BSN; Jill Burnett, RNC BSN; Susan Christensen, RNC BSN; Laura Cole-Bledsoe, RN; Brandy Davis, RN BSN; Jennifer O. Elmont, RN BSN; Jennifer J. Jensen, RN BSN; Manndi C. Loertscher, BS CCRP; Jamie Jordan, RN BSN; Trisha Marchant, RN BSN; Earl Maxson, BSN; Kandace M. McGrath, BS; Karen A. Osborne, RN BSN CCRC; D. Melody Parry, RN BSN; Brixen A. Reich, MSN RNC CCRC; Susan T. Schaefer, RRT RN BSN; Cynthia Spencer, RNC; Michael Steffen, PhD; Katherine Tice, RN BSN; Kimberlee Weaver-Lewis, RN MS; Kathryn D. Woodbury, RN BSN; Karen Zanetti, RN. Wake Forest University, Baptist Medical Center, Forsyth Medical Center, and Brenner Children’s Hospital (U10 HD40498, M01 RR7122) – T. Michael O’Shea, MD MPH; Robert G. Dillard, MD; Lisa K. Washburn, MD; Barbara G. Jackson, RN, BSN; Nancy Peters, RN; Korinne Chiu, MA; Deborah Evans Allred, MA LPA; Donald J. Goldstein, PhD; Raquel Halfond, MA; Carroll Peterson, MA; Ellen L. Waldrep, MS; Cherrie D. Welch, MD MPH; Melissa Whalen Morris, MA; Gail Wiley Hounshell, PhD. Wayne State University, Hutzel Women’s Hospital, and Children’s Hospital of Michigan (UG1 HD21385) – Seetha Shankaran, MD; Beena G. Sood, MD MS; Athina Pappas, MD; Girija Natarajan, MD; Katherine Abramczyk; Prashant Agarwal, MD; Monika Bajaj, MD; Rebecca Bara, RN BSN; Elizabeth Billian, RN MBA; Sanjay Chawla, MD; Kirsten Childs, RN BSN; Lilia C. De Jesus, MD; Debra Driscoll, RN BSN; Melissa February, MD; Laura A. Goldston, MA; Mary E. Johnson, RN BSN; Geraldine Muran, RN BSN; Bogdan Panaitescu, MD; Jeannette E. Prentiss, MD; Diane White RT; Eunice Woldt, RN MSN; John Barks, MD; Stephanie A. Wiggins, MS; Mary K. Christensen, BA RRT; Martha D. Carlson, MD PhD. Yale University, Yale-New Haven Children’s Hospital, and Bridgeport Hospital (U10 HD27871, UL1 TR142) – Richard A. Ehrenkranz, MD; Harris Jacobs, MD; Christine G. Butler, MD; Patricia Cervone, RN; Sheila Greisman, RN; Monica Konstantino, RN BSN; JoAnn Poulsen, RN; Janet Taft, RN BSN; Joanne Williams, RN BSN; Elaine Romano, MSN.

Funding

The National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Center for Research Resources, and the National Center for Advancing Translational Sciences provided grant support for the Neonatal Research Network’s Generic Database and Follow-up Studies through cooperative agreements. The authors have no financial relationships relevant to this article to disclose. Parts of this work were presented at the 2020 Pediatric Academic Societies meeting and the 2020 American Academy of Pediatrics meeting.

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Authors and Affiliations

  1. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Nicolas J. Bouey, Deanne E. Wilson-Costello, Michele Walsh & Anna Maria Hibbs

  2. Statistics and Epidemiology Unit, RTI International, Research Triangle Park, NC, USA

    Shampa Saha

  3. Department of Pediatrics, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH, USA

    Deanne E. Wilson-Costello, Michele Walsh & Anna Maria Hibbs

  4. Department of Pediatrics, McGovern Medical School, University of Texas-Houston, Houston, TX, USA

    Matthew A. Rysavy

  5. Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Myra H. Wyckoff

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  1. Nicolas J. Bouey
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Contributions

Study concept and design: NJB, AMH. Statistical analysis: SS. Acquisition, analysis, or interpretation of data: NJB, SS, DEW-C, MAR, MW, MHW, AMH. Drafting of the manuscript: NJB. Critical revision of the manuscript for important intellectual content: SS, DEW-C, MAR, MW, MHW, AMH.

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Correspondence to Nicolas J. Bouey.

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Informed or waiver of consent was obtained for the GDB, as determined by local review boards.

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Bouey, N.J., Saha, S., Wilson-Costello, D.E. et al. Delayed-interval delivery in multiple gestation pregnancies: neonatal mortality, morbidity, and development. J Perinatol 42, 1607–1614 (2022). https://doi.org/10.1038/s41372-022-01462-x

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  • DOI: https://doi.org/10.1038/s41372-022-01462-x

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