Do very preterm twins and singletons differ in their neurodevelopment at 5 years of age?
- Florence Bodeau-Livinec1,
- Jennifer Zeitlin2,3,
- Béatrice Blondel2,3,
- Catherine Arnaud4,
- Jeanne Fresson5,
- Antoine Burguet2,3,6,
- Damien Subtil7,
- Stéphane Marret8,
- Jean-Christophe Rozé9,
- Laetitia Marchand-Martin2,3,
- Pierre-Yves Ancel2,3,
- Monique Kaminski2,3,
- On behalf of the EPIPAGE group
- 1Epidemiology and Biostatistics, EHESP Rennes, Sorbonne Paris Cité, Rennes, France
- 2INSERM, UMR S953, Epidemiological Research Unit on Perinatal Health and Women's and children's health, Paris, F-75020 France
- 3Université Pierre et Marie Curie-Paris 6, Paris, France
- 4INSERM, UMR 1027, Toulouse, France
- 5Maternité Régionale Universitaire, Nancy Cedex, France
- 6Service de pédiatrie 2, Hôpital du Bocage, CHU Dijon 1 boulevard Jeanne d'Arc, Dijon, France
- 7EA 2694, hôpital Jeanne-de-Flandre, université Lille Nord de France, CHRU de Lille, Lille cedex, France
- 8Service de pédiatrie néonatale et réanimation, centre d’éducation fonctionnelle de l'Enfant, hôpital Charles-Nicolle, CHU de Rouen, Rouen cedex, France
- 9Department of Neonatal Medicine, Nantes University, CHU of Nantes, Nantes, France
- Correspondence to Dr Florence Bodeau-Livinec, Département d’épidémiologie et biostatistiques, Ecole des Hautes Etudes en Santé Publique (EHESP), Avenue du Professeur Léon Bernard, Rennes Cedex 35043, France;
- Received 23 January 2013
- Revised 12 June 2013
- Accepted 14 June 2013
- Published Online First 17 July 2013
Objective Twins have inconsistently shown poorer outcomes than singletons. Although a high proportion of twins are born very preterm, data are sparse on the long-term outcomes in very preterm twins. The objective of this study was to compare mortality and neurodevelopmental outcomes of very preterm singletons and twins and to study outcomes in relation to factors specific to twins.
Design Birth cohort study Etude Epidemiologique sur les Petits Ages Gestationnels (EPIPAGE).
Setting Nine regions in France.
Patients All very preterm live births occurring from 22 to 32 weeks of gestation in all maternity wards of nine French regions in 1997 (n=2773).
Main outcomes measures Neurodevelopmental status, including cerebral palsy, and a cognitive assessment with the Kaufman Assessment Battery for Children, with scores on the Mental Processing Composite (MPC) scale, was available for 1732 and 1473 children at 5 years of age, respectively.
Results Among live births, twins had higher hospital mortality than singletons (adjusted (a)OR: 1.4 (95% CI 1.1 to 1.9)). Among survivors, there was no crude difference at 5 years between twins and singletons in the prevalence of cerebral palsy (8.0% vs 9.1%, respectively), MPC <70 (9.5% vs 11.1%) and mean MPC (94.6 vs 94.4). However, after adjustment for sex, gestational age, intrauterine growth restriction and social factors, twins were more likely to have lower MPC scores (mean difference: −2.4 (95% CI–4.8 to 0.01)). Live born twins had a higher risk of mortality when birth weight discordance was present (aOR:2.9 (95% CI 1.7 to 4.8)), but there were no differences in long-term outcomes.
Conclusions Compared with very preterm singletons, twins had higher mortality, no difference with respect to severe deficiencies, but slightly lower MPC scores at 5 years.