Outcomes of very low birth weight twins cared for in the National Institute of Child Health and Human Development Neonatal Research Network’s intensive care units,☆☆,,★★

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Abstract

OBJECTIVE: The study’s aim was to compare outcomes of very low birth weight twins with those of matched singletons.

STUDY DESIGN: With data from the Neonatal Research Network registry (May 1991 to December 1994), univariable and multivariable comparisons of very low birth weight twin pairs and singletons were performed in 2 subgroups: (1) all paired twins and singletons with birth weights between 401 and 1500 g and (2) all paired twins and singletons born at <28 weeks’ gestation.

RESULTS: Twins constituted 19% of infants admitted with very low birth weight. Mothers of twins were more likely to receive prenatal care, have labor, have cesarean delivery, and receive antenatal glucocorticoids. Twins were more likely to have respiratory disease and to receive surfactant. Second-born twins had more early respiratory disease but similar longer-term outcomes. The risks of death, chronic lung disease, and grade III or IV intracranial hemorrhage were similar in twins and singletons.

CONCLUSIONS: Although very low birth weight twins compose a sizable proportion of admissions, in National Institute of Child Health and Human Development Neonatal Research Network intensive care units, twins and singletons have similar outcomes. (Am J Obstet Gynecol 1998;179:742-9.)

Section snippets

The National Institute of Child Health and Human Development Neonatal Research Network

The Neonatal Research Network registry contains data to evaluate VLBW morbidity and mortality, monitor clinical practice patterns, and provide information for the design of clinical trials. The registry includes all VLBW infants admitted before 14 days of age to neonatal intensive care units affiliated with 12 participating academic medical centers. Live-born infants born in registry institutions who die before they are admitted to the neonatal intensive care unit are also included. Demographic

Results

Network centers during the study period admitted 10,271 infants, either born in the admitting institution or not, with birth weights between 401 and 1500 g. Paired (1448) and unpaired (494) twins accounted for 18.9% of admissions in this birth weight category. Excluded unpaired twins were larger at birth (1159 ± 320 vs 1110 ± 281 g, mean ± SD), older (30 ± 4 vs 28 ± 3 gestational weeks, mean ± SD), more likely to be born outside the admitting institution (17.2% vs 10.6%), less likely to receive

Comment

Infants of multiple gestations constitute an increasing proportion of US births and a large portion of neonatal intensive care unit admissions.3 The risk of low birth weight among twins is approximately 10 times that among singletons.1 In 1992 twins accounted for 2.4% of all US live births, 20% of births of infants with birth weights <1500 g, and, in this study, 19% of neonatal intensive care unit admissions of infants with birth weights <1500 g.1

The mortality risk for VLBW and extremely low

References (24)

  • PL Waller et al.

    Low birthweight in twins: black and white differences

    Acta Genet Med Gemellol

    (1993)
  • JC Kleinman et al.

    Comparison of infant mortality among twins and singletons: United States 1960 and 1973

    Am J Epidemiol

    (1991)
  • Cited by (87)

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    From the University of Cincinnati,a Yale University,b Wayne State University,c Stanford University,d the National Institute of Child Health and Human Development,e The Biostatistics Center, George Washington University,f Case Western Reserve University,g the University of Tennessee at Memphis,h Emory University,i the University of Texas Southwestern Medical Center,j the University of Miami,k Indiana University,l Women and Infants Hospital,m and the University of New Mexico.n

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    Supported by a grant from the National Institutes of Health, National Institute of Child Health and Human Development through Cooperative Agreement with the authors’ institutions: U10 HD27853,aU10 HD27871,bU10 HD21385,cU10 HD27780,dU10 HD19897,fU10 HD21364,gU10 HD21415,hU10 HD27851,iU10 HD21373,jU10 HD21373,kU10 HD27856,lU10 HD27871,mand U10 HD27881.n

    Reprint requests: Edward F. Donovan, MD, Division of Neonatology, University of Cincinnati Medical Center, PO Box 670541, Cincinnati, OH 45267-0541.

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