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Neurodevelopmental outcomes of preterm singletons, twins and higher-order gestations: a population-based cohort study
  1. Lokiny Gnanendran1,
  2. Barbara Bajuk2,
  3. Julee Oei3,4,
  4. Kei Lui3,4,
  5. Mohamed E Abdel-Latif5,6,
  6. for the NICUS Network
  1. 1Department of Medicine, Canberra Hospital, Garran, Australian Capital Territory, Australia
  2. 2Neonatal Intensive Care Units’ Data Collection, NSW Pregnancy and Newborn Services Network, New South Wales, Australia
  3. 3Department of Newborn Care, Royal Hospital for Women, New South Wales, Australia
  4. 4School of Women's and Children's Health, University of New South Wales, New South Wales, Australia
  5. 5Department of Neonatology, Centenary Hospital for Women and Children, Garran, Australian Capital Territory, Australia
  6. 6School of Clinical Medicine, Australian National University, Australian Capital Territory, Australia
  1. Correspondence to Professor Mohamed E Abdel-Latif, Department of Neonatology, Centenary Hospital for Women and Children, The Australian National University Medical School, PO Box 11, Woden, ACT 2606, Australia; Abdel-Latif.Mohamed{at}


Objective To study the neurodevelopmental outcomes of multiple (twins, triplets, quads) compared with singleton extremely preterm infants <29 weeks gestation.

Design Population-based retrospective cohort study.

Setting A network of 10 neonatal intensive care units in a geographically defined area of New South Wales and the Australian Capital territory.

Patients 1473 infants <29 weeks gestation born between 1 January 1998 and 31 December 2004.

Intervention At 2–3 years of corrected age, a neurodevelopmental assessment was conducted using either the Griffiths Mental Developmental Scales or the Bayley Scales of Infant Development II.

Main outcome measure Moderate–severe functional disability was defined as developmental delay (Griffiths Mental Developmental Scales General Quotient or Bayley Scales of Infant Development-II Mental Development Index >2 SDs below the mean), moderate cerebral palsy (unable to walk without aids), sensorineural or conductive deafness (requiring amplification) or bilateral blindness (visual acuity <6/60 in the better eye).

Results Of the 1081 singletons and 392 multiples followed-up, singletons demonstrated higher rates of systemic infections, steroid treatment for chronic lung disease and birth weight <10th percentile. Moderate–severe functional disability did not differ significantly between singletons and multiples (15.8% vs 17.6%, OR 1.14; 95% CI 0.84 to 1.54; p=0.464). Further subgroup analysis of twins, higher-order gestations, 1st-born multiples, 2nd or higher-born multiples, same and unlike gender multiples, did not demonstrate statistically higher rates of functional disability compared with singletons.

Conclusions Premature infants from multiple gestation pregnancies appear to have comparable neurodevelopmental outcomes to singletons.

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