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Fetal or infant death in twin pregnancy: neurodevelopmental consequence for the survivor
  1. S V Glinianaia1,
  2. P O D Pharoah1,
  3. C Wright2,
  4. J M Rankin1,
  5. On Behalf Of The Northern Region Perinatal Mortality Survey Steering
  1. 1Department of Epidemiology and Public Health, and Regional Maternity Survey Office, University of Newcastle, Newcastle upon Tyne NE2 4HH, UK
  2. 2Department of Pathology and Regional Maternity Survey Office, 25 Claremont Place, Newcastle upon Tyne NE2 4AA, UK
  1. Correspondence to:
    Dr Glinianaia, Department of Epidemiology and Public Health, School of Health Sciences, The Medical School, University of Newcastle, Framlington Place, Newcastle upon Tyne NE2 4HH, UK;
    svetlana.glinianaia{at}ncl.ac.uk

Abstract

Aim: To determine the neurodevelopmental morbidity in the surviving twin after fetal or infant death of the co-twin.

Methods: Twin pregnancies with an antepartum or infant death delivered between 1981 and 1992 were identified from the Northern Perinatal Mortality Survey. Information on the neurodevelopmental morbidity of infant survivors of a deceased co-twin was obtained by a questionnaire sent to the community paediatrician or general practitioner.

Results: A total of 111 children who survived infancy after the fetal death of the co-twin (group 1) and 142 from liveborn twin pairs in which one twin died in infancy (group 2) were traced. Responses were received from 97 (87%) and 130 (92%) respectively. In group 1, the cerebral palsy prevalence was 93 (95% confidence interval (CI) 43 to 169) per 1000 infant survivors; it was more common in like-sex pairs (8/70) with a prevalence of 114 (95% CI 51 to 213) compared with 45 (95% CI 1 to 228) per 1000 infant survivors in unlike-sex pairs (1/22). The overall prevalence of neurodevelopmental morbidity (including developmental delay) was 175 (95% CI 106 to 266) per 1000. In group 2, the cerebral palsy prevalence was 154 (95% CI 84 to 223) per 1000 infant survivors in like-sex (16/104) and 77 (95% CI 9 to 251) in unlike-sex (2/26) survivors; the overall prevalence of neurodevelopmental morbidity was 246 (95% CI 172 to 320) per 1000.

Conclusions: The risk of cerebral palsy is increased in the surviving twin after a fetal or infant co-twin death compared with the general twin population. Like-sex twins are at greater risk than unlike-sex. The probable cause, in addition to the consequences of prematurity, is twin-twin transfusion problems associated with monochorionicity.

  • cerebral palsy
  • twins
  • twin-twin transfusion
  • gestational age
  • PMS, Northern Perinatal Mortality Survey
  • CI, confidence interval

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