Background There is a paucity of recent, prospectively collected data comparing outcomes between singletons and twins born at late and moderately preterm (32–36 weeks; LMPT) gestations.

Methods In a prospective, geographically defined, population-based study of babies born at 32–36 weeks gestation we compared neonatal outcomes in normally formed singletons and multiples.

Results We recruited 200 LMPT and 274 term-born multiples, together with 907 live-born LMPT singletons. Within the LMPT group a greater proportion of singletons than multiples had jaundice (9.3% v 6.5%; P = 0.049) and hypoglycaemia (21.9% v 15.5%; P = 0.055). Other outcomes were similar between groups. Among multiples, those born LMPT were more likely to require resuscitation at birth (20.5% v 11.3%; P = 0.007), neonatal unit admission (43.0% v 8.4%; P < 0.001) and respiratory support (28.0% v 0.7%; P < 0.001). There were higher rates of jaundice (15.5% v 1.5%; P > 0.001) and hypothermia (6.5% v 2.6%; P = 0.042) in LMPT multiples and breast-feeding at discharge was lower (53.5% v 64.6%; P = 0.018) compared with term-born multiples.

Conclusions Our results suggest that many neonatal outcomes are similar between singletons and multiples and but some morbidities are reduced in multiples. LMPT multiples have poorer outcomes than their term-born counterparts. Differing maternal health, socioeconomic status, and indications for delivery in singletons and twins are likely to be key influences on neonatal outcome; postnatal management may also be important. Further analysis will explore factors contributing to birth at 32–36 weeks of gestation and neonatal outcomes. Follow-up will be crucial to determine any differences in long-term outcome related to prematurity or plurality.