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Abstract
Objective To know the association of birth order with the risk of morbidity and mortality in very low-birthweight (VLBW) twin infants less than 32 weeks’ gestational age (GA).
Design Retrospective cohort study.
Setting Infants admitted to the collaborating centres of the Spanish SEN1500 neonatal network.
Patients Liveborn VLBW twin infants, with GA from 23+0 weeks to 31+6 weeks, without congenital anomalies, admitted from 2011 to 2020. Outborn patients were excluded.
Main outcome measures Respiratory distress syndrome (RDS), patent ductus arteriosus, bronchopulmonary dysplasia (BPD), necrotising enterocolitis, major brain damage (MBD), late-onset neonatal sepsis, severe retinopathy of prematurity, survival and survival without morbidity. Crude and adjusted incidence rate ratios were calculated.
Results Among 2111 twin pairs included, the second twin had higher risk (adjusted risk ratio (aRR) of RDS (aRR 1.08, 95% CI 1.03 to 1.12) and need for surfactant (aRR1.10, 95% CI 1.05 to 1.16). No other significant differences were found, neither in survival (aRR 1.01, 95% CI 0.99 to 1.03) nor in survival without BPD (aRR 1.02, 95% CI 0.99 to 1.05), survival without MBD (aRR 1.02, 95% CI 0.99 to 1.06) nor in survival without major morbidity (aRR 0.97, 95% CI 0.92 to 1.03). However, second twins born by caesarean section (C-section) after a vaginally delivered first twin had less overall survival and survival without MBD.
Conclusion In modern perinatology, second twins are still more unstable immediately after birth and require more resuscitation. After admission to the neonatal intensive care unit, they are at increased risk of RDS, but not other conditions, except for second twins delivered by C-section after a first twin delivered vaginally, who have decreased overall survival and survival without major brain injury.
- mortality
- neonatology
- twins
- intensive care units, neonatal
- epidemiology
Data availability statement
Data are available upon reasonable request. The data supporting the findings of this study (deidentified participant data) are available upon request to the corresponding author.
Statistics from Altmetric.com
Data availability statement
Data are available upon reasonable request. The data supporting the findings of this study (deidentified participant data) are available upon request to the corresponding author.
Footnotes
Twitter @AlexAvila81
Collaborators Spanish SEN1500 Network: H. GERMANS TRIAS I PUJOL (Gemma Ginovart); H. CLÍNIC DE BARCELONA (Josep Figueras Aloy); H. U. BASURTO (Alberto Pérez Legorburu); H.G. DE CASTELLÓN (Ramon Aguilera Olmos); H.U. DE SAN CECILIO (J Uberos); H. DE LEON (Sandra Terroba); H. CARLOS HAYA (Tomás Sanchez-Tamayo); H.I. LA PAZ (Mª Dolores Elorza Fernandez); H. CLÍNICO SAN CARLOS (Araceli Corredera Sánchez); H. CENTRAL DE ASTURIAS (Belén Fernández Colomer); COMPLEXO HOSPITALARIO PONTEVEDRA (Mª Angeles Martinez Fernandez); H. UNIVERSITARIO MARQUES DE VALDECILLA (Mª Isabel de las Cuevas Terán); H. DONOSTIA (Miguel Ángel Cortajarena Altuna); H.U.I. VIRGEN DEL ROCÍO (Carmen Macias Díaz); H.U. DE CANARIAS (Pedro Fuster Jorge); H. MIGUEL SERVET (Segundo Rite Gracia); H.C.U. LOZANO BLESA (Mª Purificación Ventura Faci); H.U. LA FE (Mª Isabel Izquierdo Macián); H. VIRGEN DE LA SALUD (Ana Belén Escobar Izquierdo); H.C.U. DE SANTIAGO (Mª Luz Couce Pico); H.U. SALAMANCA (Elena Pilar Gutierrez González); H.G.U. GREGORIO MARAÑÓN (D. Blanco Bravo); H. SAN PEDRO DE LOGROÑO (Mª Yolanda Ruiz del Prado); H.U.M.I. LAS PALMAS (Lourdes Urquía Martí); H. DE CABUEÑES (Rafael Garcia Mozo); H.U. REINA SOFÍA (Mª Pilar Jaraba Caballero); H.U. DE BURGOS (Cristina de Frutos Martínez); SCIAS-H. BARCELONA (Sílvia Martínez-Nadal); H. SAN JOAN DE DEU (Martin Iriondo); H. DE CRUCES (Amaya Rodriguez Serna); H.G.U. DE ALICANTE (María Gonzalez Santacruz); H. VIRGEN DE LAS NIEVES (Maria Fernanda Moreno Galdo); CORPORACIO PARC TAULÍ (Joan Badia Barnusell); H.U. RIO HORTEGA (Mª Mar Montejo Vicente); H. TXAGORRITXU (Aintzane Euba); H. JUAN XXIII (Mar Albújar); H. DE GETAFE (Irene Cuadrado Perez); INSTITUT DEXEUS; COMPLEJO HOSPITALARIO ALBACETE (Andres Martinez Gutierrez); H. DE LA SANTA CREU I SANT PAU (Gemma Ginovart Galiana); H. SAN PEDRO DE ALCÁNTARA CÁCERES (Mª Jesús López Cuesta); H. SEVERO OCHOA (Mª José Santos Muñoz); ESTRUCTURA ORGANIZADA DE XESTIÓN INTEGRADA DE VIGO. HOSPITAL ALVARO CUNQUEIRO (María Suárez Albo); H. VIRGEN DE LA CONCHA - COMPLEJO ASISTENCIAL DE ZAMORA (Víctor Manuel Marugán Isabel); H. DE JEREZ (María Victoria Ramos Ramos); H. MONTEPRINCIPE (Gerardo Romera Modamio); H. DE ELCHE (Carolina Vizcaíno); H. JUAN RAMÓN JIMÉNEZ (David Mora Navarro); H. VALME DE SEVILLA (Laura Acosta Gordillo); H.U. ARNAU DE VILANOVA DE LLEIDA (Eduard Soler Mir); H. VIRGEN DE LA MACARENA DE SEVILLA (Mercedes Granero Asensio); H.C.U. DE VALENCIA (Dr. Javier Estañ Capell); H.G.U. DE CIUDAD REAL (Miguel Angel García Cabezas); H. DE LA ZARZUELA (D. López Gómez); H. U. DE GIRONA DR. JOSEP TRUETA (Alberto Trujillo Fagundo); H. DE GRANOLLERS (Israel Anquela Sanz); H. PUERTA DEL MAR (Antonio Segado Arenas); H. 12 DE OCTUBRE (Carmen Rosa Pallás Alonso); H.U. NUESTRA SEÑORA DE CANDELARIA (Sabina Romero); H. PUERTA DE HIERRO (Carmen González Armengod); H.U. SANTA LUCIA DE CARTAGENA (Jose María Lloreda García); H. FUENLABRADA (Laura Domingo Comeche); H.G. DE CATALUÑA (Laura Castells Vilella); H. VIRGEN DEL CAMINO DE PAMPLONA (Concepción Goñi Orayen); H.U. QUIRÓN; CLÍNICA CORACHÁN (Mª Dolores Muro Sebastian); COMPLEXO HOSPITALARIO UNIVERSITARIO DE A CORUÑA (Alejandro Avila-Alvarez); HOSPITAL HM PUERTA DEL SUR (Mara Fernandez Diaz); HOSPITAL QUIRÓN SAGRADO CORAZÓN (Elena García Victori); HOSPITAL UNIVERSITARIO FUNDACIÓN JIMENEZ DÍAZ (T. Carrizosa).
Contributors FG-MR, LUM and DRS conceptualised the study and carried out the initial design. MJGD and ILDPH curated the database, conducted the literature review and wrote the first draft. FG-MR carried out the statistical analysis. AA-A contributed to the literature review and suggested improvements to the manuscript and tables. All authors reviewed the manuscript, suggested improvement and approved the final version. FG-MR is responsible author for the overall content, had full access to the data, and accept the resposibility of its publication.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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