Neonatal outcome of very premature infants from multiple and singleton gestations,☆☆,,★★

Presented at the Sixty-fourth Annual Meeting of the Society for Pediatric Research, Seattle, Washington, May 7-11, 1995.
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Abstract

Objectives: Our purpose was to determine whether, in the era of surfactant treatment, very premature neonates from multiple gestations have outcomes similar to those of singletons. Study design: We collected data on 572 infants (369 singletons, 203 multiple gestation) born and cared for at a single institution from July 1, 1992, through Dec. 31, 1994, of gestational ages 24 to 32 weeks. We compared singleton infants with infants from multiple gestations within gestational age categories 24 to 26 weeks, 27 to 29 weeks, and 30 to 32 weeks. Results: Infants of multiple gestations were more likely to have been born by cesarean section. The incidences of respiratory distress syndrome and bronchopulmonary dysplasia were similar, except that respiratory distress syndrome was more frequent in infants of multiple gestations at 30 to 32 weeks. Infants of multiple gestations from 27 to 29 weeks were more likely to have at least one of the following complications: patent ductus arteriosus, intraventricular hemorrhage, necrotizing enterocolitis, or retinopathy of prematurity. Further analysis suggested that this increase is unlikely to cause a difference in long-term outcome. The survival to discharge increased from 79% (multiples) and 81% (singletons) at 24 to 26 weeks to 98% (multiples) and 96% (singletons) at 30 to 32 weeks. Conclusions: Incidences of significant neonatal problems in very premature infants from multiple gestations who are born alive are little different from those of singletons. These data should have an impact on decision making in the perinatal and neonatal care of infants of multiple gestations.

Section snippets

Methods

The study is a retrospective evaluation of the neonatal outcome of all live-born infants of 24 to 32 weeks' gestation born at New England Medical Center from July 1, 1992, through Dec. 31, 1994. All deliveries were performed by the high-risk perinatology team at NEMC. The large majority of these deliveries were maternal referrals to the perinatology service from outlying hospitals. The gestational age used for this study was that which was assigned by the attending perinatologist at NEMC, with

Results

We were able to obtain data on all 572 infants born at NEMC and admitted to the NICU within the 30-month study period. Of these, 369 infants came from singleton pregnancies and 203 infants came from multiple gestations (subsequently referred to as multiples). The multiples were from 73 twin pregnancies, 18 triplet pregnancies, and 2 quadruplet pregnancies. Overall, there were 61, 112, and 196 singletons, and 39, 57, and 107 multiples in the categories of 24 to 26, 27 to 29, and 30 to 32 weeks,

Comment

It is well established that pregnancies carrying more than one fetus are more likely to be complicated.1, 2, 3, 4, 6 This study was performed to address the question of whether very premature live-born infants from multiple gestations had outcomes similar to those of premature singleton live-born infants. Although the neonatal outcome of multiple gestations has been described in several studies over the past 25 years, this study has important design and population features in comparison with

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    From the Division of Neonatology, Department of Pediatrics, the Floating Hospital for Infants and Children at New England Medical Center.

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    Supported by grant HL-37930 from the National Institutes of Health.

    Reprint requests: Heber C. Nielsen, MD, Division of Newborn Medicine, NEMC 97, Tufts New England Medical Center, 750 Washington St., Boston, MA 02111.

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    0002-9378/97 $5.00 + 0 6/1/82740

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