1. THE UNIVERSITY of TENNESSEE HEALTH SCIENCE CENTER.
Neonates Born after Multiple Gestation at the Edge of Viability- A review of Mortality and Morbidity over 20 years
Kirtikumar Upadhyay, MD; Ramasubbareddy Dhanireddy, MD; Ajay J. Talati, MD
Division of Neonatology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN.
THE UNIVERSITY of TENNESSEE HEALTH SCIENCE CENTER
All the Authors Have No Relevant Financial Relationships to Disclose or Conflict of Interests to Resolve
METHODS
Infants born alive at our center from 1989 to 2009 with birth weight ≤ 500 grams were studied. Infants with unreliable data at birth were excluded from study.
Infants were divided into two groups. Group 1 infants-singleton gestation and group 2 was infants with multiple gestation.
Data were collected for gestational age, gender, race, duration of hospitalization, survival to discharge, mortality and morbidities during NICU stay such as CLD, ROP, IVH and requirement of home oxygen/ ventilator care at discharge.
Data is presented as descriptive statistics using means and medians as appropriate. Two groups (singleton and multiple gestation) were compared using chi square test and p value <0.05 was considered significant.
RESULTS
Comparison of mortality and morbidity between singleton and multiple gestation
ABSTRACT
BACKGROUND: The incidence of multiple gestations has dramatically increased in last few years, particularly in industrialized world. This is partly contributed by the use of artificial reproductive technologies. Many of these infants are born prematurely. Several studies have shown that multiple gestation neonates are at increased risk of perinatal morbidity and mortality compared to singleton gestation neonates. However, data in literature for multiples with ≤500 gm birth weight are scarce. Decisions about approach to care of these infants are often very difficult. OBJECTIVE: To evaluate the characteristics such as mortality and morbidity of live born multiple gestation neonates and compare it with singleton live born neonates with ≤500 gm birth weight(BW) in our tertiary NICU. DESIGN/METHODS: A retrospective database review of neonates born with BW was ≤500 gm and admitted to the NICU from August 1989 to Sept RESULTS: Out of 22,672 total admissions, 219 had BW ≤500 gm. Seven babies were excluded from the study due to unreliable data. Out of 212 neonates with BW ≤500 gm, Group 1 was 160 singleton gestation neonates and Group 2 was 52 multiple gestations (2 sets triplets, 23 twins). There was no significant difference in mode of delivery and antenatal steroids. Mean BW, gestational age, gender and race between these two groups were similar. 51 (32%) in singleton neonates of infants survived to discharge in Group1 compared to 10 (19%) in group 2 (p-0.1). Only 6% of neonates in group 1 had IVH grade III- IV compared to 70% in group 2 (p ). While only 42% neonates received home care at discharge in group 1, 80% needed home care in group 2 (p-0.003). There was no significant difference in chronic lung disease(CLD), retinopathy of prematurity(ROP), between these two groups. CONCLUSIONS: Prognosis in multiple gestations remains worse even at edge of viability compared to singletons. . P=
P= 0.003 .
INTRODUCTION
Multiple gestations represent 1-2% of total live births. In general, the fetuses of multiple gestations are more likely to have congenital anomalies and to deliver preterm. During the past 25 years, studies have produced conflicting findings about morbidity and mortality in multiple gestation infants compared with singletons. Some studies have reported significant neurologic deficits, such as cerebral palsy, in twins whereas others have reported milder morbidity such as early language delay and slightly lower IQ scores in twins than in singletons. On the other hand, studies that have carefully controlled for birth weight and/or gestational age in comparing twins with singletons generally find no differences in either neonatal morbidity or subsequent neurologic and developmental outcome. These data are not clear for extremely low birth weigh infants and in addition, till date, no study has been done to observe mortality and morbidity of multiple gestations compared to singletons in infants at the edge of viability.
OBJECTIVE
To evaluate the characteristics such as mortality and morbidity of live born multiple gestation neonates and compare it with singleton live born neonates with ≤500 gm birth weight(BW) in our tertiary NICU.
SUMMARY
A significant number of neonates with ≤500 gm BW survived in both groups during the past 20 years. However, survival was not different between singleton and multiple gestation.
There was no significant difference in BW, gestational age, race and gender between these two groups.
CLD and ROP were not different between two groups, however, IVH grade III-IV and requirement of home care was significantly higher in multiple gestation compared to singleton babies.
CONCLUSIONS
Prognosis in multiple gestation remains worse even at edge of viability compared to singletons.
Total
Survived
Mean BW (gm)
Median GA (wk)
Male
White
Black
Others
Singleton
160 51
(31.8%)
459.08 24
32 (20%) 45
(28%)
112
(70%)
3 (2%)
Multiple gestation 52
10 (19.2%)
455.70
16 (30%) 26
(50%)
(46%)
2 (4%)