Do late preterm twins face an increased neonatal morbidity compared with singletons?
Late preterm infants (born between 34 0/7 and 36 6/7 weeks of gestation) have been shown to have a higher morbidity and mortality than term infants. Furthermore, twins, both term and preterm, have a higher neonatal morbidity than singletons. The aim of our study was to examine if late preterm twins consequently have twice the neonatal morbidity when both risk factors prematurity and multiple pregnancy are present.
A retrospective single-centre study was conducted to compare neonatal outcome of late preterm singletons and late preterm twins born between 34 0/7 and 36 6/7 weeks of gestation as well as term twins with a gestational age from 37 0/7 to 41 6/7 weeks. Primary outcome was length of hospitalisation. Secondary outcome was neonatal morbidity.
A total of 845 infants were included. Late preterm twins (n = 243) were hospitalised significantly longer than term twins (n = 107) (13.5 ± 8.0 vs 6.29 ± 2.0 days, p <0.001) and late preterm singletons (n = 495) (13.5 ± 8.0 vs 12.6 ± 8.6 days, p = 0.011). Hyperbilirubinaemia occurred significantly more often in late preterm singletons than in late preterm twins (49.7 vs 29.2%; p<0.001). Otherwise, no significant differences were detected regarding neonatal morbidities or mortality of late preterm singletons and late preterm twins. Late preterm twins had a significantly higher incidence of most morbidities than term twins.
Late preterm twins are hospitalised significantly longer than similar-aged singletons, but have otherwise similar neonatal morbidities. Hyperbilirubinaemia is less frequent in late preterm twins than late preterm singletons.
- Engle WA, Tomashek KM, Wallman C ; Committee on Fetus and Newborn, American Academy of Pediatrics. “Late-preterm” infants: a population at risk. Pediatrics. 2007;120(6):1390–401. doi:.https://doi.org/10.1542/peds.2007-2952
- Raju TN. Epidemiology of late preterm (near-term) births. Clin Perinatol. 2006;33(4):751–63, abstract vii. doi:.https://doi.org/10.1016/j.clp.2006.09.009
- Cheong JL, Doyle LW. Increasing rates of prematurity and epidemiology of late preterm birth. J Paediatr Child Health. 2012;48(9):784–8. doi:.https://doi.org/10.1111/j.1440-1754.2012.02536.x
- Leone A, Ersfeld P, Adams M, Meyer Schiffer P, Bucher HU, Arlettaz R. Neonatal morbidity in singleton late preterm infants compared with full-term infants. Acta Paediatr. 2012;101(1):e6–10. doi:.https://doi.org/10.1111/j.1651-2227.2011.02459.x
- Refuerzo JS, Momirova V, Peaceman AM, Sciscione A, Rouse DJ, Caritis SN, et al.; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Neonatal outcomes in twin pregnancies delivered moderately preterm, late preterm, and term. Am J Perinatol. 2010;27(7):537–42. doi:.https://doi.org/10.1055/s-0030-1248940
- Bhutani VK. Multidisciplinary guidelines for the care of late preterm infants. J Perinatol. 2014;34(1):81. doi:.https://doi.org/10.1038/jp.2013.126
- Cheng YW, Kaimal AJ, Bruckner TA, Halloran DR, Caughey AB. Perinatal morbidity associated with late preterm deliveries compared with deliveries between 37 and 40 weeks of gestation. BJOG. 2011;118(12):1446–54. doi:.https://doi.org/10.1111/j.1471-0528.2011.03045.x
- Melamed N, Klinger G, Tenenbaum-Gavish K, Herscovici T, Linder N, Hod M, et al. Short-term neonatal outcome in low-risk, spontaneous, singleton, late preterm deliveries. Obstet Gynecol. 2009;114(2 Pt 1):253–60. doi:.https://doi.org/10.1097/AOG.0b013e3181af6931
- McIntire DD, Leveno KJ. Neonatal mortality and morbidity rates in late preterm births compared with births at term. Obstet Gynecol. 2008;111(1):35–41. doi:.https://doi.org/10.1097/01.AOG.0000297311.33046.73
- Raju TN. Developmental physiology of late and moderate prematurity. Semin Fetal Neonatal Med. 2012;17(3):126–31. doi:.https://doi.org/10.1016/j.siny.2012.01.010
- Shapiro-Mendoza CK, Lackritz EM. Epidemiology of late and moderate preterm birth. Semin Fetal Neonatal Med. 2012;17(3):120–5. doi:.https://doi.org/10.1016/j.siny.2012.01.007
- Shapiro-Mendoza CK, Tomashek KM, Kotelchuck M, Barfield W, Weiss J, Evans S. Risk factors for neonatal morbidity and mortality among “healthy,” late preterm newborns. Semin Perinatol. 2006;30(2):54–60. doi:.https://doi.org/10.1053/j.semperi.2006.02.002
- Refuerzo JS. Impact of multiple births on late and moderate prematurity. Semin Fetal Neonatal Med. 2012;17(3):143–5. doi:.https://doi.org/10.1016/j.siny.2012.01.012
- Beemsterboer SN, Homburg R, Gorter NA, Schats R, Hompes PG, Lambalk CB. The paradox of declining fertility but increasing twinning rates with advancing maternal age. Hum Reprod. 2006;21(6):1531–2. doi:.https://doi.org/10.1093/humrep/del009
- Mally PV, Bailey S, Hendricks-Muñoz KD. Clinical issues in the management of late preterm infants. Curr Probl Pediatr Adolesc Health Care. 2010;40(9):218–33. doi:.https://doi.org/10.1016/j.cppeds.2010.07.005
- Lee YM, Cleary-Goldman J, D’Alton ME. The impact of multiple gestations on late preterm (near-term) births. Clin Perinatol. 2006;33(4):777–92, abstract viii. doi:.https://doi.org/10.1016/j.clp.2006.09.008
- Tranquilli AL. Introduction to ISSHP new classification of preeclampsia. Pregnancy Hypertens. 2013;3(2):58–9. doi:.https://doi.org/10.1016/j.preghy.2013.04.006
- Arlettaz RBA, Buetti L, Fahnenstich H, Mieth D, Roth-Kleiner M. Evaluation and treatment of hyperbilirubinaemia in near term/full term neonates (gestational age of at least 35 0/7 weeks). Paediatrica. 2006;17(3):26–9.
- Berger TMD-KS, Pfister RE, Pfister R, Stocker M, Zimmermann U. Prevention and therapy of hypoglycemia in infants with a gestational age above 34 0/7 weeks in maternity wards http://www.neonet.ch/files/4114/2597/8496/2007_Hypoglykaemie_e.pdf
- Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978;187(1):1–7. doi:.https://doi.org/10.1097/00000658-197801000-00001
- Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978;92(4):529–34. doi:.https://doi.org/10.1016/S0022-3476(78)80282-0
- Ribicic R, Kranjcec I, Borosak J, Tumbri J, Mihovilovic Prajz L, Ribicic T. Perinatal outcome of singleton versus twin late preterm infants: do twins mature faster than singletons? J Matern Fetal Neonatal Med. 2016;29(9):1520–4. doi:.https://doi.org/10.3109/14767058.2015.1053449
- Shah J, Shah PS, Jefferies A. Hematological parameters immediately after birth in twins and higher order multiples. Am J Perinatol. 2015;32(7):653–8. doi:.https://doi.org/10.1055/s-0034-1390353
- Kitsommart R, Janes M, Mahajan V, Rahman A, Seidlitz W, Wilson J, et al. Outcomes of late-preterm infants: a retrospective, single-center, Canadian study. Clin Pediatr (Phila). 2009;48(8):844–50. doi:.https://doi.org/10.1177/0009922809340432
- Barrett JF, Hannah ME, Hutton EK, Willan AR, Allen AC, Armson BA, et al.; Twin Birth Study Collaborative Group. A randomized trial of planned cesarean or vaginal delivery for twin pregnancy. N Engl J Med. 2013;369(14):1295–305. doi:.https://doi.org/10.1056/NEJMoa1214939
- Kolås T, Saugstad OD, Daltveit AK, Nilsen ST, Øian P. Planned cesarean versus planned vaginal delivery at term: comparison of newborn infant outcomes. Am J Obstet Gynecol. 2006;195(6):1538–43. doi:.https://doi.org/10.1016/j.ajog.2006.05.005
- Kitsommart R, Phatihattakorn C, Pornladnun P, Paes B. A prospective study of the severity of early respiratory distress in late preterms compared to term infants. J Matern Fetal Neonatal Med. 2016;29(2):207–12. doi:.https://doi.org/10.3109/14767058.2014.992335
- Vachharajani AJ, Vachharajani NA, Dawson JG. Comparison of short-term outcomes of late preterm singletons and multiple births: an institutional experience. Clin Pediatr (Phila). 2009;48(9):922–5. doi:.https://doi.org/10.1177/0009922809336359
- Breathnach FM, McAuliffe FM, Geary M, Daly S, Higgins JR, Dornan J, et al.; Perinatal Ireland Research Consortium. Optimum timing for planned delivery of uncomplicated monochorionic and dichorionic twin pregnancies. Obstet Gynecol. 2012;119(1):50–9. doi:.https://doi.org/10.1097/AOG.0b013e31823d7b06
- Langenveld J, Ravelli AC, van Kaam AH, van der Ham DP, van Pampus MG, Porath M, et al. Neonatal outcome of pregnancies complicated by hypertensive disorders between 34 and 37 weeks of gestation: a 7 year retrospective analysis of a national registry. Am J Obstet Gynecol. 2011;205(6):540.e1–7. doi:.https://doi.org/10.1016/j.ajog.2011.07.003
- Baumann MU, Marti M, Durrer L, Koumoutsakos P, Angelikopoulos P, Bolla D, et al. Placental plasticity in monochorionic twins: Impact on birth weight and placental weight. Placenta. 2015;36(9):1018–23. doi:.https://doi.org/10.1016/j.placenta.2015.07.120
- Talge NM, Holzman C, Wang J, Lucia V, Gardiner J, Breslau N. Late-preterm birth and its association with cognitive and socioemotional outcomes at 6 years of age. Pediatrics. 2010;126(6):1124–31. doi:.https://doi.org/10.1542/peds.2010-1536
- Woythaler MA, McCormick MC, Smith VC. Late preterm infants have worse 24-month neurodevelopmental outcomes than term infants. Pediatrics. 2011;127(3):e622–9. doi:.https://doi.org/10.1542/peds.2009-3598
- Guy A, Seaton SE, Boyle EM, Draper ES, Field DJ, Manktelow BN, et al. Infants born late/moderately preterm are at increased risk for a positive autism screen at 2 years of age. J Pediatr. 2015;166(2):269–75.e3. doi:.https://doi.org/10.1016/j.jpeds.2014.10.053