 |
Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2021, vol. 27, issue3
Subject Area: Medicine
-
DOI: 10.5272/jimab.2021273.3985
Published online: 29 September 2021
Original article
J of IMAB. 2021 Jul-Sep;27(3):3985-3991
IMPACT OF MULTIPLE BIRTHS ON THE OUTCOME IN EXTREMELY LOW BIRTH WEIGHT NEWBORNS
Victoria Atanasova1, 2
, Petar Ivanov3, 4, Elitsa Gyokova2, 5, Desislava Georgieva6, Lyuben Veskov1, 2,
1) Clinic of Neonatology, UMHAT 'Dr. G. Stranski’, Pleven, Bulgaria.
2) Department of Obstetrics and Gynecology, Medical University of Pleven, Bulgaria.
3) Clinical Institute for Reproductive Medicine, Pleven, Bulgaria.
4) Department of Biochemistry, Medical University, Pleven, Bulgaria.
5) Clinic of Obstetrics and Gynecology, UMHAT 'Dr. G. Stranski’, Pleven, Bulgaria.
6) Home of medical and social care for children, Pleven, Bulgaria.
ABSTRACT:
Objective: To evaluate the outcome of the extremely low birth weight newborns (ELBWNs) from single and twin pregnancies.
Material and methods: The study lasts from 2005 to 2017 and includes all life born ELBWNs treated in University Hospital, Pleven, Bulgaria. Patients' groups: singletons (1) and twins (2); twins conceived naturally(2.1) and after assisted reproductive technologies – ART(2.2).
Results: One hundred and eighty two (182) ELBWNs are examined, 65 (35.7%) of them are twins. The twins, compared to singletons, are significantly more often conceived by ART (47.7 vs 4.3%, p<0.001) and significantly more rarely infected prenatally (18 vs 41%, p 0.002). The survival rate is 51.3% for singletons and 56.6% for twins, NS.
Survived twins (n 37) achieve later their optimal nutritive tolerance (30±11 vs 25±10 days, p 0.046), require more blood transfusions (3.6±1.9 vs 2.6±1.8 per patient, p 0.009) and longer mechanical ventilation (16±15 vs 9±12 days, p 0.03) than survival singletons (n 60).
The twins suffer more often from intraventricular haemorrhage (46 vs 18%, p 0.004), patent ductus arteriosus (35 vs 15%, p 0.02) and long-term complications (51 vs 30%, p 0.04) than singletons.
ART-twins (n 31)compared to the subgroup 2.1 (n 34) are more frequently intubated in the delivery room (81 vs. 50%, p 0.01)but suffer less frequently from nosocomial infections (53 vs. 85%, p 0.03).
Conclusions: According to our data, ELBW-twins frequently suffer from respiratory, haemorrhagic, and gastrointestinal problems than ELBW-singletons, resulting in more long-term complications.
Our study proves that ART does not influence the outcome in multiples.
Keywords: newborn, twins, extremely low birth weight, assisted reproductive technology, follow-up,
- Download FULL TEXT /PDF 1271 KB/
Please cite this article as: Atanasova V, Ivanov P, Gyokova E, Georgieva D, Veskov L. Impact of multiple births on the outcome in extremely low birth weight newborns. J of IMAB. 2021 Jul-Sep;27(3):3985-3991. DOI: 10.5272/jimab.2021273.3985
Correspondence to: Victoria Atanasova, Clinic of Neonatology, UMHAT 'Dr. G. Stranski', Pleven; Department of Obstetrics and Gynecology, Medical University of Pleven; 91, Gen. Vladimir Vazoff Str., Second Clinical Base Pleven, Bulgaria; E-mail: victoria_atanasova@yahoo.co.uk
REFERENCES:
1. Jobe AH, Bancalari E. Bronchopulmonary Dysplasia. Am J Respir Crit Care Med. 2001 Jun;163(7):1723-9. [PubMed]
2. International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol. 2005 Jul;123(7):991-9. [PubMed]
3. Caplan MS, Jilling T. New concepts in necrotizing enterocolitis. Curr Opin Pediatr. 2001 Apr;13(2):111-5. [PubMed]
4. Inder TE, Perlman JM, Volpe JJ. Chapter 24 - Preterm IVH/Posthemorrhagic Hydrocephalus. In: Volpe's Neurology of the Newborn. 6th Edition. Elsevier. 2018. Pages 637-698.e21. [Crossref]
5. Broughton< DE, Jungheim ES. 7 - Multiple Gestations and Assisted Reproductive Technology. In: Avery's Diseases of the Newborn. Tenth Edition. Editors Gleason CA, Juul SE. Elsevier. 2018. Part II. Chapter 7, pp.70-77.e4. [Crossref]
6. Franca MS, Hamamoto TENK, Moron AF. Preterm Birth in Twins. In: Multiple Pregnancy - New Challenges. Edited by Elito J. Jr. IntechOpen. December 14th 2018. Chapter 9, p.684. [Crossref
7. Hack KE, Derks JB, Elias SG, Franx A, RoosEJ, Voerman SK, et al. Increased perinatal mortality and morbidity in monochorionic versus dichorionic twin pregnancies: clinical implications of a large Dutch cohort study. BJOG. 2008 Jan;115(1):58-67. [PubMed]
8. ACOG Practice Bulletin No. 144: Multifetal gestations: twin, triplet, and higher-order multifetal pregnancies. Obstet Gynecol. 2014 May;123(5):1118-32. [PubMed]
9. Shinwell ES. Neonatal morbidity of very low birth weight infants from multiple pregnancies. Obstet Gynecol Clin North Am. 2005 Mar;32(1):29-38, viii. [PubMed]
10. Atanasova V. Follow up of physical and neuropsychological development of children born before 33rd GW [in Bulgarian] MedInfo. 2017; 01:64-67.
11. Qiu X, Lee SK, Tan K, Piedboeuf B, Canning R; Canadian Neonatal Network. Comparison of singleton and multiple-birth outcomes of infants born at or before 32 weeks of gestation. Obstet Gynecol. 2008 Feb;111(2 Pt 1):365-71. [PubMed]
12. Garite TJ, Clark RH, Elliott JP, Thorp JA. Twins and triplets: the effect of plurality and growth on neonatal outcome compared with singleton infants. Am J Obstet Gynecol. 2004 Sep;191(3):700-7. [PubMed]
13. Blickstein I, Goldman RD, Mazkereth R. Risk for one or two very low birth weight twins: a population study. Obstet Gynecol. 2000 Sep;96(3):400-2. [PubMed]
14. Wright VC, Chang J, Jeng G, Macaluso M; Centers for Disease Control and Prevention (CDC). Assisted reproductive technology surveillance--United States, 2005. MMWR Surveill Summ. 2008 Jun 20;57(5):1-23. [PubMed]
15. Ortibus E, Lopriore E, Deprest J, Vandenbussche FP, Walther FJ, Diemert A, et al. The pregnancy and long-term neurodevelopmental outcome of monochorionic diamniotic twin gestations: a multicenter prospective cohort study from the first trimester onward. Am J Obstet Gynecol. 2009 May;200(5):494.e1-8. [PubMed]
16. Garg P, Abdel-Latif ME, Bolisetty S, Bajuk B, Vincent T, Lui K. Perinatal characteristics and outcome of preterm singleton, twin and triplet infants in New South Wales and the ACT, Australia (1994–2005). Arch Dis Child Fetal Neonatal Ed. 2010 Jan;95(1):F20-4. [PubMed]
17. Helmerhorst FM, Perquin DA, Donker D, Keirse MJ. Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies. BMJ. 2004 Jan 31;328(7434):261. [PubMed]
18. Sullivan EA, Wang YA, Hayward I, Chambers GM, Illingworth P, McBain J, et al. Single embryo transfer reduces the risk of perinatal mortality, a population study. Hum Reprod. 2012 Dec;27(12):3609-15. [PubMed]
19. Shah PS, Kusuda S, Hakansson S, Reichman B, Lui K, Lehtonen L, et al. Neonatal outcomes of very preterm and very low birth weight triplets. Pediatrics. 2018 Dec;142(6):e20181938. [PubMed]
20. Yeo KT, Lee QY, Quek WS, Wang YA, Bolisetty S, Lui K, et al. Trends in Morbidity and Mortality of Extremely Preterm Multiple Gestation Newborns. Pediatrics. 2015 Aug;136(2):263-71. [PubMed].
Received: 11 February 2021
Published online: 29 September 2021