Comparison of neonatal outcomes between multiples and singletons among very low birth weight infants: the Korean Neonatal Network cohort study

Abstract

Objective

To compare neonatal outcomes between multiples and singletons among very low birth weight infants, this was a prospective cohort study that was conducted by collecting data registered in the Korean Neonatal Network database.

Methods

From January 2013 to December 2016, there were 8265 infants in the Korean Neonatal Network database, and 2958 of them were from multiples. Among them, 2636 infants were twins, 308 infants were triplets, and 14 infants were quadruplets. Maternal and neonatal variables including and mortality major morbidity were compared. Finally, the predicted rates of major morbidity between singletons and multiples.

Results

Multiples had higher gestational age, birth weight, Apgar score at 5 min, rates of cesarean section and artificial reproductive technology but lower maternal hypertension, oligohydramnios, chorioamnionitis rates and Clinical Risk Index for Babies scores II without base excess than the singletons. In univariate analysis, multiples had a lower incidence of respiratory distress syndrome, bronchopulmonary dysplasia, and sepsis. The mortality rate was not significantly different for overall gestational ages except for those born at ≤26 weeks of gestation. In multivariate logistic analysis, the incidences of intraventricular hemorrhage (grade ≥3), and retinopathy of prematurity requiring treatment were significantly higher than the singletons.

Conclusions

Mortality was not significantly different between multiples and singletons according to overall gestational age, except for multiples born at ≤26 weeks. A significant higher risk of intraventricular hemorrhage and retinopathy of prematurity requiring treatment was found in multiples. A new strategy to improve the mortality of immature multiples born at ≤26 weeks of gestation should be developed.

Graphical abstract

Keywords:

• Pregnancy
• multiple
• infant
• very low birth weight
• outcome

Acknowledgements

We thank all patients for their generous contributions. We also thank the members of the Korean Neonatal Network (KNN).

Author contributions

J.H.L., J.H.H., H.G.J., and S.C. conceptualized, designed, investigated and conducted research and wrote manuscripts. O.K.N., J.H.L., J.H.H., H.G.J., and S.C. formally analyzed the data. J.H.L. and J.H.H. critically reviewed and supervised the manuscript. All authors approved the final version of the manuscript.

Disclosure statement

The authors report there are no competing interests to declare.

Research data

All the data generated and/or analyzed during the current study are included in this article and are available from the corresponding author upon reasonable request.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supprted by a fund(2022-ER0603-01#) by Research of the Korea National Institute of Health.)