Neonatal outcomes of preterm twins according to mode of birth and presentation

Abstract

Purpose: To compare neonatal outcomes of twins delivered <33 weeks’ gestation in tertiary centers in Canada according to the mode of birth and presentation.

Materials and methods: This retrospective cohort from the Canadian Neonatal Network database studied preterm twins born from 24 + 0 to 32 + 6 weeks’ gestation between 2005 and 2012. Twins were grouped by the mode of birth: both vaginal, combined vaginal/cesarean section (CS), and both CS. Additionally, twins were grouped by the mode of presentation: both vertex, vertex/breech, breech/vertex, and both breech. The primary outcome was a composite of mortality or severe neonatal morbidity (severe neurological injury [intraventricular hemorrhage grade 3/4 or periventricular leukomalacia], bronchopulmonary dysplasia, retinopathy of prematurity, and necrotizing enterocolitis).

Results: Of the 6636 twins, 1934 (29%) were delivered vaginally, 418 (6%) by combined vaginal birth/CS, and 4284 (65%) were born by CS. The composite did not differ between the groups. However, severe neurological injury was decreased (adjusted odds ratio [AOR], 0.77; 95% confidence interval [CI], 0.61–0.98) and respiratory distress syndrome (AOR, 1.34; 95%CI, 1.15–1.56) was increased when both the twins were delivered by CS.

Conclusions: Preterm twin infants born via CS experienced less severe neurological injury when compared to those delivered vaginally, but had an increase in respiratory distress syndrome.

Keywords:

• Infant
• premature
• multiple pregnancy
• mortality
• neurological injury
• respiratory distress syndrome
• mode of delivery

Acknowledgements

The authors would like to thank the staff of the Canadian Neonatal Network (CNN) Coordinating Centre for their hard work. We would also like to thank Dr. Ruth Warre from the Maternal-Infant Care Research Centre (MiCare) and Josie Chundamala, Scientific Grant Editor in the Department of Obstetrics and Gynaecology at Mount Sinai Hospital, for editorial help during manuscript preparation. Although no funding was received specifically for this study, the CNN Coordinating Centre is based at MiCare in Mount Sinai Hospital, Toronto, Ontario, Canada. MiCare is supported by grant funding from the Canadian Institutes of Health Research and in-kind support from Mount Sinai Hospital, Toronto. The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Site Investigators of the Canadian Neonatal Network (Collaborators)

Prakesh S Shah, MD, MSc (Director, Canadian Neonatal Network), Mount Sinai Hospital, Toronto, Ontario; Adele Harrison, MD, MBChB, Victoria General Hospital, Victoria, British Columbia; Anne Synnes, MDCM, MHSC, British Columbia Children’s Hospital, Vancouver, British Columbia; Todd Sokoran, MD, Royal Columbian Hospital, New Westminster, British Columbia and Surrey Memorial Hospital, Surrey, British Columbia; Wendy Yee, MD, Foothills Medical Centre, Calgary, Alberta; Khalid Aziz, MBBS, MA, MEd, Royal Alexandra Hospital, Edmonton, Alberta; Zarin Kalapesi, MD, Regina General Hospital, Regina, Saskatchewan; Koravangattu Sankaran, MD, MBBS, Royal University Hospital, Saskatoon, Saskatchewan; Mary Seshia, MBChB, Winnipeg Health Sciences Centre, Winnipeg, Manitoba; Ruben Alvaro, MD, St. Boniface General Hospital, Winnipeg, Manitoba; Sandesh Shivananda, MBBS, MD, DM, Hamilton Health Sciences Centre, Hamilton, Ontario; Orlando Da Silva, MD, MSc, London Health Sciences Centre, London, Ontario; Chuks Nwaesei, MD, Windsor Regional Hospital, Windsor, Ontario; Kyong-Soon Lee, MD, MSc, Hospital for Sick Children, Toronto, Ontario; Michael Dunn, MD, Sunnybrook Health Sciences Centre, Toronto, Ontario; Nicole Rouvinez-Bouali, MD, Children’s Hospital of Eastern Ontario and Ottawa General Hospital, Ottawa, Ontario; Kimberly Dow, MD, Kingston General Hospital, Kingston, Ontario; Ermelinda Pelausa, MD, Jewish General Hospital, Montréal, Québec; Keith Barrington, MBChB, Hôpital Sainte-Justine, Montréal, Québec; Christine Drolet, MD, Centre Hospitalier Universitaire de Québec, Sainte Foy Québec; Patricia Riley, MD, MDCM, BSc, Montréal Children’s Hospital, Montréal, Québec and Royal Victoria Hospital, Montréal, Québec; Valerie Bertelle, MD, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec; Rody Canning, MD, Moncton Hospital, Moncton, New Brunswick; Barbara Bulleid, MD, Dr. Everett Chalmers Hospital, Fredericton, New Brunswick; Cecil Ojah, MBBS, and Luis Monterrosa, MD, Saint John Regional Hospital, Saint John, New Brunswick; Akhil Deshpandey, MD, MBBS, Janeway Children’s Health and Rehabilitation Centre, St. John’s, Newfoundland; Jehier Afifi, MB BCh, MSc, IWK Health Centre, Halifax, Nova Scotia; Andrzej Kajetanowicz, MD, Cape Breton Regional Hospital, Sydney, Nova Scotia; Shoo K Lee, MBBS, PhD (Chairman, Canadian Neonatal Network), Mount Sinai Hospital, Toronto, Ontario.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

Although no funding was received specifically for this study, the CNN Coordinating Centre is based at MiCare in Mount Sinai Hospital, Toronto, Ontario, Canada. MiCare is supported by grant funding from the Canadian Institutes of Health Research and in-kind support from Mount Sinai Hospital, Toronto.