Neonatal complications and neurophysiological development in twins – a long-term follow-up study

Abstract

Objectives

To investigate the association between neonatal complications and neurophysiological development in twins at 18 and 48–60 months of age.

Methods

This was a secondary analysis of 841 Danish mono- and dichorionic diamniotic twins from a randomized controlled trial (PREDICT study), which included an assessment of the twin’s neurophysiological development using the Ages and Stages Questionnaire (ASQ) that had been filled out by the parents at 18 and 48 or 60 months. The correlation within twin pairs was accounted for by the method of generalized estimating equation. Models were adjusted for maternal educational score and gestational age at delivery.

Results

ASQ data were available for 823 children at 18 months and 425 children at 48 or 60 months. Low maternal educational score and preterm delivery <34 weeks were associated with a lower ASQ score at 48–60 months (−15.4 points (95%CI −26.4; −4.5) and −13.2 points (95%CI −23.8; −2.5), respectively). Neonatal sepsis and a compound of intraventricular hemorrhage, retinopathy of prematurity and necrotizing enterocolitis (IVH/ROP/NEC) were associated with lower ASQ score at 18 months (−15.3 points (95%CI −28.1; −2.5) and −30.8 points (95%CI −59.5; −2.1), respectively). Children with IVH/ROP/NEC had a lower ASQ score at 48–60 months (−34.2 points (95%CI −67.9; −0.6)). The associations were not specific to only one ASQ domain.

Conclusion

Several neonatal complications are associated with poorer neurophysiological development in twins during childhood, even after adjustment for gestational age at delivery.

Keywords:

• Ages and stages questionnaire
• neonatal complications
• neurophysiological development
• twins
• follow-up

Disclosure of interest

No potential conflict of interest was reported by the authors.

Additional information

Funding

The PREDICT study was funded by the Danish Medical Research Council, The Fetal Medicine Foundation, The Copenhagen University Hospital’s Research Fund, The Aase and Ejnar Danielsens Fund, The Augustinus Fund, The Ivan Nielsen Fund, the Sofus Carl Emil Friis and wife Olga Doris Friis’ Fund, the Simon Fougner Hartmanns Family Fund, The Danish Medical Society in Copenhagen and the AP Moeller Foundation. There was no additional funding for this study.