Introduction: It is impossible to achieve the target of Sustainable Developmental Goal without focusing on care of twins' neonates as they are more prone for death and higher chance of long-term morbidity and neurodevelopmental handicap in survivors. Aim: To estimate the outcome among twin and singleton neonates at a tertiary care teaching center of Eastern Maharashtra. Materials and Methods: Prospective observational study was conducted on neonatal intensive care unit graduates of twin birth and simultaneously admitted singletons at Government Medical College and Hospital Nagpur from June 2020 to February 2021 (9 months). Outcome among twin and singleton neonates, and their morbidity and mortality pattern were studied. Results: A total of 210 neonates of twin birth and 870 singleton neonates were recruited. Male were dominant in both groups. Preterm and low birth weight neonates were significantly more in twins compared to singleton neonates. Twin neonates were significantly more hypothermic (P < 0.001) and hypoxic (P = 0.001) compared to singleton. Jaundice (37.62%) and respiratory distress syndrome (36.67%) were the most common diagnosis in twin neonates while sepsis (34.71%) was predominant in singleton. Sepsis (33.9%) was the most common cause of death in singleton neonates while respiratory distress syndrome (35.38%) in twin births. Length of hospital stay (P < 0.0001) and neonatal mortality were significantly higher in twin neonates compared to singleton neonates (P = 0.001). Conclusion: Sepsis is the leading cause of admission and death in singleton neonates while respiratory distress syndrome in twins. Twin neonates have significantly higher mortality and longer hospital stay because of prematurity and low birth weight.

Background: The targets of Sustainable Development Goals cannot be achieved without reducing mortality of inborn as well as outborn neonates. Objective: The objective was to predict the mortality of neonates by applying Modified Sick Neonatal Score (MSNS). Material and Methods: Parameters of MSNS scoring system were applied to 450 neonates at the time of admission and followed up prospectively till discharge or death. The score and individual parameters were correlated with outcome. A receiver operating curve was plotted to determine the cutoff value for score to predict the mortality. Results: The common clinical diagnoses were respiratory distress (38%), sepsis (26%), and jaundice (14.44%). Sixty-two percent neonates were born at term and 38% were preterm while 55.56% neonates were low birth weight and 44.4% were weighted more than 2500 gms. Neonates who died were older at the time of admission, and duration of hospital stay was shorter compared to alive neonates (P < 0.001) with a mortality rate of 23.11%. The total MSNS for neonates who died was statistically significantly low, (mean ± standard deviation) 7.93 ± 2.70, compared to alive neonates, 12.02 ± 1.84 (P < 0.0001). With optimum cutoff score of ≤10, the sensitivity was 79.80% and the specificity was 82.37% while the positive predictive value and negative predictive value was 57.64% and 93.14% respectively with the area under curve was 0.89 (odds ratio-18.46, 95% confidence interval 10.3-33.64, P < 0.0001). Conclusion: The MSNS of ≤10 has a better sensitivity and specificity in predicting neonatal mortality and is easy to use with minimal resources to both preterm and term neonates.