Does birth weight discordance in preterm twins affect neonatal outcome?

Kılıç, Mehtap; Aygün, Canan; Kaynar-Tunçel, E; Küçüködük, Şükrü

doi:10.1038/sj.jp.7211495

Cited by 21 publications

(19 citation statements)

References 20 publications

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“…Three studies (7468 twins) explored the risk of composite neonatal morbidity in twins compared with those without a BW discordance ≥15% (Figure ) . When considering all twin pregnancies, the risk of composite morbidities was higher in twins with compared to those without a BW discordance ≥15% (OR 1.4, 95% CI 1.0‐1.9; I 2 = 52%, P = 0.05).…”

Section: Resultsmentioning

confidence: 99%

Birthweight discordance and neonatal morbidity in twin pregnancies: A systematic review and meta‐analysis

Mascio

Acharya

Khalil

et al. 2019

Acta Obstet Gynecol Scand

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Introduction The aim of this systematic review was to quantify the association between birthweight discordance and neonatal morbidity in twin pregnancies. Material and methods MEDLINE, Embase and Cinahl databases were searched. Studies reporting the occurrence of morbidity in twins affected compared with those not affected by birthweight discordance were included. The primary outcome was composite neonatal morbidity (including neurological, respiratory, infectious morbidities, abnormal acid‐base status and necrotizing enterocolitis). The secondary outcomes were the individual morbidities. Sub‐group analysis according to chorionicity, gestational age at birth and fetal weight (smaller vs larger twin) was also performed. Random‐effect head‐to‐head meta‐analyses were used to analyze the data. Results Twenty studies (10 851 twin pregnancies) were included. The risk of composite morbidity was significantly higher in the pregnancies with birthweight discordance ≥15% (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.0‐1.9), ≥20% (OR 2.2, 95% CI 1.40‐3.45), ≥25% (OR 2.5, 95% CI 1.8‐3.6), and ≥30% (OR 3.4, 95% CI 2.2‐3.2). In dichorionic twins, birthweight discordance ≥15% (OR 2.4, 95% CI 1.65‐3.46), ≥20% (OR 2.2, 95% CI 1.3‐3.8), ≥25% (OR 2.7, 95% CI 1.4‐5.1) and ≥30% (OR 3.6, 95% CI 2.3‐5.7) were all significantly associated with composite neonatal morbidity. Analysis of monochorionic twins was hampered by the very small number of included studies, which precluded adequate statistical power. Monochorionic twins with a birthweight discordance ≥20% were at significantly higher risk of composite neonatal morbidity (OR 2.2, 95% CI 1.1‐4.9) compared with those presenting with lesser degree of discordance. When stratifying the analysis according to gestational age at birth and fetal size, twins with birthweight discordance ≥15%, 20%, 25% and 30% delivered at ≥34 weeks were at higher risk of neonatal morbidity compared with controls, but there was no difference in the risk of morbidity between the larger and the smaller twin in the discordant pair. Conclusions Birthweight discordance is associated with neonatal morbidity in twin pregnancies. The strength of this association persists for dichorionic twins. It was not possible to extrapolate robust evidence on monochorionic twins due to the low power of the analysis due to the small number of included studies.

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Section: Resultsmentioning

confidence: 99%

Birthweight discordance and neonatal morbidity in twin pregnancies: A systematic review and meta‐analysis

Mascio

Acharya

Khalil

et al. 2019

Acta Obstet Gynecol Scand

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“…Several studies that examined this population have shown that multifetal gestations with discordant but appropriatefor-gestational age growth are not at increased risk of fetal or neonatal morbidity and mortality (93)(94)(95)(96). Several studies that examined this population have shown that multifetal gestations with discordant but appropriatefor-gestational age growth are not at increased risk of fetal or neonatal morbidity and mortality (93)(94)(95)(96).…”

Section: Are Multifetal Gestations With Discordant Fetal Growth At Rimentioning

confidence: 99%

Practice Bulletin No 144

Gynecologists¹

2014

Obstetrics &Amp; Gynecology

164

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The incidence of multifetal gestations in the United States has increased dramatically over the past several decades. The rate of twin births increased 76% between 1980 and 2009, from 18.9 to 33.3 per 1,000 births (). The rate of triplet and higher-order multifetal gestations increased more than 400% during the 1980s and 1990s, peaking at 193.5 per 100,000 births in 1998, followed by a modest decrease to 153.4 per 100,000 births by 2009 (). The increased incidence in multifetal gestations has been attributed to two main factors: 1) a shift toward an older maternal age at conception, when multifetal gestations are more likely to occur naturally, and 2) an increased use of assisted reproductive technology (ART), which is more likely to result in a multifetal gestation ().

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“…Newborns who have a high-risk of hypoglycemia and need of hypoglycemia screening in the first hour of life [22] are newborns who weigh more than 4 kg or less than 2 kg, large for gestational age (LGA) infants who are above the 90th percentile, small for gestational age (SGA), infants below the 10th percentile [23], and infants with intrauterine growth restriction [24][25][26][27][28][29][30][31]. In addition, high risk newborns are children with gestational age less than 37 weeks, children with sepsis [32] or born to a mother having chorioamnionitis or toxemia.…”

Section: High Risk Neonatesmentioning

confidence: 99%

Neonatal Hypoglycemia: A Continuing Debate in Definition and Management

Stomnaroska-Damcevski

Petkovska

Jancevska

et al. 2015

Prilozi

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Neonatal hypoglycemia (NH) is one of the most common abnormalities encountered in the newborn. Maintaining glucose homeostasis is one of the important physiological events during fetal-to-neonatal transition. Transient low blood glucose concentrations are frequently encountered in the majority of healthy newborns and are the reflections of normal metabolic adaptation processes. Nevertheless, there is a great concern that prolonged or recurrent low blood glucose levels may result in long-term neurological and developmental consequences. Strikingly, it was demonstrated that the incidence and timing of low glucose concentrations in the groups most at risk for asymptomatic neonatal hypoglycemia, did not find association between repetitive low glucose concentrations and poor neurodevelopmental outcomes. On the contrary, NH due to hyperinsulinism is strongly associated with brain injury. Fundamental issue of great professional controversy is concerning the best manner to manage asymptomatic newborns NH. Both, overtreating NH and undertreating NH are poles with significant potential disadvantages. Therefore, NH is one of the most important issues in the day-to-day practice. This article appraises the critical questions of definition (widely accepted blood glucose concentration: < 2.6 mmol/l or 47 mg/dl), follow-up ad management of NH.

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Does birth weight discordance in preterm twins affect neonatal outcome?

Cited by 21 publications

References 20 publications

Birthweight discordance and neonatal morbidity in twin pregnancies: A systematic review and meta‐analysis

Birthweight discordance and neonatal morbidity in twin pregnancies: A systematic review and meta‐analysis

Practice Bulletin No 144

Neonatal Hypoglycemia: A Continuing Debate in Definition and Management

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