Neonatal Outcomes of Very Preterm or Very Low Birth Weight Triplets

Abstract

OBJECTIVES:To compare the neonatal outcomes of very preterm triplets with those of matched singletons using a large international cohort. METHODS:A retrospective matched-cohort study of preterm triplets and singletons born between 2007 and 2013 in the International Network for Evaluation of Outcomes in neonates database countries and matched by gestational age, sex, and country of birth was conducted. The primary outcome was a composite of mortality or severe neonatal morbidity (severe neurologic injury, treated retinopathy of prematurity, and bronchopulmonary dysplasia). Unadjusted and adjusted odds ratios with 95% confidence intervals (CIs) were calculated for model 1 (maternal hypertension and birth weight z score) and model 2 (variables in model 1, antenatal steroids, and mode of birth). Models were fitted with generalizing estimating equations and random effects modeling to account for clustering. RESULTS:A total of 6079 triplets of 24 to 32 weeks' gestation or 500 to 1499 g birth weight and 18 232 matched singletons were included. There was no difference in the primary outcome between triplets and singletons (23.4% vs 24.0%, adjusted odds ratio: 0.91, 95% CI: 0.83-1.01 for model 1 and 1.00, 95% CI: 0.90-1.11 for model 2). Rates of severe neonatal morbidities did not differ significantly between triplets and singletons. The results were also similar for a subsample of the cohort (1648 triplets and 4944 matched singletons) born at 24 to 28 weeks' gestation. CONCLUSIONS: No significant differences were identified in mortality or major neonatal morbidities between triplets who were very low birth weight or very preterm and matched singletons.abstract

The International Network for Evaluating Outcomes (iNeo) of neonates: evolution, progress and opportunities

“…The iNeo database contains information on >200,000 VPT infants, a population size that has allowed us to evaluate the association between exposure to risk factors and neonatal outcomes with a very high precision and especially study rare exposures such as severe congenital heart defects (34). For example, we identified that maternal diabetes was not associated with composite adverse outcome of mortality or major morbidities in VPT neonates (35), and that triplets of <29 weeks' GA had similar outcomes to singletons of <29 weeks' GA (36). In contrast, preterm neonates of <29 weeks GA born to mothers with hypertensive disorder were associated with lower odds of mortality, severe brain injury and treated ROP and higher odds of BPD than preterm neonates of <29 weeks GA born to normotensive mothers (37).…”

Incidence, Risk Factors, and Outcomes of Preterm and Early Term Births: A Population-Based Register Study

“…Causal factors linked to PTB include medical conditions [ 20 ], genetic influences [ 21 , 22 , 23 ], environmental exposure [ 24 , 25 ], infertility treatments [ 26 , 27 ], as well as behavioral and socioeconomic factors [ 28 , 29 , 30 ]. While extreme to very PTBs have been extensively studied, and the associated morbidities are well-documented [ 31 , 32 , 33 ], studies on infants born at later stages of pregnancy, particularly late PTBs and ETBs, are lacking. Thus, in this population-based study, we aimed to assess the incidence of PTB and ETB over a period of 12 months in Qatar, and examine the associated neonatal and maternal risk factors, as well as the feto-maternal consequences in the perinatal-neonatal period.…”

Precision Medicine in Neonates: A Tailored Approach to Neonatal Brain Injury

“…Technological innovations make it possible to combine different information sources and provide information on a more detailed level. Clinically collected data from EHR with well-regulated, international, and privacy proof unrestricted access for researchers, such as the MIMIC-III and AmsterdamUMCdb database, and the increased availability of raw trial data could bring about a revolution in research on preterm neonates (149)(150)(151)(152).…”