Significance of chorionicity on long‐term outcome of low birthweight infants of <1500g in twin pregnancies

Abstract

Aim: The aim of this study was to evaluate the long-term outcomes of very low birthweight twins by chorionicity and to identify the perinatal predictors for outcomes in the era of laser surgery for twin-twin transfusion syndrome. Material and Methods: This was a retrospective single-center cohort study of twin pregnancy infants <1500 g from 2003 through 2010. During the study period, laser surgery was performed on cases of twin-twin transfusion syndrome. The composite of adverse outcomes at 3 years of age was defined, including death, cerebral palsy, and developmental delay. The association between perinatal factors and adverse outcomes was evaluated by multiple logistic regression analysis. Results: A total of 162 infants (79 dichorionic diamniotic twins [DCDA] and 83 monochorionic diamniotic twins [MCDA]) were included in this study. Laser surgery was performed on 11 cases. The rate of adverse outcomes was 13.9% for DCDA and 26.5% for MCDA. The incidence of each outcome for DCDA and MCDA was: cerebral palsy, 1.3% and 4.8%; developmental delay, 8.9% and 9.6%; and death, 3.8% and 14.5%. Gestational age at birth (adjusted odds ratio: 0.69; 95% confidence interval, 0.57-0.84); and anemia at birth (adjusted odds ratio, 10.64; 95% confidence interval, 1.69-66.9) were independent risk factors, whereas chorionicity did not have significance for outcomes. Conclusion: The long-term outcome of very low birthweight MCDA was almost identical to that of DCDA. Gestational age and anemia at birth were independent risk factors for adverse outcomes.

Influence of chorionicity on healthy twin pregnancy outcome

“…Most literature data show that monochorionic twins have higher rate of very preterm birth (before 33 rd gestational week), very low birth weight (birth weight <1500g), first minute Apgar <7 and hospitalization (1,4). Perinatal mortality is usually also significantly higher as well as intrauterine fetal death (6).…”

“…This risk arises as a result of complications such as high incidence of preterm birth, fetal growth restriction, preeclampsia, etc. (1). Twin pregnancies are classified according to either zygosity or chorionicity, and chorionicity rather than zygosity determines the outcome.…”

Long-Term Neurodevelopmental Outcome of Monochorionic Twins after Laser Therapy or Umbilical Cord Occlusion for Twin-Twin Transfusion Syndrome

“…Multiple logistic regression analysis was used to calculate odds ratios (OR) for impairment. The statistical analyses were adjusted for the relatedness of twins and for confounders: age at follow-up; ASQ form; GA at birth; birthweight; sex, and maternal education, as appropriate [20,22,32].…”

Neurodesenvolvimento de Grandes Prematuros ou Recém-Nascidos com Muito Baixo Peso: Comparação de Gémeos Monocoriónicos e Bicoriónicos com Recém-Nascidos de Gestação Unifetal

“…Contudo, os resultados publicados revelam taxas de alterações do neurodesenvolvimento muito variáveis 2,3,26 e por vezes sem controlo das variáveis confundentes. Um trabalho recente, 27 tratando a corionicidade, não revelou uma frequência superior de alterações de neurodesenvolvimento nos gémeos monocoriónicos em relação aos bicoriónicos, tendo demonstrado que a prematuridade representou um fator de risco independente para aquelas alterações. A prematuridade tem sido referida como fator de risco para o desenvolvimento de sequelas neurológicas na maior parte da literatura, daí a necessidade de estratificar este tipo de estudos em relação à idade gestacional.…”