Trends in Morbidity and Mortality of Extremely Preterm Multiple Gestation Newborns

Yeo, Kee Thai; Lee, Qin Ying; Quek, Wei Shern; Wang, Alex; Bolisetty, Srinivas; Lui, Kei

doi:10.1542/peds.2014-4075

Cited by 35 publications

(30 citation statements)

References 33 publications

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“…These pregnancies are closely monitored and managed in specialized multiple pregnancy clinics in our institution and appropriate intervention is offered when deemed necessary such as use of antenatal steroids in the presence of threatened preterm labor. Similar to our findings, Yeo et al 11 and Nielson et al 24 have shown a significantly higher rate of cesarean delivery and use of antenatal steroids in preterm VLBW multiples. Vulić has shown a higher incidence of cesarean delivery in multiple births conceived by ART.…”

Section: Discussionsupporting

confidence: 92%

“…This gender disadvantage has been demonstrated in a local study by Agarwal et al in infants born extremely preterm between 23 and 26 weeks 30 as well as other international studies. 11,31 Recent Spanish network data 29 documented a higher risk of composite adverse outcome with OR of 1.82 (95% CI: 1.28-2.24) in multiples born less than 26 weeks of gestational age similar to ours. However, Yeo et al did not show any difference in the major neonatal morbidities or composite adverse outcome between singletons and multiples at this gestation and postulated this improvement could be due to closer monitoring and improved perinatal care of these highrisk pregnancies.…”

Section: Discussionsupporting

confidence: 81%

“…10 Recent literature on trends in morbidity and mortality from the Australian and New Zealand neonatal network also showed no difference in the rates of major morbidities or composite adverse outcomes between multiples and singletons across all gestations in VLBW infants in the most recent 5 year epoch. 11 Accurate and up to date knowledge of neonatal outcomes is an essential requirement for perinatologists to enable evidence-based antenatal counseling and informed parental decision-making regarding embryo reduction, therapeutic interventions, timing of delivery, and extent of resuscitation, especially at thresholds of viability. There is a paucity of local data regarding neonatal outcome of preterm multiple births and having relevant antenatal, perinatal, and neonatal morbidity data from a local population will be useful for those involved in the care and counseling of such high-risk pregnancies.…”

mentioning

confidence: 99%

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Single Center Outcome of Multiple Births in the Premature and Very Low Birth Weight Cohort in Singapore

Anand

Sabapathy

Sriram³

et al. 2020

Am J Perinatol

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Objective The aim of this study is to compare neonatal mortality and morbidity in multiple and singleton preterm/very low birthweight (PT/VLBW) multiethnic Asian infants. Study Design Cohort study of 676 singleton and 299 multiple PT/VLBW infants born between 2008 and 2012 at KK Women's and Children's Hospital, the largest tertiary perinatal center in Singapore with further stratification by gestational ages 23 to 25 (Group 1), 26 to 28 (Group 2), and ≥29 (Group 3) weeks. Outcome measures included predischarge mortality and major neonatal morbidity. Results Overall survival to discharge was comparable for singletons 611/676 (90%) and multiples 273/299 (91%). Use of assisted reproductive technologies (47 vs. 4%), antenatal steroids (80 vs. 68%), and delivery by cesarean section (84 vs. 62%) were significantly higher (p < 0.001) in multiples while pregnancy induced hypertension (8.7 vs. 31.6%, p < 0.001) and maternal chorioamnionitis (31 vs. 41%, p < 0.01) were seen less commonly compared with singleton pregnancies. Survival was comparable between singletons and multiples except for a lower survival in multiples in Group 2 (81.7 vs. 92.4%, p = 0.007). Major neonatal morbidities were comparable for multiples and singletons in the overall cohort. Presence of hemodynamically significant patent ductus arteriosus (HsPDA) requiring treatment (88.9 vs. 72.5%), air leaks (33 vs. 14.6%, p = 0.02), NEC (30 vs. 14.6%, p = 0.04), and composite morbidity (86 vs. 66%, p = 0.031) were significantly higher in multiples in Group 1. A significantly higher incidence of HsPDA (68.1 vs. 52.4%, p = 0.008) was also observed in multiples in Group 2. Multiple pregnancy was not an independent predictor of an adverse outcome on regression analysis (OR: 0.685, 95% confidence interval: 0.629–2.02) even in GA ≤25 weeks. Conclusion Neonatal mortality and morbidity were comparable in our cohort of PT/VLBW singletons and multiple births, but preterm multiple births ≤25 weeks had a higher incidence of neonatal morbidity. Key Points

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 81%

mentioning

confidence: 99%

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Single Center Outcome of Multiple Births in the Premature and Very Low Birth Weight Cohort in Singapore

Anand

Sabapathy

Sriram³

et al. 2020

Am J Perinatol

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“…The impact of birth weight and the other a priori selected variables on death and death and major morbidity combined was remarkably similar. Multiple gestation was not linked to poor outcome, an observation made for recent cohorts also in Australia and New Zealand ( 23 ). Small for gestational age was associated with reduced ORs for poor outcome as the investigation used birth weight as primary variable, the opposite would have been observed with gestational age as primary variable.…”

Section: Discussionmentioning

confidence: 85%

Mortality and Major Morbidity of Very-Low-Birth-Weight Infants in Germany 2008–2012: A Report Based on Administrative Data

Jeschke¹,

Biermann²,

Günster³

et al. 2016

Front. Pediatr.

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BackgroundExpectant parents of very preterm infants, physicians, and policy makers require estimates for chances of survival and survival without morbidity. Such estimates should derive from a large, reliable, and contemporary data base of easily available items known at birth.ObjectiveTo determine short-term outcome and risk factors in very-low-birth-weight preterm infants based on administrative data.MethodsAnonymized routine data sets transmitted from hospital administrations to statutory health insurance companies were used to assess survival and survival free of major morbidities in a large cohort of preterm infants in Germany.ResultsAfter exclusion of infants with lethal malformations, there were 13,147 infants with a birth weight below 1,500 g admitted to neonatal care 2008–2012, of whom 1,432 infants (10.9%) died within 180 days. Estimated 180 days survival probabilities were 0.632 (95% confidence interval 0.583–0.677) for infants with 250–499 g birth weight, 0.817 (0.799–0.834) for 500–749 g, 0.931 (0.920–0.940) for 750–999 g, 0.973 (0.967–0.979) for 1,000–1,249 g, and 0.985 (0.981–0.988) for 1,250–1,499 g. Estimated probabilities for survival without major morbidity (surgically treated intraventricular hemorrhage, necrotizing enterocolitis, intestinal perforation, or retinopathy) were 0.433 (0.384–0.481) for 250–499 g, 0.622 (0.600–0.643) for 500–749 g, 0.836 (0.821–0.849) for 750–999 g, 0.938 (0.928–0.946) for 1,000–1,249 g, and 0.969 (0.964–0.974) for 1,250–1,499 g, respectively. Prediction of survival and survival without major morbidities was moderately improved by adding sex, small for gestational age, and severe or moderate congenital malformation, increasing receiver operating characteristic areas under the curve from 0.839 (0.827–0.850) to 0.862 (0.852–0.874) (survival) and from 0.827 (0.822–0.842) to 0.852 (0.846–0.863) (survival without major morbidities), respectively.ConclusionThe present analysis encourages attempts to use administrative data to investigate the association between risk factors and outcome in preterm infants.

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“…In singleton, survival to discharge following delivery at 24, 25, and 26 weeks is 31.2%, 59.1%, and 75.3%, respectively [ 5 ]. In multiples, the mortality rate was 32% from 23 to 25 weeks' gestational age, compared to 19.2% from 26 to 27 weeks' gestational age and 11.1% in all gestational age [ 6 ]. At these extremely premature gestational ages, even small increases in gestational age have tremendous impact on neonatal survival [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

A Case of Delayed Interval Delivery with a Successful Hospital Move

Yodoshi

Tipton

Rouse

2015

Case Reports in Pediatrics

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This report is the first case of delayed interval twin delivery in which the first infant and mother survived without major morbidity following transport to another facility. In addition, this case is only the second report of asynchronous delivery in which both twins survived and neither suffered any major morbidity. A 30-year-old G5P1031 African American female with a diamniotic/dichorionic twin pregnancy presented to U.S. Naval Hospital Okinawa, Japan, at 22 + 5 weeks due to vaginal bleeding. At 23 + 2 weeks, Twin A was born secondary to advanced cervical dilation. Twin A's birth weight was 650 g with APGAR scores of 6 (1 min) and 7 (5 min). Following delivery of Twin A, Placenta A was left in utero with high ligation of the umbilical cord. Due to a scheduled hospital move, the mother and Twin A were transported to the new facility at Camp Foster. Three weeks later, Twin B was delivered at 26 + 4 weeks. Twin B's birth weight was 930 g with APGAR scores of 3 (1 min) and 7 (5 min). Both twins were discharged without IVH, PVL, ROP, or CLD. This case demonstrates the possibility of transporting both the mother and surviving infant A to a higher level of care prior to delivery of subsequent fetuses.

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Trends in Morbidity and Mortality of Extremely Preterm Multiple Gestation Newborns

Cited by 35 publications

References 33 publications

Single Center Outcome of Multiple Births in the Premature and Very Low Birth Weight Cohort in Singapore

Single Center Outcome of Multiple Births in the Premature and Very Low Birth Weight Cohort in Singapore

Mortality and Major Morbidity of Very-Low-Birth-Weight Infants in Germany 2008–2012: A Report Based on Administrative Data

A Case of Delayed Interval Delivery with a Successful Hospital Move

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