Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and the Department of Newborn & Developmental Paediatrics, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
Obstet Gynecol. 2017 Sep;130(3):582-590. doi: 10.1097/AOG.0000000000002187.
To test the hypothesis that the risk of neonatal morbidity among late-preterm twins is similar to that of late-preterm singletons.
We conducted a retrospective cohort study of all women with twin or singleton pregnancy who gave birth during the late-preterm period in a single tertiary center between 2008 and 2015. Neonatal outcomes of low-risk, late-preterm twins were compared with those of low-risk, late-preterm singletons. The primary outcome was the same primary composite respiratory morbidity variable that was used in the randomized controlled trial of Gyamfi-Bannerman et al on the administration of antenatal corticosteroids during the late-preterm period.
A total of 922 singleton and 721 twin late-preterm neonates met the inclusion criteria. The rates of composite respiratory morbidity and severe composite respiratory morbidity were similar for twins and singletons (8.3% compared with 7.4%, P=.5 and 6.8% compared with 6.0%, P=.5, respectively), but were lower than the rates of the same composite respiratory morbidity variable in the randomized controlled study described previously. The odds for respiratory morbidity were similar for twins and singletons for both composite respiratory morbidity (adjusted odds ratio [OR] 0.73, 95% CI 0.48-1.12) and severe composite respiratory morbidity (adjusted OR 0.79, 95% CI 0.50-1.24).
The risk of respiratory morbidity among late-preterm twins is similar to that of late-preterm singletons. Still, the low absolute rates of the composite respiratory morbidity in our population suggest that administration of antenatal corticosteroids may be mostly justified among neonates born closer to 34 weeks of gestation.
检验晚早产儿中双胎的新生儿发病风险与单胎相似的假设。
我们对 2008 年至 2015 年期间在一家三级中心分娩的所有晚早产儿的双胎或单胎妊娠妇女进行了回顾性队列研究。将低危晚早产儿双胎的新生儿结局与低危晚早产儿单胎的新生儿结局进行了比较。主要结局是 Gyamfi-Bannerman 等人进行的关于在晚孕期使用产前皮质激素的随机对照试验中使用的相同主要复合呼吸发病率变量。
共有 922 例单胎和 721 例双胎晚早产儿符合纳入标准。双胞胎和单胎的复合呼吸发病率和严重复合呼吸发病率相似（8.3%比 7.4%，P=.5 和 6.8%比 6.0%，P=.5），但低于前文所述的随机对照研究中的相同复合呼吸发病率变量的发生率。双胞胎和单胎的呼吸发病率的比值相似，复合呼吸发病率（调整比值比[OR]0.73，95%置信区间 0.48-1.12）和严重复合呼吸发病率（调整 OR 0.79，95%置信区间 0.50-1.24）。
晚早产儿的呼吸发病率风险与晚早产儿相似。尽管如此，我们人群中复合呼吸发病率的绝对低发生率表明，在接近 34 孕周出生的新生儿中，产前皮质激素的使用可能更有理由。
