Kalikkot Thekkeveedu Renjithkumar, Dankhara Nilesh, Desai Jagdish, Klar Angelle L, Patel Jaimin
Newborn Medicine, University of Mississippi Medical Center, 2500 N State St, W154, Jackson, MS, 39216, USA.
Matern Health Neonatol Perinatol. 2021 Oct 28;7(1):15. doi: 10.1186/s40748-021-00135-5.
The available data regarding morbidity and mortality associated with multiple gestation births is conflicting and contradicting.
To compare morbidity, mortality, and length of stay (LOS) outcomes between multiple gestation (twin, triplet and higher-order) and singleton births.
Data from the national multicenter Kids' Inpatient Database of the Healthcare Cost and Utilization Project from the years 2000, 2003, 2006, 2009, 2012, and 2016 were analyzed using a complex survey design using Statistical Analysis System (SAS) 9.4 (SAS Institute, Cary NC). Neonates with ICD9 and ICD10 codes indicating singletons, twins or triplets, and higher-order multiples were included. Mortality was compared between these groups after excluding transfer outs to avoid duplicate inclusion. To analyze LOS, we included inborn neonates and excluded transfers; who died inpatient and any neonates who appear to have been discharged less than 33 weeks PMA. The LOS was compared by gestational age groups.
A total of 22,853,125 neonates were analyzed for mortality after applying inclusion-exclusion criteria; 2.96% were twins, and 0.13% were triplets or more. A total of 22,690,082 neonates were analyzed for LOS. Mean GA, expressed as mean (SD), for singleton, twins and triplets, were 38.30 (2.21), 36.39 (4.21), and 32.72 (4.14), respectively. The adjusted odds for mortality were similar for twin births compared to singleton (aOR: 1.004, 95% CI:0.960-1.051, p = 0.8521). The adjusted odds of mortality for triplet or higher-order gestation births were higher (aOR: 1.33, 95% CI: 1.128-1.575, p = 0.0008) when compared to the singleton births. Median LOS (days) was significantly longer in multiple gestation compared to singleton births overall (singletons: 1.59 [1.13, 2.19] vs. twins 3.29 [2.17, 9.59] vs. triplets or higher-order multiples 19.15 [8.80, 36.38], p < .0001), and this difference remained significant within each GA category.
Multiple gestation births have higher mortality and longer LOS when compared to singleton births. This population data from multiple centers across the country could be useful in counseling parents when caring for multiple gestation pregnancies.
关于多胎妊娠分娩相关的发病率和死亡率的现有数据相互矛盾。
比较多胎妊娠（双胞胎、三胞胎及以上）和单胎分娩之间的发病率、死亡率及住院时间（LOS）结果。
使用统计分析系统（SAS）9.4（SAS Institute，北卡罗来纳州卡里），采用复杂的调查设计，分析了2000年、2003年、2006年、2009年、2012年和2016年医疗成本与利用项目的全国多中心儿童住院数据库中的数据。纳入了国际疾病分类第九版（ICD9）和国际疾病分类第十版（ICD10）编码显示为单胎、双胞胎或三胞胎及以上多胞胎的新生儿。在排除转出病例以避免重复纳入后，比较这些组之间的死亡率。为了分析住院时间，我们纳入了出生的新生儿并排除了转院病例；排除住院死亡的新生儿以及任何孕龄小于33周的出院新生儿。按孕周组比较住院时间。
应用纳入 - 排除标准后，共分析了22,853,125例新生儿的死亡率；其中2.96%为双胞胎，0.13%为三胞胎及以上。共分析了22,690,082例新生儿的住院时间。单胎、双胞胎和三胞胎的平均孕龄，以平均值（标准差）表示，分别为38.30（2.21）、36.39（4.21）和32.72（4.14）。与单胎分娩相比，双胞胎分娩调整后的死亡几率相似（调整后比值比：1.004，95%置信区间：0.960 - 1.051，p = 0.8521）。与单胎分娩相比，三胞胎及以上孕龄分娩的调整后死亡几率更高（调整后比值比：1.33，95%置信区间：1.128 - 1.575，p = 0.0008）。总体而言，多胎妊娠的中位住院时间（天）明显长于单胎分娩（单胎：1.59 [1.13, 2.19]，双胞胎：3.29 [2.17, 9.59]，三胞胎及以上多胞胎：19.15 [8.80, 36.38]，p < 0.0001），并且在每个孕龄类别中这种差异仍然显著。
与单胎分娩相比，多胎妊娠分娩的死亡率更高且住院时间更长。来自全国多个中心的这些人群数据在为多胎妊娠孕妇的父母提供咨询时可能会有所帮助。
