Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, South Korea.
Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, South Korea.
Pediatr Neonatol. 2023 Sep;64(5):570-576. doi: 10.1016/j.pedneo.2022.12.014. Epub 2023 Mar 15.
Twin pregnancies can be complicated by birthweight (BW) discordance. We analyzed the impact of BW discordance on clinical outcomes of very-low-birthweight (VLBW) twins.
The study population was preterm infants in the Korean Neonatal Network registry. Multivariate logistic regression analyses were used to determine the contribution of BW discordance on respiratory morbidities and mortality of VLBW infants. Also, we assessed the effect of small for gestational age (SGA) on morbidity and mortality in discordant twins (DTs) and compared separately the clinical outcomes of smaller and larger DTs with different singletons matched for perinatal factors including BW percentile.
A total of 935 twin pairs [1548 concordant twins (CTs) and 322 DTs] were included. BW discordance was associated with increased odds of moderate bronchopulmonary dysplasia, mortality, and composite outcomes. Compared with the CTs, the smaller, but not larger, DTs had greater odds of morbidities and mortality. DTs had higher odds of adverse neonatal outcome when combined with SGA. Meanwhile, DTs had morbidities and mortality similar to singletons matched for BW percentile.
BW discordance in VLBW twins adversely affects neonatal mortality or respiratory morbidity which is predominant in smaller DTs. The impact of BW discordance could be increased through SGA.
双胞胎妊娠可能会因出生体重（BW）不一致而变得复杂。我们分析了 BW 不一致对极低出生体重（VLBW）双胞胎临床结局的影响。
研究人群为韩国新生儿网络登记处的早产儿。采用多变量逻辑回归分析来确定 BW 不一致对 VLBW 婴儿呼吸疾病发病率和死亡率的影响。此外，我们评估了小于胎龄儿（SGA）对 BW 不一致的双胎（DT）发病率和死亡率的影响，并分别比较了 SGA 与不同的单胎在围产期因素（包括 BW 百分位数）相匹配的情况下，较小和较大的 DT 的临床结局。
共纳入 935 对双胞胎[1548 对 CTs 和 322 对 DTs]。BW 不一致与中度支气管肺发育不良、死亡率和复合结局的发病风险增加相关。与 CTs 相比，较小的 DTs，但不是较大的 DTs，发病和死亡的风险更高。当 DTs 与 SGA 结合时，发生不良新生儿结局的可能性更高。同时，DTs 在 BW 百分位数匹配的单胎中发病率和死亡率相似。
VLBW 双胞胎的 BW 不一致对新生儿死亡率或呼吸疾病发病率有不利影响，而较小的 DTs 则更为明显。BW 不一致的影响可能会因 SGA 而增加。
