Department of Pediatrics, Samcheok-si Public Health Center, Samcheok, South Korea.
Department of Pediatrics, Ajou University School of Medicine, Suwon, South Korea.
J Matern Fetal Neonatal Med. 2023 Dec;36(2):2245530. doi: 10.1080/14767058.2023.2245530.
To compare neonatal outcomes between multiples and singletons among very low birth weight infants, this was a prospective cohort study that was conducted by collecting data registered in the Korean Neonatal Network database.
From January 2013 to December 2016, there were 8265 infants in the Korean Neonatal Network database, and 2958 of them were from multiples. Among them, 2636 infants were twins, 308 infants were triplets, and 14 infants were quadruplets. Maternal and neonatal variables including and mortality major morbidity were compared. Finally, the predicted rates of major morbidity between singletons and multiples.
Multiples had higher gestational age, birth weight, Apgar score at 5 min, rates of cesarean section and artificial reproductive technology but lower maternal hypertension, oligohydramnios, chorioamnionitis rates and Clinical Risk Index for Babies scores II without base excess than the singletons. In univariate analysis, multiples had a lower incidence of respiratory distress syndrome, bronchopulmonary dysplasia, and sepsis. The mortality rate was not significantly different for overall gestational ages except for those born at ≤26 weeks of gestation. In multivariate logistic analysis, the incidences of intraventricular hemorrhage (grade ≥3), and retinopathy of prematurity requiring treatment were significantly higher than the singletons.
Mortality was not significantly different between multiples and singletons according to overall gestational age, except for multiples born at ≤26 weeks. A significant higher risk of intraventricular hemorrhage and retinopathy of prematurity requiring treatment was found in multiples. A new strategy to improve the mortality of immature multiples born at ≤26 weeks of gestation should be developed.
比较极低出生体重儿中单胎与多胎新生儿的结局，这是一项前瞻性队列研究，通过收集韩国新生儿网络数据库中登记的数据进行。
2013 年 1 月至 2016 年 12 月，韩国新生儿网络数据库中有 8265 例婴儿，其中 2958 例来自多胎。其中，双胞胎 2636 例，三胞胎 308 例，四胞胎 14 例。比较了母体和新生儿变量，包括死亡率和主要发病率。最后，预测了单胎和多胎之间的主要发病率。
多胎妊娠的胎龄、出生体重、5 分钟时的 Apgar 评分、剖宫产率和人工生殖技术率较高，而母体高血压、羊水过少、绒毛膜羊膜炎的发生率和无基础不足的临床婴儿风险指数 II 较低。在单变量分析中，多胎妊娠呼吸窘迫综合征、支气管肺发育不良和败血症的发生率较低。除了出生在 26 周及以下的总体胎龄外，死亡率在总体胎龄上没有显著差异。多变量逻辑分析显示，脑室内出血（≥3 级）和需要治疗的早产儿视网膜病变的发生率明显高于单胎。
除了出生在 26 周及以下的多胎外，多胎与单胎的死亡率在总体胎龄上没有显著差异。多胎发生脑室内出血和需要治疗的早产儿视网膜病变的风险显著增加。应制定新的策略，以提高出生在 26 周及以下的不成熟多胎的存活率。
