381: Comparison of neonatal morbidity and mortality in twin pregnancies born at moderately preterm, late preterm, and term gestation

Abstract

ObjectiveTo describe and compare neonatal outcomes in twin pregnancies following moderately preterm (MPTB), late preterm (LPTB) and term birth.Study DesignSecondary analysis of a multi-center, RCT of multiple gestations was performed. LPTB was defined as delivery between 34 0/7 to 36 6/7 weeks and MPTB between 32 0/7 to 33 6/7 weeks. Primary outcome was a composite of serious adverse events defined as one of the following: neonatal death, RDS, early-onset culture proven sepsis, stage 2 or 3 NEC, BPD, grade 3 or 4 IVH, PVL, pneumonia or severe ROP. Secondary outcomes included rate of TTN and mechanincal ventilation (MV). Statistical analysis included Cochran-Armitage trend test. The earliest time of delivery, death or mobidity of either of the fetuses was used in the analysis.ResultsAmong 552 twin pregnancies, the MPTB rate was 14.6%, LPTB 49.9% and term birth rate 35.5%. The rate of the primary outcome was different between groups: 30.0% for MPTB, 12.8% for LPTB, 0.5% for term; p< 0.001. Most of the differences in neonatal outcomes were respiratory morbidities as illustrated in the table. There were no cases of severe ROP, grade 3 or 4 IVH or PVL and only one case of BPD, Stage 2 or 3 NEC, seizures and neonatal death within the preterm groups. There were no differences between groups in rate of pneumonia.Tabled 1MPTB (n=80)LPTB (n=275)Term(n=197)P-valueRDS28.8%11.7%0%<.0001TTN38.8%20.8%6.7%<.0001MV26.3%6.2%1.0%<.0001Sepsis5.0%2.2%0%.004 Open table in a new tab ConclusionTwin pregnancies born moderately and late preterm encounter higher rates of neonatal respiratory morbidities compared to twins born at term. ObjectiveTo describe and compare neonatal outcomes in twin pregnancies following moderately preterm (MPTB), late preterm (LPTB) and term birth. To describe and compare neonatal outcomes in twin pregnancies following moderately preterm (MPTB), late preterm (LPTB) and term birth. Study DesignSecondary analysis of a multi-center, RCT of multiple gestations was performed. LPTB was defined as delivery between 34 0/7 to 36 6/7 weeks and MPTB between 32 0/7 to 33 6/7 weeks. Primary outcome was a composite of serious adverse events defined as one of the following: neonatal death, RDS, early-onset culture proven sepsis, stage 2 or 3 NEC, BPD, grade 3 or 4 IVH, PVL, pneumonia or severe ROP. Secondary outcomes included rate of TTN and mechanincal ventilation (MV). Statistical analysis included Cochran-Armitage trend test. The earliest time of delivery, death or mobidity of either of the fetuses was used in the analysis. Secondary analysis of a multi-center, RCT of multiple gestations was performed. LPTB was defined as delivery between 34 0/7 to 36 6/7 weeks and MPTB between 32 0/7 to 33 6/7 weeks. Primary outcome was a composite of serious adverse events defined as one of the following: neonatal death, RDS, early-onset culture proven sepsis, stage 2 or 3 NEC, BPD, grade 3 or 4 IVH, PVL, pneumonia or severe ROP. Secondary outcomes included rate of TTN and mechanincal ventilation (MV). Statistical analysis included Cochran-Armitage trend test. The earliest time of delivery, death or mobidity of either of the fetuses was used in the analysis. ResultsAmong 552 twin pregnancies, the MPTB rate was 14.6%, LPTB 49.9% and term birth rate 35.5%. The rate of the primary outcome was different between groups: 30.0% for MPTB, 12.8% for LPTB, 0.5% for term; p< 0.001. Most of the differences in neonatal outcomes were respiratory morbidities as illustrated in the table. There were no cases of severe ROP, grade 3 or 4 IVH or PVL and only one case of BPD, Stage 2 or 3 NEC, seizures and neonatal death within the preterm groups. There were no differences between groups in rate of pneumonia.Tabled 1MPTB (n=80)LPTB (n=275)Term(n=197)P-valueRDS28.8%11.7%0%<.0001TTN38.8%20.8%6.7%<.0001MV26.3%6.2%1.0%<.0001Sepsis5.0%2.2%0%.004 Open table in a new tab Among 552 twin pregnancies, the MPTB rate was 14.6%, LPTB 49.9% and term birth rate 35.5%. The rate of the primary outcome was different between groups: 30.0% for MPTB, 12.8% for LPTB, 0.5% for term; p< 0.001. Most of the differences in neonatal outcomes were respiratory morbidities as illustrated in the table. There were no cases of severe ROP, grade 3 or 4 IVH or PVL and only one case of BPD, Stage 2 or 3 NEC, seizures and neonatal death within the preterm groups. There were no differences between groups in rate of pneumonia. ConclusionTwin pregnancies born moderately and late preterm encounter higher rates of neonatal respiratory morbidities compared to twins born at term. Twin pregnancies born moderately and late preterm encounter higher rates of neonatal respiratory morbidities compared to twins born at term.