Abstract
BackgroundRecent literature has investigated the role of multiple birth on neurodevelopmental outcomes of premature infants, especially extremely preterm ones. Multiple gestations are often associated to increased neurodevelopmental disability. Actually, research findings are controversial.ObjectiveTo compare the neurodevelopmental and behavioral outcomes of multiples and singletons in a cohort of preterm infants ≤28 weeks gestational age at 1 and 2 years of corrected age.MethodsThe study included 86 infants, born from January 2014 to September 2017 and enrolled in the follow-up program provided at authors’ Institution. Exclusion criteria included: major brain lesions and malformations, severe neuro-sensorial deficits, genetic syndromes, single-twin survivors. Thirty four multiples were compared to 52 singletons, using the Griffiths Mental Development Scales and the Child Behavior Checklist 1½–5. Statistical analysis was based on ANOVA techniques to test group differences. A p < 0.05 was considered statistically significant.ResultsThe neurodevelopmental outcomes of multiples and singletons at 1 and 2 years of corrected age did not significantly differ at a general level (p > 0.05). Multiples showed significantly lower mean scores than singletons at 1 year in Locomotor (87.15 ± 11.94 vs. 92.48 ± 11.59) and Personal-Social (84.88 ± 10.25 vs. 89.63 ± 8.19) subscales. Considering the behavioral outcomes, higher rates of externalizing problems were observed in multiples at 2 years (54.27 ± 9.64 vs. 49.31 ± 10.39).ConclusionThe slightly lower neurodevelopmental outcome showed by multiples, especially in the gross-motor and personal-social domains at 1 year, might be related to the specific environmental condition they experience. Multiple birth may affect mother’s sensitivity to infant’s needs and infant’s acquisition of emotional and behavioral regulation. This affects the separation process and the acquisition of the independent walking and other gross-motor skills. Being multiples might also induce an hyperstimulation and this could explain their higher vulnerability to externalizing problems (impulsiveness, hyperactivity, attention deficits). Additionally, males are more affected by the multiple condition than females.
Highlights
In the last decades multiple births have exponentially increased, largely due to the diffusion of assisted reproductive technologies (Asztalos et al, 2001; Garg et al, 2010; Klebanoff and Keim, 2011)
Many multiple pregnancies result in premature births, increasing the number of infants born at extremely low gestational age or extremely low birth weight (ELBW) (Heino et al, 2016), who are widely acknowledged for being at higher risk of perinatal mortality and neurodevelopmental sequelae
A total of 186 infants (64.5% singletons and 35.5% multiples) with gestational age ≤28 weeks were admitted to NICU Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico during the study period
Summary
In the last decades multiple births have exponentially increased, largely due to the diffusion of assisted reproductive technologies (Asztalos et al, 2001; Garg et al, 2010; Klebanoff and Keim, 2011). Many multiple pregnancies result in premature births, increasing the number of infants born at extremely low gestational age or extremely low birth weight (ELBW) (Heino et al, 2016), who are widely acknowledged for being at higher risk of perinatal mortality and neurodevelopmental sequelae. Multiple birth poses important challenges both on parenting and on infants’ emotional and social development. The author posits that there is a system of relationships between the twins which influences their emotional and relational development. This “couple-effect” has both negative and positive effects, isolating twins from the environment and hindering their reciprocal separation process and generating complementary roles which gradually help the partners’ differentiating from one another.
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