Risk Factors for Neonatal Intensive Care Unit Admission After Term Twin Deliveries

Abstract

INTRODUCTION: The rate of twin delivery has increased by 76% since the 1980s and is associated with risk of neonatal intensive care unit (NICU) admission. Research on twin outcomes at term is limited. Our objective was to profile twin term pregnancies at increased risk of NICU admission. METHODS: The U.S. Natality database of birth certificate data from all births in the nation from 2007 to 2010 was reviewed. Inclusion criteria were twin delivery, term gestational age (37–42 weeks of gestation), and admission compared with no admission to a NICU. Congenital anomalies and missing data were excluded. Variables considered were demographics (maternal race, live birth order, fetal gender), obstetric complications (hypertension and diabetes-related disorders), labor complications (fetal distress, chorioamnionitis, meconium), labor outcomes (induction of labor, delivery method), and newborn status (Apgar score). Adjusted odds ratios for NICU admission were obtained from logistic regression. RESULTS: From 2007 to 2010, NICU admission rates for term twin deliveries increased from 19.9% to 30.2%. Table 1 shows NICU admission was higher for African American, male newborns delivered by cesarean of primiparas with premature rupture of membranes and chorioamnionitis as well as preeclampsia, chronic hypertension, diabetes mellitus, and meconium (P=.000).CONCLUSIONS: In term twins, the profile of neonates requiring NICU admission includes medical complications of pregnancy with evidence of infection during labor. Although these neonates tend to be African American males born to primiparas, the major warning signs for adverse perinatal outcome are premature rupture of membranes, chorioamnionitis, and low 5-minute Apgar scores. Recognition of this high-risk profile may allow for timely assessment and early intervention to improve outcomes for these high-risk perinates.