Weight Twins Research Articles

Co-design of SLC/MLC FeFET-based highly error-tolerant low-power CiM and strong lottery ticket hypothesis-based algorithm

This study co-designs single-level cell (SLC) mask and multilevel cell (MLC) weight twin FeFET devices and a strong lottery ticket hypothesis (SLTH)-based neural network (NN) algorithm to achieve highly error-tolerant low-power Computation-in-Memory (CiM). The SLC mask FeFET masks or transfers the NN weight stored in the MLC weight FeFET, and the masked NN weight reduces the CiM power consumption. The proposed SLC mask FeFETs, which are trained, and MLC weight FeFETs, in which V TH are uniformly randomized, achieve 87% inference accuracy against 10-year data retention and read disturb. The SLC mask FeFETs show 86% inference accuracy even at 2000 endurance cycles. In addition, shared-bottom-select-gate (BSG) SLTH CiM and common-mask SLTH CiM for the NN convolutional layer are proposed to reduce the CiM area by sharing BSG and mask FeFET. Moreover, NN weight mapping schemes for SLTH CiM are proposed. The proposed mapping schemes show a tradeoff between inference accuracy and CiM area. One of the schemes reduces the CiM area by 45% with a 9.1% accuracy loss.

Breastfeeding Disparities between Multiples and Singletons by NICU Discharge.

Multiple pregnancy increases the risk of a range of adverse perinatal outcomes, including breastfeeding failure. However, studies on predictive factors of breastfeeding duration in preterm twin infants have a conflicting result. The purpose of this observational study was to compare feeding practices, at hospital discharge, of twin and singleton very low birth weight infants. The study is part of a prospective survey of a national Spanish cohort of very low birth weight infants (SEN1500) that includes 62 neonatal units. The study population comprised all infants registered in the network from 2002 to 2013. They were grouped into singletons and multiples. The explanatory variables were first analyzed using univariate models; subsequently, significant variables were analyzed simultaneously in a multiple stepwise backward model. During the twelve-year period, 32,770 very low birth weight infants were included in the database, of which 26.957 were discharged alive and included in this analysis. Nine thousand seven hundred and fifty-eight neonates were multiples, and 17,199 were singletons. At discharge, 31% of singleton infants were being exclusively breastfed, 43% were bottle-fed, and 26% were fed a combination of both. In comparison, at discharge, only 24% of multiple infants were exclusively breastfed, 43% were bottle-fed, and 33% were fed a combination of both (p < 0.001). On multivariable analysis, twin pregnancy had a statistically significant, but small effect, on cessation of breastfeeding before discharge (OR 1.10; 95% CI: 1.02, 1.19). Risks of early in-hospital breastfeeding cessation were also independently associated with multiple mother-infant stress factors, such as sepsis, intraventricular hemorrhage, retinopathy, necrotizing enterocolitis, intubation, and use of inotropes. Instead, antibiotic treatment at delivery, In vitro fertilization and prenatal steroids were associated with a decreased risk for shorter in-hospital breastfeeding duration. Multiple pregnancy, even in the absence of pathological conditions associated to very low birth weight twin infants, may be an impeding factor for in-hospital breastfeeding.

Birth weight discordance in very low birth weight twins: mortality, morbidity, and neurodevelopment.

ObjectiveExamine outcomes among birth weight concordant and discordant 401–1500 g twins.Study DesignTwins (n=8,114) at NICHD Neonatal Research Network (1994–2011) were studied. Discordance (birth weight difference/larger twin birth weight × 100%) was categorized into: ≤14%, >14–20%, >20–30%, and >30%. Separate logistic regression models for the smaller and larger infants assessed the adjusted association between discordance and outcomes.ResultsCompared to the smaller twin with ≤14% discordance, mortality, necrotizing enterocolitis, severe retinopathy of prematurity, bronchopulmonary dysplasia, and neurodevelopmental impairment or death were highest among the smaller twins with discordance >30%. The larger twins with discordance >30% had higher odds of patent ductus arteriosus, moderate-to-severe cerebral palsy, blindness, cognitive and motor scores <70. Odds of cerebral palsy and blindness were also higher among the larger twins with discordance >14–20%.ConclusionDiscordance >30% was associated with higher mortality in the smaller twin and higher morbidities among the smaller and larger twins.

Growth follow-up of monochorionic diamniotic twins discordant for birth weight during their first 24 months of life

Objective To assess the growth of monochorionic diamniotic (MCDA) twins discordant for birth weight during their first 24 months of life. Methods Clinical data and growth parameters from birth to 24 months of age of 31 pairs(62 cases) of birth weight-discordant MCDA twins (≥25% difference in birth weight) who were born alive in the First Affiliated Hospital, Sun Yat-sen University between January 1, 2010 and June 30, 2016 were retrospectively analyzed. Each pair of twins was divided into the large birth weight group (31 cases) and the small birth weight group (31 cases). All datas were statistically analyzed with Chi-square test, paired t test, analysis of variance or LSD-t test. Results (1) The incidence of birth defects and hypoproteinemia in the small birth weight group were higher than that in the large birth weight group [29.0% (9/31) vs 0.0% (0/31), 54.8% (17/31) vs 25.8% (8/31); χ2=8.319 and 5.429; both P 0.67 were significantly higher in the small birth weight group than those in the large birth weight group [ΔSDS: (2.20±1.10) vs (0.92±0.91), (1.17±1.21) vs (0.37±1.14), (1.05±1.07) vs (0.16±0.89), t=8.422, 3.918 and 3.547, all P 0.67: 93.5% (29/31) vs 61.3% (19/31), 61.3% (19/31) vs 35.5% (11/31), 61.3% (19/31) vs 29.0% (9/31), χ2=9.226, 4.133 and 6.531, all P<0.05]. (3) The difference in SDS for weight, length and head circumference between the large and small birth weight twins at 24 months of age were significantly lower than those at birth [(0.68±0.71) vs (1.95±0.63), (0.67±0.77) vs (1.46±0.97), (0.71±0.80) vs (1.60±1.15); all P<0.05]. Conclusions Growth differences are found between birth weight-discordant MCDA twins all the way to 24 months of age from birth at a reduced trend. Key words: Twins, monozygotic; Birth weight; Fetal development; Follow-up studies

Evaluation of Inter-pair Differences in Caries among South Indian Monozygotic Twins: A Cross-sectional Study.

ABSTRACTIntroductionAssessment of difference in caries prevalence among twins may help determine the character and the extent of the influence exercised by the environment, as a complement of the genetic constitution.AimTo investigate the inter-pair differences in caries prevalence among South Indian monozygotic twins in relation to birth weight, birth order, and gender. Possible correlation among other attributes such as breastfeeding, socioeconomic status, oral habits, frequency of brushing, and sweet intake were also assessed.Materials and methodsA sample of 40 monozygotic children between the age group of 6 and 12 was selected. The parents were asked to complete the questionnaire and report with their children. Then dental examinations were carried out and the prevalence of dental caries among the twins were assessed.ResultsAmong the total samples, 61.5% exhibited caries. Lower birth weight twins showed an increased chance of caries (72.22%), compared to higher birth weight twins (68.18%). Second of the twins had an increased risk of dental caries (70%) compared to the first (60%). 90% of the male twins and 45% of the female twins had caries. The association between dental caries and other variables were also assessed; those who were exclusively breastfed had an increased risk (70%) of caries. Evaluation of socioeconomic status and caries revealed a risk of for the high (65%), middle (62.5%), and lower groups (58.33%). Children without oral habits showed a higher prevalence (73.3%) of caries when compared to those without any habits (50%). It was noticed that the brushing frequency is not related to the severity of caries. The strongest association was noticed between excessive sweet liking and prevalence of dental caries.ConclusionThe study revealed difference in caries prevalence among monozygotic twins in relation to birth weight, birth order, and gender. It was found that variations in caries prevalence existed with other attributes also.How to cite this articleZarina R, Kuriakose S, et al. Evaluation of Inter-pair Differences in Caries among South Indian Monozygotic Twins: A Cross-sectional Study. Int J Clin Pediatr Dent 2019;12(4):318–324.

Infusoabdomen with abdominal compartment in extremely low birth weight neonates

Abstract Central venous catheters (CVCs) are frequently used in neonatal care. The rate of complications upon CVC use is high and the spectrum ranges from catheter tip dislocation to cardiac tamponade and death. Here we present an explanation model to the phenomenon of paravasate into human anatomical cavities based on two illustrative cases: Extremely low birth weight twins suffering from abdominal compartment syndromes due to different pathologies – one with a trans-peritoneal and one with intra-abdominal effusion. In both siblings the peripherally introduced central catheter (PICC) perforated the vessel without clinical signs of bleeding and contributed to abdominal and thoracal complications. Case I (23 + 5 gestational week; 770 g; female) showed clinical signs of an abdominal compartment syndrome without respective intestinal pathology upon open surgical procedure with ileostomy. Radiographic contrast examination showed retroperitoneal leakage when administered through the catheter. Replacement into the subclavian vein led to cardio-respiratory misbalance due to severe pleural effusion. Re-replacement finally led to clinical restitution after 60 days of intensive care. Case II (23 + 5 gestational week; 690 g; female) showed clinical signs of an abdominal compartment syndrome, too. Radiographic contrast examination showed leakage from the PICC into the abdomen. Replacement of the PICC and invasive care led to improvement after 3 days. The 2 cases reveal that the displacement of a PICC can occur without direct clinical signs of hemodynamic imbalance i.e. bleeding or hematoma. Displacement of the catheter tip from intra-vascular, retro-peritoneal position can cause abdominal compartment syndromes either via trans-peritoneal migration of fluids or after perforation of the peritoneum via intra-abdominal administration of given infusion. Both options caused life threatening complications. Watchfulness and intensive surgical and non-surgical care are indicated to handle these severe complications.

Congenital cytomegalovirus infection in monozygotic twins with twin-to-twin transfusion syndrome

Symptoms of congenital cytomegalovirus infection remains unclear. Extremely low birth weight twins with twin-to-twin transfusion syndrome were infected with cytomegalovirus congenitally. The donor showed neuronal impairment, whereas the recipient showed hepatic dysfunction. Intrauterine hemodynamics may be important in pathophysiology of congenital cytomegalovirus infection.

A rare case of maxillary sinus osteomyelitis with intraorbital, extraconal abscess in a term low birth weight twin

Introduction: Acute osteomyelitis in neonates is a rare infectious disorder of bone leading to diagnostic and therapeutic challenge, more so in neonates. While the long bones are frequently affected sites, maxilla is rarely involved. Physiological immaturity of the immune system coupled with invasive diagnostic and therapeutic procedures render them susceptible for this

Prophylactic Effect of Clofibrate on Hyperbilirubinemia in Very Low Birth Weight Twins

Prophylactic Effect of Clofibrate on Hyperbilirubinemia in Very Low Birth Weight Twins

Prenatal and postnatal factors increase risk of severe ROP

To determine that slower weight premature twins have more risk to develop severe retinopathy of prematurity (ROP) than the higher weight twins. We know that the lower weight twins had less optimal intra-uterine environments than their higher weight twins. We screened 94 consecutive premature twins for ROP. We compared the lower weight twins (n = 47) against their higher weight twins (n = 47). The risk of severe ROP (ROP stage 3 or greater) was significantly higher in the lower weight twin group (p < 0.006). In the same way, in the lower weight twin group the non-perfused area of the temporal retinal artery was higher than that of the other group (an average of 1.2 diameters of the optic nerve head), in the 4–6 postnatal weeks (p < 0.004). The lower weight twin group have an increased risk of severe ROP associated with bacteremia (p = 0.045), or a weight gain less than 7 g per day in the 4–6 postnatal weeks (p = 0.013) or a supplementary postnatal oxygen >4 days (p = 0.007) compared to the higher weight twin group. We confirm Dr. Lee's work that less optimal prenatal factors, in preterm twins, increase the risk of severe ROP.

Discordance in neonatal risk factors and early childhood outcomes of very low birth weight (&lt;1.5 kg) twins

To examine the rates of discordance in neonatal risk factors and neurodevelopmental outcomes within very low birth weight twin pairs and the factors associated with discordant outcomes. Rates of neonatal risk factors and neurodevelopmental outcomes, and discordance in outcomes were examined for 88 very low birth weight twin pairs born between 1990 and 2005 and followed through 20 months' corrected age. Discordance rates ranged from 17 to 42% for neonatal risk factors and from 18 to 31% for neurodevelopmental outcomes. In regression analysis, affected co-twins were significantly more likely to have had an abnormal cerebral ultrasound than their unaffected co-twins in pairs discordant for cerebral palsy (odds ratio (OR): 13.00, 95% confidence interval (CI): 2.22 to 76.03)) and in pairs discordant for neurodevelopmental impairment (OR: 4.00, 95% CI: 1.13 to 14.18). Outcomes and discordance in outcomes were similar for monochorionic and dichorionic pairs. Despite shared genetics and risk factors, twins may have discordant outcomes. Information on discordant neonatal and neurodevelopmental outcomes is important for counseling families of twins.

Physical growth and cognitive abilities in concordant versus discordant birth weight twins at three years old

BackgroundDiscordant birth weight twins have been shown to have high rates of adverse perinatal outcomes, but little is known about their growth and development. AimTo determine whether smaller and larger birth weight premature twins in concordant and discordant birth weight groups differ on measures of physical growth and intelligence at 3years. Study designProspective cohort study. Eight-four children, 52 concordant and 32 discordant birth weight twin pairs, were measured for height, weight, and head circumference and on intelligence at 3years. Perinatal and demographic variables, including birth weight, head circumference, small for gestational age, zygosity, in vitro fertilization, gender and social class were recorded. ResultsSmaller and larger birth weight twins did not differ significantly from each other on any growth parameters in either concordant or discordant birth weight groups at 3years of age. Smaller birth weight twins in the discordant birth weight group performed significantly less well on Verbal, Performance, and Full Scale IQ scores (Verbal IQ for smaller twins was 8.6 points lower, p<0.005; Performance IQ, 11.9 points lower, p<0.03; Full Scale IQ, 12.4 points lower, p<0.004), but there were no significant intra-twin differences between larger and smaller birth weight concordant twins. ConclusionsSmaller discordant birth weight twins performed significantly less well on intelligence, although they did not differ significantly from their larger twins on growth parameters at 3years old. We conclude that smaller discordant birth weight twins had less optimal intra-uterine environments than their larger birth weight twin, which affected both their birth weights and brain development.

The Editor takes a closer look at some of this month's articles

The Editor takes a closer look at some of this month's articles

Neurodevelopmental Outcomes of Triplets or Higher-Order Extremely Low Birth Weight Infants

Extremely low birth weight twins have a higher rate of death or neurodevelopmental impairment than singletons. Higher-order extremely low birth weight multiple births may have an even higher rate of death or neurodevelopmental impairment. Extremely low birth weight (birth weight 401-1000 g) multiple births born in participating centers of the Neonatal Research Network between 1996 and 2005 were assessed for death or neurodevelopmental impairment at 18 to 22 months' corrected age. Neurodevelopmental impairment was defined by the presence of 1 or more of the following: moderate to severe cerebral palsy; mental developmental index score or psychomotor developmental index score less than 70; severe bilateral deafness; or blindness. Infants who died within 12 hours of birth were excluded. Maternal and infant demographic and clinical variables were compared among singleton, twin, and triplet or higher-order infants. Logistic regression analysis was performed to establish the association between singletons, twins, and triplet or higher-order multiples and death or neurodevelopmental impairment, controlling for confounding variables that may affect death or neurodevelopmental impairment. Our cohort consisted of 8296 singleton, 2164 twin, and 521 triplet or higher-order infants. The risk of death or neurodevelopmental impairment was increased in triplets or higher-order multiples when compared with singletons (adjusted odds ratio: 1.7 [95% confidence interval: 1.29-2.24]), and there was a trend toward an increased risk when compared with twins (adjusted odds ratio: 1.27 [95% confidence: 0.95-1.71]). Triplet or higher-order births are associated with an increased risk of death or neurodevelopmental impairment at 18 to 22 months' corrected age when compared with extremely low birth weight singleton infants, and there was a trend toward an increased risk when compared with twins.

163: Is chorionicity an independent risk factor for adverse neurological outcome in very low birth weight (VLBW) twins?

163: Is chorionicity an independent risk factor for adverse neurological outcome in very low birth weight (VLBW) twins?

External hydrocephalus in discordant birth weight twins: a case report

The term “external hydrocephalus (EH)” is used to describe excessively rapid head growth in infants who are found to have enlarged subarachnoid spaces and little or no ventricular enlargement. EH has not yet been described in discordant birth weight twins.We report the cases of two sets of discordant twins with normal neonatal course and normal neonatal brain ultrasound scans who developed an EH in the first months after birth and had a mild neurodevelopmental delay.Our findings suggest that EH may be part of neurologic morbidity in discordant birth weight twins and represents one of the potential complications to look for in the follow-up of these infants.

Intertwin Birth Weight Differences and Conduct Problems in Early Childhood

To examine whether twin birth weight differences relate to subsequent differences in conduct problems at 3 to 4 years of age. Retrospective cohort study using mothers' reports on twins' behavior, birth weight, and zygosity. A partial sample participated in laboratory visits. Jerusalem, Israel. All ethnic Jewish families identified by the Israeli Ministry of the Interior as having twins born in 2004 and 2005 were sent mail surveys regarding children's development. Families of twins (n = 1319) answered the survey when the twins were 3 years old. Same-sex birth weight-discordant twin pairs (n = 112) were selected for the main analyses of the study. A birth weight difference of 20.0% or more between the twins. Mothers' reports on twins' conduct problems using the Strengths and Difficulties Questionnaire and difference in conduct problems between the lower and higher birth weight twins in birth weight-discordant twin pairs. In birth weight-discordant twin pairs, the twin with the higher birth weight was reported to have more conduct problems compared with the twin with the lower birth weight in 41.1% of twin pairs, whereas the twin with the lower birth weight was reported to have more conduct problems only in 20.5% of twin pairs. This effect tended to be stronger in dizygotic compared with monozygotic twins. The findings suggest an effect of birth weight differences on development of subsequent conduct problems. Further studies are needed to clarify the mediating factors of this effect. The results point to the importance of birth history for subsequent development.

No juvenile arterial hypertension in sheep multiples despite reduced nephron numbers

Low birth weight is associated with an increased risk of metabolic dysfunction and arterial hypertension in later life. Because of their reduced birth weight twins have been used repeatedly as a natural model to investigate prenatal programming of hypertension. To reveal an early impact of lower nephron endowment on blood pressure, we performed a longitudinal study on lambs from single, twin and triplet pregnancies. The lambs were studied from birth until adulthood, including regular blood analyses, measurements of body weight and blood pressure and post-mortem estimation of glomerular numbers. Relative weight differences between multiples and singletons at birth were -28% for twins and -44% for triplets, respectively. Some lambs showed rapid catch-up growth. Total nephron number of twins and triplets was reduced by 21 and 37% with respect to that of singletons (p < 0.01). However, multiples did not show increased blood pressure within the time frame of this study. No gender-specific effect was observed. Plasma concentrations of creatinine, urea, electrolytes or osmolality also did not differ. Our data indicate that the previously reported postnatal blood pressure differences between sheep multiples and singletons are a time-limited phenomenon. During infancy and adolescence, a reduced nephron number in sheep multiples is neither associated with increased blood pressure nor reflected by plasma parameters.

Profile of asymmetrical retinopathy of prematurity in twins

Background:In twin births, both babies have the same gestational age and pre-natal conditions. However, twins may develop a varied retinopathy of prematurity (ROP) course depending on birth weight and other systemic factors.Objective:To study the profile of asymmetric ROP in twinsDesign:Retrospective studySetting:Tertiary ROP referral eye hospital.Materials and Methods:The profile of 56 pairs of twins with ROP were studied and analyzed for differences in zone or need for treatment, while studying possible causes for the varied outcome.Results:In 45 pairs of twins (80%) the disease progressed identically in both eyes, while in 11 pairs (20%) the ROP showed differences in zone or need for treatment. Four of these pairs were discordant. In 3 of these 4 pairs, the heavier birth weight twin had a more severe ROP course.Conclusions:Twins can present with asymmetric ROP course, and it is therefore essential to examine both twins as per screening protocols.

Academic achievement of twins and singletons in early adulthood: Taiwanese cohort study

Objectives To examine the long term effects of low birth weight on academic achievements in twins and singletons and to determine whether the academic achievement of twins in early adulthood...