Evaluating 2 year outcome in twins < or = 30 weeks gestation at birth: a regional perinatal unit's experience.
Evaluating 2 year outcome in twins < or = 30 weeks gestation at birth: a regional perinatal unit's experience.
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DOI：
10.1375/twin.4.6.431
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发表时间：
2001-12-01
期刊：
影响因子：
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通讯作者：
Luther, M
中科院分区：
文献类型：
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作者：
Asztalos, E;Barrett, J F;Luther, M
随着辅助生殖医学技术的改进，双胞胎怀孕的绝对数量增加，围产期死亡率和发病率也相应增加。围产期死亡率和发病率的增加主要是由于早产发生率高于单胎。双胎妊娠有其独特的并发症，包括异常胎盘沟通和不协调的生长，这是与围产儿死亡率和发病率。本研究的目的有两个：i）确定妊娠24 - 30周出生的双胞胎队列在18 - 24个月矫正年龄时的发病率/死亡率结果与同一妊娠的单胎早产儿相比是否存在显着差异;和ii）确定和评估单绒毛膜（MC）和双绒毛膜（DC）双胞胎之间的任何差异。确定了1997年1月1日至1999年6月30日出生的妊娠24 - 30周的双胞胎，并前瞻性随访至18 - 24个月的校正年龄（c.a.）。他们与同一性别的单胎婴儿匹配，并且在同一妊娠的1周内。产科，新生儿和神经发育的数据进行了收集和分析。主要结局是在18 - 24个月矫正年龄时死亡或存在严重的神经发育缺陷。在确定的56对双胞胎中，对52对双胞胎进行了前瞻性随访，其中101名婴儿可供匹配。在这个队列中，双胎妊娠的妊娠高血压和胎膜早破的发生率低于单胎妊娠（p <0.05）。两组新生儿特征相似。双胞胎的死亡或严重残疾发生率为29.7%，单胞胎为22.8%（p = 0.337，Fisher精确检验）。两组的主要缺陷领域均为认知类，分别为9.9%和7.9%。MC双胎占35.6%，DC双胎占64.4%。双胎输血综合征（TTTS）发生率为6.9%。MC妊娠中更常发生不协调生长（p = 0.016）。与DC双胞胎相比，MC双胞胎倾向于更早产，出生体重更低，并且经历以动脉导管未闭和败血症形式的新生儿发病率（p <0.05）。然而，在18 - 24个月的c.a.时死亡或严重神经发育缺陷的主要结局。两组之间无显著差异，38.9%（MC）vs. 24.6%（DC），（p = 0.173，Fisher精确检验）。双胞胎TTTS的神经发育发病率或死亡率为42%。双胞胎的死亡率和严重的神经发育发病率并没有显著高于单胞胎。但是，双胞胎的趋势略高，这可能具有临床意义。虽然没有统计学意义，但MC双胞胎不良结局的发生率为38.9%，可能具有临床意义。随着双胞胎数量的稳步增加，需要进一步监测ng以确定未来干预和研究的方向。早期识别单绒毛膜性对于优化这些婴儿的护理和神经发育仍然至关重要。
With improved technology in assisted reproductive medicine, there has been an absolute increase in the numbers of twin pregnancies with an associated increase in perinatal mortality and morbidity. This increase in perinatal mortality and morbidity is largely due to a higher incidence of delivering preterm as compared to singletons. Twin pregnancies have their unique complications that include abnormal placental communication and discordant growth which are associated with perinatal mortality and morbidity. The objectives of this study were two-fold: i) to determine if the morbidity/mortality outcome at 18-24 months corrected age seen in a cohort of twins born between 24-30 weeks gestation was significantly different as compared to singleton preterm infants of the same gestation; and ii) to determine and evaluate any differences between monochorionic (MC) and dichorionic (DC) twins. Twins 24-30 weeks gestation at birth born between 01/01/97-30/06/99 were identified and prospectively followed to 18-24 months corrected age (c.a.). They were matched with a singleton infant of the same gender and within 1 week of the same gestation. Obstetrical, neonatal and neurodevelopmental data were gathered and analyzed. The primary outcome was death or the presence of a severe neurodevelopmental deficit at 18-24 months corrected age. Of the 56 sets of twins identified, 52 sets were followed prospectively with 101 infants available for matching. In this cohort, twin pregnancies had a lower incidence of pregnancy-induced hypertension and premature rupture of membranes than singletons (p < 0.05). The two groups were comparable in neonatal characteristics. The incidence of death or severe disability was 29.7% in twins vs. 22.8% in singletons (p = 0.337, Fisher's exact test). The major area of defect was in the cognitive category for both groups, 9.9% vs. 7.9% respectively. MC twins made up 35.6%; DC twins 64.4%. Twin to twin transfusion syndrome (TTTS) occurred in 6.9%. Discordant growth occurred more frequently in MC pregnancies (p = 0.016). MC twins tended to be more premature, lower in birth weight, and experience neonatal morbidity in the form of patent ductus arteriosus and sepsis (p < 0.05) as compared to DC twins. However, the primary outcome of death or severe neurodevelopmental deficit at 18-24 months c.a. was not significantly different between the two groups, 38.9% (MC) vs. 24.6% (DC), (p = 0.173, Fisher's exact test). Neurodevelopmental morbidity or mortality in twins with TTTS was 42%. Mortality and severe neurodevelopmental morbidity were not signif cantly higher in twins as compared to singletons in this cohort. However, the trend is slightly higher in twins, which may have clinical significance. Though not statistically significant, the incidence of 38.9% in adverse outcome wth MC twins may be clinically significant. With the number of twins steadily increasing, further monitor ng is required to determine future directions in intervention and research. Early recognition of monochorionicity remains essential to optimize care and neurodevelopment for these infants.