Published online January 12, 2009
PEDIATRICS Vol. 123 No. 2 February 2009, pp. e220-e227 (doi:10.1542/peds.2008-1126)
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ARTICLE

Twin Gestation and Neurodevelopmental Outcome in Extremely Low Birth Weight Infants

Rajan Wadhawan, MDa,b, William Oh, MDb,c, Rebecca L. Perritt, MSb, Scott A. McDonald, BSb, Abhik Das, PhDb, W. Kenneth Poole, PhDb, Betty R. Vohr, MDb,c and Rosemary D. Higgins, MDb

a West Coast Neonatology, All Children's Hospital, St Petersburg, Florida
c Division of Neonatology, Women and Infant's Hospital, Providence, Rhode Island
b Eunice Kennedy Shriver National Institute of Child Health and Human Development, Neonatal Research Network, Bethesda, Maryland

OBJECTIVE. The purpose of this work was to compare the risk-adjusted incidence of death or neurodevelopmental impairment at 18 to 22 months’ corrected age between twin and singleton extremely low birth weight infants. We hypothesized that twin gestation is independently associated with increased risk of death or adverse neurodevelopmental outcomes at 18 to 22 months’ corrected age in these infants.

METHODS. We conducted a retrospective study of inborn extremely low birth weight infants admitted to Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network units between 1997 and 2005, who either died or had follow-up data available at 18 to 22 months’ corrected age. Neurodevelopmental impairment, the primary outcome variable, was defined as the presence of any 1 of the following: moderate or severe cerebral palsy, severe bilateral hearing loss, bilateral blindness, Bayley Mental Developmental Index or Psychomotor Developmental Index of <70. Death was included with neurodevelopmental impairment as a composite outcome. Results were compared for both twins, twin A, twin B, same-gender twins, unlike-gender twins, and singleton infants. Logistic regression analysis was performed to control for demographic and clinical factors that were different among the groups.

RESULTS. The cohort of infants who either died or were assessed for neurodevelopmental impairment consisted of 7630 singleton infants and 1376 twins. Logistic regression adjusting for clinical and sociodemographic risk factors showed an increased risk of death or neurodevelopmental impairment for twins as a group when compared with the singletons. On analyzing twin A and B separately as well, risk of death or neurodevelopmental impairment was increased in both twin A and twin B.

CONCLUSIONS. Twin gestation in extremely low birth weight infants is associated with an independent increased risk of death or neurodevelopmental impairment at 18 to 22 months’ corrected age compared with singleton-gestation infants. Both first- and second-born twins are at increased risk.

Key Words: twins • neurodevelopmental impairment • extremely low birth weight infants

Abbreviations: CP—cerebral palsy • NICHD—Eunice Kennedy Shriver National Institute of Child Health and Human Development • ELBW—extremely low birth weight • MDI—Mental Developmental Index • PDI—Psychomotor Developmental Index • NDI—neurodevelopmental impairment • IVH—intraventricular hemorrhage • PVL—periventricular leukomalacia • OR—odds ratio • CI—confidence interval

Accepted Oct 8, 2008.


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