Neonatal outcome of very premature infants from multiple and singleton gestations


      Objectives: Our purpose was to determine whether, in the era of surfactant treatment, very premature neonates from multiple gestations have outcomes similar to those of singletons. Study design: We collected data on 572 infants (369 singletons, 203 multiple gestation) born and cared for at a single institution from July 1, 1992, through Dec. 31, 1994, of gestational ages 24 to 32 weeks. We compared singleton infants with infants from multiple gestations within gestational age categories 24 to 26 weeks, 27 to 29 weeks, and 30 to 32 weeks. Results: Infants of multiple gestations were more likely to have been born by cesarean section. The incidences of respiratory distress syndrome and bronchopulmonary dysplasia were similar, except that respiratory distress syndrome was more frequent in infants of multiple gestations at 30 to 32 weeks. Infants of multiple gestations from 27 to 29 weeks were more likely to have at least one of the following complications: patent ductus arteriosus, intraventricular hemorrhage, necrotizing enterocolitis, or retinopathy of prematurity. Further analysis suggested that this increase is unlikely to cause a difference in long-term outcome. The survival to discharge increased from 79% (multiples) and 81% (singletons) at 24 to 26 weeks to 98% (multiples) and 96% (singletons) at 30 to 32 weeks. Conclusions: Incidences of significant neonatal problems in very premature infants from multiple gestations who are born alive are little different from those of singletons. These data should have an impact on decision making in the perinatal and neonatal care of infants of multiple gestations.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Wenstrom KD
        • Gall SA
        Incidence, morbidity and mortality, and diagnosis of twin gestations.
        Clin Perinatol. 1988; 15: 1-12
        • Benirschke K
        • Kim CK
        Multiple pregnancy.
        N Engl J Med. 1973; 288: 1276-1284
        • Rothman KJ
        Fetal loss, twinning, and birth weight after oral contraception.
        N Engl J Med. 1977; 297: 468-471
        • Cohen M
        • Kohl SG
        • Rosenthal AH
        Fetal interlocking complicating twin gestation.
        Am J Obstet Gynecol. 1965; 91: 407-412
        • Gardner MO
        • Goldenberg RL
        • Cliver SP
        • Tucker JM
        • Nelson KG
        • Copper RL
        The origin and outcome of preterm twin pregnancies.
        Obstet Gynecol. 1995; 85: 553-557
        • Naeye RL
        • Tafari N
        • Judge D
        • Marboe CC
        Causes of perinatal death in 12 United States cities and one African city.
        Am J Obstet Gynecol. 1978; 131: 267-272
        • Ghai V
        • Vidyasagar D
        Morbidity and mortality factors in twins: an epidemiologic approach.
        Clin Perinatol. 1988; 15: 123-140
        • Wolf EJ
        • Vintzileos AM
        • Rosenkrantz TS
        • Rodis JF
        • Lettieri L
        • Mallozzi A
        A comparison of pre-discharge survival and morbidity in singleton and twin very low birth weight infants.
        Obstet Gynecol. 1992; 80: 436-439
        • Leonard CH
        • Piecuch RE
        • Ballard RA
        • Cooper BA
        Outcome of very low birth weight infants: multiple gestation versus singletons.
        Pediatrics. 1994; 93: 611-615
        • Thorp JMJ
        • Turney LA
        • Bowes WAJ
        Outcome of multifetal gestations: a case-control study.
        J Matern Fetal Med. 1994; 3: 23-26
        • Crowley P
        • Chalmers I
        • Keirse MJNC
        The effects of corticosteroid administration before preterm delivery: an overview of the evidence from controlled trials.
        Br J Obstet Gynaecol. 1990; 97: 11-25
        • Schwartz RM
        • Luby AM
        • ScanIon JW
        • Kellogg RJ
        Effect of surfactant on morbidity, mortality, and resource use in newborn infants weighing 500 to 1500 g.
        N Engl J Med. 1994; 330: 1476-1480
        • Whitsett JA
        • Pryhuber GS
        • Rice WR
        • Warner BB
        • Wert SE
        Acute respiratory disorders.
        in: Neonatology: pathophysiology and management of the newborn. JB Lippincott, Philadelphia1994: 429-452
        • Avery ME
        • Tooley WH
        • Keller JB
        • Hurd SS
        • Bryan MH
        • Cotton RB
        • et al.
        Is chronic lung disease in Iow-birthweight infants preventable?.
        Pediatrics. 1987; 79: 26-30
        • Bell JJ
        • Ternberg JL
        • Feigin RD
        • Keating JP
        • Marshall R
        • Barton L
        • et al.
        Neonatal necrotizing enterocolitis: therapeutic decisions based upon clinical staging.
        Ann Surg. 1978; 187: 1-7
        • Zar JH
        Biostatistical analysis.
        Prentice-Hall, Englewood Cliffs (NJ)1984
        • Chervenak FA
        • Johnson RE
        • Youcha S
        • Hobbins JC
        • Berkowitz RL
        Intrapartum management of twin gestation.
        Obstet Gynecol. 1985; 65: 119-124
        • MacGillivray I
        Some observations on the incidence of pre-eclampsia.
        J Obstet Gynaecol Br Emp. 1958; 65: 536-539
        • McMullan PF
        • Norman RJ
        • Marivate M
        Pregnancy induced hypertension in twin pregnancy.
        Br J Obstet Gynaecol. 1984; 91: 240-243
        • Chitkara U
        • Berkowitz GS
        • Levine R
        • Riden DJ
        • Fagerstrom Jr., RM
        • Chervenak FA
        • et al.
        Twin pregnancy: routine use of ultrasound examinations in the prenatal diagnosis of intrauterine growth retardation and discordant growth.
        Am J Perinatol. 1985; 2: 49-54
        • Grumbach K
        • Coleman BG
        • Arger PH
        • Mintz MC
        • Gabbe SV
        • Mennuti MT
        Twin and singleton growth patterns compared using ultrasound.
        Radiology. 1986; 158: 237-241
        • Gilstrap LCI
        • Brown CEL
        Prevention and treatment of preterm labor in twins.
        Clin Perinatol. 1988; 15: 71-78