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Journal of Pediatrics, The

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Neonatal and Early Childhood Outcomes of Twin and Singleton Infants Born Preterm - 08/11/23

Doi : 10.1016/j.jpeds.2023.02.021 
Nir Melamed, MD, MSc 1, 2, ⁎ , Omer Weitzner, MD 1, Paige Church, MD 3, 4, Rudaina Banihani, MD 3, 4, Jon Barrett, MD 5, Junmin Yang, MSc 6, Jonathan Wong, MD 7, Bruno Piedboeuf, MD 8, Prakesh S. Shah, MD 6, 9
on behalf of the

Canadian Neonatal Network (CNN)

Prakesh S. Shah, MD, MSc, Marc Beltempo, MD, Jaideep Kanungo, MD, Jonathan Wong, MD, Miroslav Stavel, MD, Rebecca Sherlock, MD, Ayman Abou Mehrem, MD, Jennifer Toye, MD, Joseph Ting, MD, Carlos Fajardo, MD, Jaya Bodani, MD, Lannae Strueby, MD, Mary Seshia, MBChB, Deepak Louis, MD, Ruben Alvaro, MD, Amit Mukerji, MD, Orlando Da Silva, MD, MSc, Sajit Augustine, MD, Kyong-Soon Lee, MD, MSc, Eugene Ng, MD, Brigitte Lemyre, MD, Thierry Daboval, MD, Faiza Khurshid, MD, Victoria Bizgu, MD, Keith Barrington, MBChB, Anie Lapointe, MD, Guillaume Ethier, NNP, Christine Drolet, MD, Bruno Piedboeuf, MD, Martine Claveau, MSc, LLM, NNP, Marie St-Hilaire, MD, Valerie Bertelle, MD, Edith Masse, MD, Hamid Mehdizadeh-Hakak, MD, Hala Makary, MD, Cecil Ojah, MBBS, Jo-Anna Hudson, MD, Jehier Afifi, MB BCh, MSc, Ameer Aslam, MD, Shoo K. Lee, MBBS, PhD

Canadian Preterm Birth Network (CPTBN)

Haim Abenhaim, MD, Jehier Afifi, MBBCh, MSc, Ruben Alvaro, MD, James Andrews, MD, Anthony Armson, MD, Francois Audibert, MD, Khalid Aziz, MBBS, MA, Med, Marilyn Ballantyne, RN, PhD, Jon Barrett, MD, Marc Beltempo, MD, Anick Berard, PhD, Valerie Bertelle, MD, Lucie Blais, PhD, Alan Bocking, MD, Jaya Bodani, MD, Jason Burrows, MD, Kimberly Butt, MD, Roderick Canning, MD, George Carson, MD, Nils Chaillet, PhD, Sue Chandra, MD, Paige Church, MD, Zenon Cieslak, MD, Kevin Coughlin, MD, Joan Crane, MD, Dianne Creighton, PhD, Orlando Da Silva, MD, MSc, Thierry Daboval, MD, Leanne Dahlgren, MD, Sibasis Daspal, MD, Cecilia de Cabo, MD, Akhil Deshpandey, MBBS, MRCPI, Kimberly Dow, MD, Christine Drolet, MD, Michael Dunn, MD, Salhab el Helou, MD, Darine El-Chaar, MD, Walid El-Naggar, MD, Carlos Fajardo, MD, Jonathan Foster, Robert Gagnon, MD, Rob Gratton, MD, Victor Han, MD, Adele Harrison, MD, MBChB, Shabih Hasan, MD, Michael Helewa, MD, Matthew Hicks, MD, PhD, K.S. Joseph, MD, PhD, Andrzej Kajetanowicz, MD, Zarin Kalapesi, MD, May Khairy, MD, Thierry Lacaze-Masmonteil, MD, Kyong-Soon Lee, MD, MSc, Brigitte Lemyre, MD, Abhay Lodha, MD, Deepak Louis, MD, Thuy Mai Luu, MD, MSc, Linh Ly, MD, Annette Majnemer, PhD, MSc, Hala Makary, MD, Isabelle Marc, MD, Edith Masse, MD, Sarah D. McDonald, MD, MSc, Doug McMillan, MD, Nir Melamed, MD, Amy Metcalfe, PhD, Diane Moddemann, MD, Med, Luis Monterrosa, MD, Michelle Morais, MD, Amit Mukerji, MD, William Mundle, MD, Lynn Murphy, MD, Kellie Murphy, MD, Anne-Monique Nuyt, MD, Chuks Nwaesei, MD, Karel O'Brien, MD, Martin Offringa, MD, Cecil Ojah, MBBS, Annie Ouellet, MD, Jean-Charles Pasquier, MD, PhD, Petros Pechlivanoglou, PhD, Ermelinda Pelausa, MD, Bruno Piedboeuf, MD, Elodie Portales-Casamar, PhD, Shahirose Premji, PhD, Pramod Puligandla, MD, MSc, Eleanor Pullenayegum, PhD, Amber Reichert, MD, Kate Robson, Carol Schneider, MD, Mary Seshia, MBChB, Prakesh S. Shah, MD, MSc, Vibhuti Shah, MD, MSc, Rebecca Sherlock, MD, Sandesh Shivananda, MD, MSc, Nalini Singhal, MD, Erik Skarsgard, MD, Amanda Skoll, MD, Graeme Smith, MD, Anne Synnes, MDCM, MHSC, Katherine Thériault, MD, Joseph Ting, MD, Suzanne Tough, PhD, Jennifer Toye, MD, Jagdeep Ubhi, MD, Michael Vincer, MD, Wendy Whittle, MD, PhD, Hilary Whyte, MD, Doug Wilson, MD, Stephen Wood, MD, Philip Ye, MSc, Wendy Yee, MD, Jill Zwicker, PhD

Canadian Neonatal Follow-Up Network (CNFUN) Investigators∗

  Names of the CNN, CPTBN, and CNFUN Investigators are listed in the Acknowledgments.
Thevanisha Pillay, MD, Anne Synnes’, MDCM’ MHSc (Past Director), Lindsay Colby, RN BScN, MSN (steering committee), Jill Zwicker, PhD, OT (steering committee), Shelagh Anson, MD, Rebecca Sherlock, MD, Miroslav Stavel, MD, Anitha Moodley, MD, Leonora Hendson, MD, Amber Reichert, MD, Matthew Hicks, MD, PhD (steering committee), Diane Moddemann, MD, MEd, Cecilia de Cabo, MD, M. Florencia Ricci, MD, PhD (steering committee), Sajit Augustine, MD, Sarah McKnight, MD, Kevin Coughlin, MD, Linh Ly, MD, Edmond Kelly, MD, Kamini Raghuram, MD, Karen Thomas, MD (steering committee), Paige Church, MD, Rudaina Banihani, MD (steering committee), Kim-Anh Nguyen, MD, Ruth Mandel, MD, May Khairy, MD, Marc Beltempo, MD, Thuy Mai Luu, MD, MSc (Director), Alyssa Morin, MD, Sylvie Bélanger, MD, Jehier Afifi, MB, BCh, MSc, (Co-Director)

1 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada 
2 Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada 
3 Department of Newborn & Developmental Pediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada 
4 Department of Pediatrics, University of Toronto, Toronto, ON, Canada 
5 Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada 
6 Maternal-infant Care (MiCare) Research Centre, Mount Sinai Hospital, Toronto, ON, Canada 
7 Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada 
8 Department of Pediatrics, CHU de Québec – Université Laval, Quebec City, QC, Canada 
9 Department of Pediatrics, University of Toronto, Toronto, ON, Canada 

∗Reprint requests: Nir Melamed, MD, MSc, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5, CanadaDivision of Maternal-Fetal MedicineDepartment of Obstetrics and GynecologySunnybrook Health Sciences Center2075 Bayview AveTorontoOntarioM4N 3M5Canada

Abstract

Objective

To compare neonatal and early-childhood outcomes of twins and singletons born preterm and explore the association of chorionicity with outcomes.

Study design

This was a national retrospective cohort study of singleton and twin infants admitted at 230/7-286/7 weeks to level III neonatal intensive care units in Canada (2010-2020). The primary neonatal outcome was a composite of neonatal death or severe neonatal morbidities. The primary early-childhood outcome was a composite of death or significant neurodevelopmental impairment.

Results

The study cohort included 3554 twin and 12 815 singleton infants. Twin infants born at 230/7-256/7 weeks had a greater risk of the composite neonatal outcome (adjusted risk ratio 1.04, 95% CI 1.01-1.07). However, these differences were limited to the subgroups of same-sex and monochorionic twin pregnancies. Twin infants of 230/7-256/7 weeks were also at an increased risk of the composite early-childhood outcome (adjusted risk ratio 1.22, 95% CI 1.09-1.37). Twin infants of 260/7-286/7 weeks were not at an increased risk of adverse neonatal outcomes or the composite early-childhood outcome compared with singleton infants.

Conclusions

Among infants born at 230/7-256/7 weeks, twins have a greater risk of adverse neonatal outcomes and the composite early-childhood outcome than singleton infants. However, the increased risk of adverse neonatal outcomes is mostly limited to monochorionic twins and may thus be driven by complications related to monochorionic placentation.

Le texte complet de cet article est disponible en PDF.

Abbreviations : aRD, aRR, Bayley-III, BPD, CNFUN, CNN/CPTBN, NICU, sNDI


Plan


 The project is supported by the funding for the Canadian Preterm Birth Network from the Canadian Institutes of Health Research (Principal Investigator: P.S, PBN 150642). Maternal-infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, Ontario, is supported by a Canadian Institutes of Health Research (CIHR) Team Grant (CTP 87518), the Ontario Ministry of Health and Long-Term Care, and the participating hospitals. The funders had no roles in the study design; the collection, analysis, or interpretation of data; the writing of the report; or the decision to submit the article for publication. We confirm the independence of the study researchers from the funders; and we confirm that all authors, external and internal, had full access to all the data in the study (including statistical reports and tables) and can take responsibility for the integrity of the data and the accuracy of the analysis. N.M. holds the Waugh Family Chair in Twin Fetal Medicine Research at the Sunnybrook Health Sciences Center and the University of Toronto. The authors have no conflicts of interest to disclose.


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Vol 262

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