Impact of delivery order on short-term clinical outcomes of preterm twins born before 32 weeks of gestation
10.3760/cma.j.cn113903-20230917-00205
- VernacularTitle:胎龄<32周双胎早产儿娩出顺序对近期临床结局的影响
- Author:
Qianyu LIU
1
;
Sijie SONG
1
;
Qian XIE
1
;
Yan WU
1
Author Information
1. 重庆市妇幼保健院（重庆医科大学附属妇女儿童医院）儿一科，重庆 401147
- Publication Type:Journal Article
- Keywords:
Parturition;
Infant, premature;
Pregnancy, twin;
Respiratory distress syndrome, newborn
- From:
Chinese Journal of Perinatal Medicine
2024;27(12):1015-1023
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the impact of delivery orders on the short-term clinical outcomes of preterm twins born before 32 weeks of gestation.Methods:A retrospective analysis was conducted on the clinical data of preterm twins born before 32 weeks of gestation who were admitted to the Neonatology Department of Women and Children's Hospital of Chongqing Medical University from January 2018 to December 2022. The twins were divided into two groups based on the order of delivery: the first-born group and the second-born group. The study analyzed the impact of delivery orders on resuscitation support measures and outcomes during the transition period in the delivery room, respiratory support modes and treatments in the neonatal intensive care unit (NICU), severe complications (hemodynamically significant patent ductus arteriosus, neonatal necrotizing entercolitis≥stage Ⅱ, early- and late-onset sepsis, retinopathy of prematurity, and intracranial hemorrhage), and mortality. Subgroup analyses were also conducted based on chorionicity and mode of delivery. Statistical analyses were performed using paired t-tests, rank-sum tests, and McNemar's tests (paired Chi-square tests). Results:(1) A total of 296 cases (148 pairs) of preterm twins born before 32 weeks of gestation were included in the study. The proportion of 1-minute Apgar scores≤7 was higher in the second-born group compared to the first-born group [27.7% (41/148) vs. 17.6% (26/148), χ2=5.94, P=0.015]; however, there were no statistically significant differences between the two groups in terms of the proportion of umbilical artery blood gas pH<7.2, 5-minute Apgar scores, intubation, use of pulmonary surfactant (PS) in the delivery room, chest compressions, birth weight, and/or adrenaline use. There were also no statistically significant differences in 1-minute Apgar scores≤7 between the first-born and second-born groups when analyzed by chorionicity and mode of delivery. (2) There was no statistically significant difference in the overall incidence of neonatal respiratory distress syndrome (NRDS) between the first-born and second-born groups, but the incidence of NRDS stages Ⅲ-Ⅳ was higher in the second-born group compared to the first-born group [27.0% (40/148) vs. 16.9% (25/148), χ2=5.94, P=0.015]. There were no statistically significant differences between the two groups in terms of the proportion of single and multiple doses of PS use, the proportion and total duration of mechanical ventilation, and the incidence of bronchopulmonary dysplasia. Among dichorionic twins, the incidence of respiratory failure and NRDS stages Ⅲ-Ⅳ was higher in the second-born group compared to the first-born group [87.4% (104/119) vs. 79.8% (95/119), paired Chi-square test, P=0.035; 27.7% (33/119) vs. 17.6% (21/119), χ2=4.03, P=0.045]. The incidence of NRDS stages Ⅲ-Ⅳ was higher in the second-born group compared to the first-born group during vaginal delivery and cesarean section [51.6% (16/31) vs. 22.6% (7/31), paired Chi-square test, P=0.012; 20.5% (24/117) vs. 15.4% (18/117), χ2=56.14, P<0.001]. (3) There were no statistically significant differences in the mortality and the incidence of complications between the first-born and second-born groups. When analyzed by different chorionicity and delivery methods, the differences in the mortality and incidence of the complications between the different birth order groups were also not statistically significant. Conclusions:Among preterm twins born before 32 weeks of gestation, the proportion of second-born infants with a 1-minute Apgar score≤7 and the incidence of NRDS stages Ⅲ-Ⅳ were higher. However, with active resuscitation, management during the transition period in the delivery room, and respiratory support treatment, the birth order did not significantly affect the short-term incidence of severe complications and mortality in the second-born infants.
