Perinatal characteristics and neonatal outcomes of singletons and twins in Chinese very preterm infants: a cohort study

Min Yang; Lingyu Fang; Yanchen Wang; Xiaoying Li; Yun Cao; Jianhua Sun; Joseph Ting; Xiafang Chen; Xiaobo Fan; Jiale Dai; Xiaomei Tong; Dongmei Chen; Jimei Wang; Chinese Neonatal Network

doi:10.1186/s12884-023-05409-8

Perinatal characteristics and neonatal outcomes of singletons and twins in Chinese very preterm infants: a cohort study

BMC Pregnancy Childbirth. 2023 Feb 1;23(1):89. doi: 10.1186/s12884-023-05409-8.

Authors

Min Yang^#¹, Lingyu Fang^#², Yanchen Wang³, Xiaoying Li⁴, Yun Cao^{3

5}, Jianhua Sun⁶, Joseph Ting⁷, Xiafang Chen⁶, Xiaobo Fan¹, Jiale Dai¹, Xiaomei Tong², Dongmei Chen⁸, Jimei Wang⁹; Chinese Neonatal Network

Collaborators

Chinese Neonatal Network:
Shoo K Lee, Chao Chen, Lizhong Du, Wenhao Zhou, Falin Xu, Xiuying Tian, Huayan Zhang, Yong Ji, Zhankui Li, Jingyun Shi, Xindong Xue, Chuanzhong Yang, Sannan Wang, Ling Liu, Xirong Gao, Hui Wu, Changyi Yang, Shuping Han, Ruobing Shan, Hong Jiang, Gang Qiu, Qiufen Wei, Rui Cheng, Wenqing Kang, Mingxia Li, Yiheng Dai, Lili Wang, Jiangqin Liu, Zhenlang Lin, Yuan Shi, Xiuyong Cheng, Jiahua Pan, Qin Zhang, Xing Feng, Qin Zhou, Long Li, Pingyang Chen, Ling Yang, Deyi Zhuang, Yongjun Zhang, Jinxing Feng, Li Li, Xinzhu Lin, Yinping Qiu, Kun Liang, Li Ma, Liping Chen, Liyan Zhang, Hongxia Song, Zhaoqing Yin, Mingyan Hei, Huiwen Huang, Jie Yang, Dong Li, Guofang Ding, Qianshen Zhang, Xiaolu Ma

Affiliations

¹ Division of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, No. 419, Fangxie Road, Shanghai, 200011, China.
² Division of Neonatology, QuanZhou Women's and Children's Hospital, No. 700, Fengze Road, Fujian, 362000, China.
³ NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, 201102, China.
⁴ Division of Neonatology, Children's Hospital Affiliated to Shandong University, Jinan, 250022, China.
⁵ Division of Neonatology, Children's Hospital of Fudan University, Shanghai, 201102, China.
⁶ Division of Neonatology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
⁷ Department of Pediatrics, University of Alberta, EdmontonAlberta, T6G 1K8, Canada.
⁸ Division of Neonatology, QuanZhou Women's and Children's Hospital, No. 700, Fengze Road, Fujian, 362000, China. chendm9090@163.com.
⁹ Division of Neonatology, Obstetrics and Gynecology Hospital of Fudan University, No. 419, Fangxie Road, Shanghai, 200011, China. wjm8219@163.com.

^# Contributed equally.

Abstract

Background: The prevalence of preterm birth has been rising, and there is a paucity of nationwide data on the perinatal characteristics and neonatal outcomes of twin deliveries of very preterm infants (VPIs) in China. This study compared the perinatal characteristics and outcomes of singletons and twins admitted to neonatal intensive care units (NICUs) in China.

Methods: The study population comprised all infants born before 32 weeks in the Chinese Neonatal Network (CHNN) between January 2019 and December 2019. Three-level and population-average generalized estimating equation (GEE)/alternating logistic regression (ALR) models were used to determine the association of twins with neonatal morbidities and the use of NICU resources.

Results: During the study period, there were 6634 (71.2%) singletons and 2680 (28.8%) twins, with mean birth weights of 1333.70 g and 1294.63 g, respectively. Twins were significantly more likely to be delivered by caesarean section (p < 0.01), have antenatal steroid usage (p = 0.048), have been conceived by assisted reproductive technology (ART) (p < 0.01), have a higher prevalence of maternal diabetes (p < 0.01) and be inborn (p < 0.01) than singletons. In addition, twins had a lower prevalence of small for gestational age, maternal hypertension, and primigravida mothers than singletons (all p < 0.01). After adjusting for potential confounders, twins had higher mortality rates (adjusted odds ratio [AOR] 1.28, 95% confidence interval [CI] 1.10-1.49), higher incidences of short-term composite outcomes (AOR 1.28, 95% CI 1.09-1.50), respiratory distress syndrome (RDS) (AOR 1.30, 95% CI 1.12-1.50), and bronchopulmonary dysplasia (BPD) (AOR 1.10, 95% CI 1.01-1.21), more surfactant usage (AOR 1.22, 95% CI 1.05-1.41) and prolonged hospital stays (adjusted mean ratio 1.03, 95% CI 1.00-1.06), compared to singletons.

Conclusion: Our work suggests that twins have a greater risk of mortality, a higher incidence of RDS and BPD, more surfactant usage, and longer NICU stays than singletons among VPIs in China.

Keywords: Neonatal outcome; Singletons; Twins; Very preterm birth.

MeSH terms

Cesarean Section
Cohort Studies
East Asian People
Female
Fetal Growth Retardation
Gestational Age
Humans
Infant
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases*
Pregnancy
Premature Birth* / epidemiology

Grants and funding

21Y21900802/Jimei Wang