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Morbidity and mortality of twins and triplets compared to singleton infants delivered between 26–34 weeks gestation in the United States

Journal of Perinatology volume 44, pages 231–238 (2024)Cite this article

Subjects

Abstract

Objective

To describe in-hospital morbidities and mortality among twins and triplets delivered at ≥26 to ≤34 weeks gestational age (GA) while controlling for prematurity and growth restriction.

Study design

Retrospective analysis of inborn infants discharged from a neonatal intensive care unit (NICU) managed by the Pediatrix Medical Group between 2010 and 2018.

Result

Among 247 437 infants included, 27.4% were multiples. Adjusted for GA and other factors typically known prior to delivery, in-hospital morbidities varied by plurality and generally were more common in singletons. The odds of death prior to discharge were less for twins at 0.74 (95% CI: 0.67–0.83) and triplets at 0.69 (95% CI: 0.51–0.92) compared to singletons.

Conclusion

Singletons experience greater morbidity and mortality compared to twins and triplets born ≥26 weeks to ≤34 weeks GA, except PDA requiring procedural intervention, ROP requiring treatment, and longer length of stay.

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Fig. 1: Consort diagram.
Fig. 2: Multiples and singletons discharged from Pediatrix NICUs from 2010–2018.
Fig. 3: Adjusted in-hospital and discharge outcomes for twins and triplets compared to singletons.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Department of Pediatrics, University of Washington, Seattle Children’s Hospital, Seattle, WA, USA

    Sara Khan

  2. Department of Pediatrics, Duke University Medical Center, Durham, NC, USA

    Ryan Kilpatrick, Rachel G. Greenberg & Kanecia O. Zimmerman

  3. Department of Pediatrics, Duke Clinical Research Institute, Durham, NC, USA

    Ryan Kilpatrick, Rachel G. Greenberg & Kanecia O. Zimmerman

  4. Department of Economics, Clemson University, Clemson, SC, USA

    Daniel K. Benjamin

  5. Department of Pediatrics, Division of Neonatology, University of Washington and Seattle Children’s Hospital, Seattle, WA, USA

    Sarah E. Kolnik & Mihai Puia-Dumitrescu

  6. Center for Research, Education, Quality, and Safety, Pediatrix Medical Group, Inc, Sunrise, FL, USA

    Reese Clark

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Contributions

SK and RK had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis and contributed to the conception and design of the study, the data analysis, the data interpretation, the manuscript drafting, and the critical revision of the manuscript. DKB contributed to the data analysis and interpretation, the manuscript drafting, and the critical revision of the manuscript. SEK, KOZ, and RC contributed to the data interpretation, the manuscript drafting, and the critical revision of the manuscript. RGG and MP-D contributed to the conception and design of the study, the supervision, data interpretation, and the critical revision of the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Sara Khan.

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Competing interests

RG has received support from industry for research services (https://dcri.org/about-us/conflict-of-interest/). OZ reports funding from the National Institutes of Health (NIH) and US Food and Drug Administration (FDA). The other authors have no conflicts of interest to disclose.

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Khan, S., Kilpatrick, R., Benjamin, D.K. et al. Morbidity and mortality of twins and triplets compared to singleton infants delivered between 26–34 weeks gestation in the United States. J Perinatol 44, 231–238 (2024). https://doi.org/10.1038/s41372-023-01822-1

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