Am J Perinatol 2008; 25(6): 373-380
DOI: 10.1055/s-2008-1078762
© Thieme Medical Publishers

Triplet Infants with Birthweight ≤ 1250 Grams: How Well Do They Compare with Twin and Singleton Infants at 36 to 48 Months of Age?

Wendy H. Yee1 , Matt Hicks1 , Sophie Chen4 , Heather Christianson2 , Reg Sauve3
  • 1Department of Pediatrics, University of Calgary, Calgary Alberta, Canada
  • 2Department of Community Health Sciences, University of Calgary, Calgary Alberta, Canada
  • 3Department of Pediatrics and Department of Community Health Sciences, University of Calgary, Calgary Alberta, Canada
  • 4Primary Health Care and Public Health Directorate, Health Canada
Further Information

Publication History

Publication Date:
02 June 2008 (online)

ABSTRACT

The purpose of this study was to determine if triplet infants with birthweight ≤ 1250 g were at increased risk of long-term disability compared with similar birthweight and gestational age singletons and twins. This was a retrospective cohort study of ≤ 1250-g infants admitted to a regional neonatal intensive care unit from 1986 to 2001 with follow-up to 36 to 48 months corrected gestational age. Outcomes studied were cognitive ability, cerebral palsy, and neurosensory impairment at 36 to 48 months. Enrollment was 1717 infants: 59 triplets, 402 twins, and 1256 singletons. Triplet infants differed from twin or singleton infants because they were more likely to have older, married mothers (relative risk [RR] 3.62, 95% CI 1.31, 5.94), be products of assisted reproductive technology pregnancies (RR 29.59, 95% CI 13.97, 62.68), be exposed to antenatal steroids (RR 1.55, 95% CI 1.38, 1.75), and were all delivered by cesarean section. Triplet infants had lower risk of having intraventricular hemorrhage (RR 0.19, 95% CI 0.05, 0.75). The risk of cerebral palsy, cognitive delay, total major disability, or chronic lung disease was similar in triplet and twin infants compared with singleton infants. The lower risk of having intraventricular hemorrhage in triplet infants may have been due to the use of antenatal corticosteroids and cesarean section delivery.

REFERENCES

  • 1 Jewell S E, Yip R. Increasing trends in plural births in the United States.  Obstet Gynecol. 1995;  85(2) 229-232
  • 2 Joseph K S, Marcoux S, Ohlsson A et al.. Preterm birth, stillbirth and infant mortality among triplet births in Canada, 1985-96.  Paediatr Perinat Epidemiol. 2002;  16(2) 141-148
  • 3 Wilcox L S, Kiely J L, Melvin C L, Martin M C. Assisted reproductive technologies: estimates of their contribution to multiple births and newborn hospital days in the United States.  Fertil Steril. 1996;  65(2) 361-366
  • 4 Blickstein I, Keith L G. The decreased rates of triplet births: temporal trends and biologic speculations.  Am J Obstet Gynecol. 2005;  193(2) 327-331
  • 5 Gunby J, Daya S. Assisted reproductive technologies (ART) in Canada: 2001 results from the Canadian ART Register.  Fertil Steril. 2005;  84(3) 590-599
  • 6 Blickstein I. How and why are triplets disadvantaged compared to twins?.  Best Pract Res Clin Obstet Gynaecol. 2004;  18(4) 631-644
  • 7 Petterson B, Nelson K B, Watson L, Stanley F. Twins, triplets, and cerebral palsy in births in Western Australia in the 1980s.  BMJ. 1993;  307(6914) 1239-1243
  • 8 Pharoah P O, Cooke T. Cerebral palsy and multiple births.  Arch Dis Child Fetal Neonatal Ed. 1996;  75(3) F174-F177
  • 9 Yokoyama Y, Shimizu T, Hayakawa K. Prevalence of cerebral palsy in twins, triplets and quadruplets.  Int J Epidemiol. 1995;  24(5) 943-948
  • 10 Ballabh P, Kumari J, AlKouatly H B et al.. Neonatal outcome of triplet versus twin and singleton pregnancies: a matched case control study.  Eur J Obstet Gynecol Reprod Biol. 2003;  107(1) 28-36
  • 11 Barr S, Poggi S, Keszler M. Triplet morbidity and mortality in a large case series.  J Perinatol. 2003;  23(5) 368-371
  • 12 Garite T J, Clark R H, Elliott J P, Thorp J A. Twins and triplets: the effect of plurality and growth on neonatal outcome compared with singleton infants.  Am J Obstet Gynecol. 2004;  191(3) 700-707
  • 13 Kaufman G E, Malone F D, Harvey-Wilkes K B, Chelmow D, Penzias A S, D'Alton M E. Neonatal morbidity and mortality associated with triplet pregnancy.  Obstet Gynecol. 1998;  91(3) 342-348
  • 14 Maayan-Metzger A, Naor N, Sirota L. Comparative outcome study between triplet and singleton preterm newborns.  Acta Paediatr. 2002;  91(11) 1208-1211
  • 15 Shinwell E S, Blickstein I, Lusky A, Reichman B. Excess risk of mortality in very low birthweight triplets: a national, population based study.  Arch Dis Child Fetal Neonatal Ed. 2003;  88(1) F36-F40
  • 16 Ziadeh S M. Perinatal outcome in 41 sets of triplets.  Gynecol Obstet Invest. 2000;  50(3) 162-165
  • 17 Luke B, Brown M B, Hediger M L, Misiunas R B, Anderson E. Perinatal and early childhood outcomes of twins versus triplets.  Twin Res Hum Genet. 2006;  9(1) 81-88
  • 18 Feldman R, Eidelman A I. Does a triplet birth pose a special risk for infant development? Assessing cognitive development in relation to intrauterine growth and mother-infant interaction across the first 2 years.  Pediatrics. 2005;  115(2) 443-452
  • 19 Bax M C. Terminology and classification of cerebral palsy.  Dev Med Child Neurol. 1964;  11 295-297
  • 20 Blishen B R, Carroll W K, Moore C. The 1981 socioeconomic index for occupations in Canada.  Can Rev Sociol Anthropol. 1986;  24 465-488
  • 21 Salihu H M, Bekan B, Aliyu M H, Rouse D J, Kirby R S, Alexander G R. Perinatal mortality associated with abruptio placenta in singletons and multiples.  Am J Obstet Gynecol. 2005;  193(1) 198-203
  • 22 Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Consensus Development Panel on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes.  JAMA. 1995;  273(5) 413-418
  • 23 Garite T J, Rumney P J, Briggs G G et al.. A randomized, placebo-controlled trial of betamethasone for the prevention of respiratory distress syndrome at 24 to 28 weeks' gestation.  Am J Obstet Gynecol. 1992;  166(2) 646-651
  • 24 Leviton A, Kuban K C, Pagano M, Allred E N, Van M L. Antenatal corticosteroids appear to reduce the risk of postnatal germinal matrix hemorrhage in intubated low birth weight newborns.  Pediatrics. 1993;  91(6) 1083-1088
  • 25 Shankaran S, Bauer C R, Bain R, Wright L L, Zachary J. Relationship between antenatal steroid administration and grades III and IV intracranial hemorrhage in low birth weight infants. The NICHD Neonatal Research Network.  Am J Obstet Gynecol. 1995;  173(1) 305-312
  • 26 Ment L R, Oh W, Ehrenkranz R A, Philip A G, Duncan C C, Makuch R W. Antenatal steroids, delivery mode, and intraventricular hemorrhage in preterm infants.  Am J Obstet Gynecol. 1995;  172(3) 795-800
  • 27 Blickstein I, Reichman B, Lusky A, Shinwell E S. Plurality-dependent risk of severe intraventricular hemorrhage among very low birth weight infants and antepartum corticosteroid treatment.  Am J Obstet Gynecol. 2006;  194(5) 1329-1333
  • 28 Salihu H M, Aliyu M H, Rouse D J, Kirby R S, Alexander G R. The association of parity with mortality outcomes among triplets.  Am J Obstet Gynecol. 2004;  190(3) 784-789
  • 29 Topp M, Huusom L D, Langhoff-Roos J, Delhumeau C, Hutton J L, Dolk H. Multiple birth and cerebral palsy in Europe: a multicenter study.  Acta Obstet Gynecol Scand. 2004;  83(6) 548-553
  • 30 Adegbite A L, Ward S B, Bajoria R. Perinatal outcome of spontaneously conceived triplet pregnancies in relation to chorionicity.  Am J Obstet Gynecol. 2005;  193(4) 1463-1471
  • 31 Bajoria R, Ward S B, Adegbite A L. Comparative study of perinatal outcome of dichorionic and trichorionic iatrogenic triplets.  Am J Obstet Gynecol. 2006;  194(2) 415-424
  • 32 Blickstein I, Keith L G. Neonatal mortality rates among growth-discordant twins, classified according to the birth weight of the smaller twin.  Am J Obstet Gynecol. 2004;  190(1) 170-174
  • 33 Glinianaia S V, Pharoah P O, Wright C, Rankin J M. Fetal or infant death in twin pregnancy: neurodevelopmental consequence for the survivor.  Arch Dis Child Fetal Neonatal Ed. 2002;  86(1) F9-F15
  • 34 Shinwell E S. Neonatal morbidity of very low birth weight infants from multiple pregnancies.  Obstet Gynecol Clin North Am. 2005;  32(1) 29-38 viii
  • 35 Adegbite A L, Castille S, Ward S, Bajoria R. Neuromorbidity in preterm twins in relation to chorionicity and discordant birth weight.  Am J Obstet Gynecol. 2004;  190(1) 156-163
  • 36 Hvidtjorn D, Grove J, Schendel D E et al.. Cerebral palsy among children born after in vitro fertilization: the role of preterm delivery-a population-based, cohort study.  Pediatrics. 2006;  118(2) 475-482
  • 37 Ito A, Honma Y, Inamori E, Yada Y, Momoi M Y, Nakamura Y. Developmental outcome of very low birth weight twins conceived by assisted reproduction techniques.  J Perinatol. 2006;  26(2) 130-133
  • 38 Schieve L A, Rasmussen S A, Buck G M, Schendel D E, Reynolds M A, Wright V C. Are children born after assisted reproductive technology at increased risk for adverse health outcomes?.  Obstet Gynecol. 2004;  103(6) 1154-1163
  • 39 Laptook A R, O'Shea T M, Shankaran S, Bhaskar B. Adverse neurodevelopmental outcomes among extremely low birth weight infants with a normal head ultrasound: prevalence and antecedents.  Pediatrics. 2005;  115(3) 673-680
  • 40 Anderson P J, Doyle L W. Executive functioning in school-aged children who were born very preterm or with extremely low birth weight in the 1990s.  Pediatrics. 2004;  114(1) 50-57
  • 41 Hack M, Taylor H G, Drotar D et al.. Chronic conditions, functional limitations, and special health care needs of school-aged children born with extremely low-birth-weight in the 1990s.  JAMA. 2005;  294(3) 318-325
  • 42 Marlow N, Wolke D, Bracewell M A, Samara M. Neurologic and developmental disability at six years of age after extremely preterm birth.  N Engl J Med. 2005;  352(1) 9-19

Wendy H YeeM.D. M.Sc. 

Department of Pediatrics, University of Calgary

Unit 63, 7007 14th Street SW, Calgary, Alberta, T2V 1P9 Canada

    >