Tuesday, July 7, 2015

Understanding Morbidity and Mortality Concerns When Multiple Gestations Are Born Extremely Preterm

By: Lewis First, MD, MS; Editor-in-Chief 
     We are certainly aware of a myriad of potential complications that can occur to an extremely preterm infant and are grateful that our neonatology colleagues are there to help as needed.  But what if a mother in your practice gives birth to twins or triplets at an extremely preterm gestational age?  What advice do you give that family when they ask if this makes things better or worse for each individual twin or triplet infant?   
     Yeo et al. (doi: 10.1542/peds.2015-0479) share with us the results of a retrospective study of more than 15,000 infants born at or less than 27 weeks gestation from 1995-2009 into the Australian and New Zealand Neonatal Network in which singletons are compared to multiple gestation births in this preterm cohort.  There is a lot of data worth paying attention to in this study, with good news and bad news for multiple gestation infants compared to singletons born extremely preterm.  The bad news is that not unexpectedly, the odds of mortality in infancy are greater for multiples than for singletons across the 15 years studied.   
     The good news is that thanks to ongoing advances in neonatal care and technology, the odds of a poor outcome over the most recent 5 years studied is no different for multiple compared to single extremely preterm births.  If you are asked to care for a family expecting twins or triplets, and want to help them better understand what the future might hold if the babies are born earlier than expected, then labor a bit over this interesting study and deliver what you have learned in a way that hopefully will reassure expectant parents of multiple gestations as much as possible.

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