Abstract
Objective
To compare neonatal respiratory morbidity of twins according to birth order related to gestational age and mode of delivery.
Methods
We performed the retrospective research of the medical records of 3,224 neonates (1,612 twin pairs) born in a single center from January 2011 to December 2015. Subjects were classified into four gestational age groups: very (<32 weeks), moderate (32-33 weeks), late (34-36 weeks) preterm, and term (≥37 weeks) groups. We investigated clinical characteristics and respiratory morbidity according to birth order related to gestational age group and mode of delivery.
Results
We found increased risk of respiratory morbidity in second-born twin than first-born twin (P=0.039). Second-born twin was associated with increased risk of respiratory distress syndrome (RDS) in late preterm group (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.30-5.95), and transient tachypnea of newborn in term group (OR 1.4, 95% CI 1.03-1.81). In vaginal delivery mode, there was no difference of respiratory morbidity between first and second-born twin in each group, but in cases of Cesarean delivery, second-born twin was related with a greater risk of RDS in late preterm group (OR 2.3, 95% CI 1.07-5.09). Birth order and Cesarean section independently increased the risk of RDS (adjusted OR [aOR] 1.69, 95% CI 1.12-2.54; aOR 2.14, 95% CI 1.25-3.66, respectively).
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Table 1.
Characteristics and Respiratory Outcomes of the Study Population (n=3,224)
Values are presented as mean±standard deviation or number (%). Abbreviations: TTN, transient tachypnea of newborn; RDS, respiratory distress syndrome with surfactant; RD, respiratory distress of newborn with ventilator care; IVH, intraventricular hemorrhage; HIE, hypoxic ischemic encephalopathy; PVL, periventricular leukomalacia.
Table 2.
Difference of Respiratory Morbidity Incidence between 1st and 2nd Twin by Gestational Age and Mode of Delivery
Table 3.
Comparison of Respiratory Morbidity in 1st and 2nd Twin by Mode of Delivery
Table 4.
Logistic Regression Analysis of the Relative Effects of Birth Order on Respiratory Distress Syndrome by Mode of Delivery