Objective To study the early complications and neurological prognosis within 12 months of corrected age in twin preterms with birth weight discordance,in order to provide evidence for the prevention of complications in twin preterms with birth weight discordance. Methods A prospective cohort study was conducted.a total of 67 pairs of live twin preterms with birth weight discordance≥25% but without twin to twin transfusion syndrome hospitalized in the neonatal department of the Third Affiliated Hospital of Zhengzhou University from January 1,2016 to December 31,2017 were included,and were divided into low birth weight group and high birth weight group.The early complications and neurological prognosis within 12 months of corrected age were observed. Results 1)The rates of neonatal respiratory distress syndrome (NRDS),feeding intolerance and infectious diseases were significantly higher in the low birthweight group than in the high birth weight group (t=4.418,4.251,3.983,5.858,4.733,P<0.05).2)A total of 55 pairs of twins were both cured and 43 pairs were followed up to 12 months of correct age.In different gestational age groups (＜32 weeks,32-33+6 weeks and 34-36+6weeks),neonatal behavioral neurological assessment (NBNA) scores in low birthweight group were significantly lower than that of heavy birthweight group (t=4.850,3.269,3.381,P<0.05).There was no statistical difference in mental development index (MDI) between the two groups among different gestational age groups at 6 and 12 months of correct age respectively,while psychomotor development index (PDI) in the low birth weight group was lower than that of high birth weight group with statistical difference among different gestational age groups at 6 and 12 months of correct age (6months t=3.735,2.494,2.129;12months t=4.269,3.233,2.578,P<0.05). Conclusions In the twin preterms with birth weight discordance,those with low birthweight have more complications and a higher incidence of poor prognosis.Therefore,strict follow-up should be taken to those patients,and more attention should be paid to the psychomotor development.
Key words
twins /
preterm /
birth weight discordance /
complications /
neurological development
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References
[1] 中华医学会围产医学分会胎儿医学学组,中华医学会妇产科学分会产科学组.双胎妊娠临床处理指南(第二部分)-双胎妊娠并发症的诊治[J].中华妇产科杂志,2015,50(9):641-647.
[2] Cecilie H,Fergal DM,Fionnuala MB,et al.Neuro-developmental outcome of a large cohort of growth discordant twins[J].Eur J Pediatr,2016,175:381-389.
[3] 邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].4版.北京:人民卫生出版社,2011:206-719.
[4] Cambiaso O,Zhao DP,Abasolo JI,et al. Discordance of cord insertions as a predictor of discordant fetal growth in monochorionic twins[J]. Placenta,2016,47:81-85.
[5] 肖玲玲,肖翠勇,汪吉梅.双胎生长不一致现状及其高危因素分析[J].中国优生与遗传杂志,2017,25(12):55-57.
[6] 吴丹燕,索冬梅,鲁云涯.双胎发育不一致性的相关因素分析[J].大连医科大学学报,2017,39(6):557-561.
[7] 张丽,董彦会,马军.新生儿双胎体重不均衡的现状及其危险因素分析[J].中国新生儿科杂志,2016,31(6):438-441.
[8] Jahanfar S,Lim K,Ovideo-Joekes E.Birth weight discordance and adverse perinatal outcomes[J].J Perinat Med,2017,45(5):603-611.
[9] Nawab US,Greenspan JS,Kirkby S,et al. Differences in short-term neonatal outcomes between discordant twins[J].Adv Neonatal Care,2008,8(6):334-342.
[10] 李慧玲,张巍,王萍.双胎体重差异与新生儿疾病[J].中华临床医师杂志:电子版,2013,7(14):6317-6321.
[11] Di Mascio D,Acharya G,Khalil A,et al.Birthweight discordance and neonatal morbidity in twin pregnancies:A systematic review and meta-analysis[J].Acta Obstet Gynecol Scand,2019.doi:10.1111/aogs.13613.
[12] 蔡岳鞠,宋燕燕,黄志坚.宫内发育迟缓早产儿生后生长迟缓对早期神经发育的影响[J].中国当代儿科杂志,2015,17(9):893-897.
[13] Steingass KJ,Taylor HG,Wilson-Costello D,et al. Discordance in neonatal risk factors and early childhood outcomes of very low birth weight (<1.5 kg) twins[J].J Perinatol,2013,33(5):388-393.
[14] 项慧秋,黄贤苹,金佳希,等.宫内发育不一致性双胎出生后1年婴儿生长发育的研究[J].温州医科大学学报,2016,46(2):84-87.
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