Analysis Of Complications During Hospitalization Of Twin Newborns With Discordant Birth Weight

ObjectiveTo analyse the occurrence of complications during hospitalization of twins with discordant birth weights and to explore the impact of discordant birth weight.MethodsA retrospective analysis was performed on 1686 pairs of twins who born in the Department of Obstetrics of the Third Affiliated Hospital of Guangzhou Medical University from January 1,2011 to December 31,2020,admitted to the NICU of our hospital after birth and had complete data during hospitalization,excluding birth defects of one or both twins,twin transfusion syndrome,edema,and twin-anemia-polycythemia sequence,a total of 1546 pairs of twin fetuses were included in the analysis.Study 1:According to the birth weight discordant(BWD)between twins,BWD>15%were grouped as birth weight discordant twins(BWDT)and BWD≤15%were group as birth weight concordant twins(BWCT).The basic data of pregnant mothers during pregnancy and delivery,the outcome of twin births and the occurrence of complications in NICU were compared between the BWDT group and the BWCT group.Study 2:According to the degree of birth weight discordant(ΔBW),the four groups were divided into ΔBWv15%group,15%<Δ BW≤20%group,20%<Δ BW≤25%group and Δ BW>25%group,and the basic conditions of pregnant mothers during pregnancy and delivery,birth outcomes of twins and complications during hospitalization were compared between the four groups,and the effects of different birth weight discordance on complications during hospitalization of twin fetuses were analyzed.Study 3:Taking ΔBW>15%as the criterion for BWDT,the twins in the BWDT group were divided into heavy birth weight(heavy infants)and low birth weight(light infants)according to their birth weight,and the complications during hospitalization of light infants and heavy infants were compared.Result1.From 2011 to 2020,4081 pairs of twins were delivered in our hospital,and 168 6 pairs of live birth twins were admitted to the Neonatology department after birth and had complete data,of which one of the twins or twins with defects were 86 pairs,51 pairs of TTTS,1 pair of edema fetuses,2 pairs of TP AS,and finally included a total of 1546 pairs of twins in the study;There were 486 pairs(31.4%)in the BWDT group and 1060 pairs(68.6%)in the BWCT group.According to the degree of ΔBW,there were 1060 pairs(68.6%)in ΔBW≤15%group,15%<180 pairs(11.6%)in 15%<ΔBW≤20%group,124 pairs(8.0%)in 20%<ΔBW≤25%group,and 182 pairs(11.8%)in ΔBW>25%group.2.The BWDT group compared to the BWCT group:(1)Comparison of maternal condition in BWDT group and BWCT group:the incidence of cesarean section(84.8%),prenatal gluconeogenesis(34.8%),gestational hypertension(22.6%),amniotic fluid abnormalities(15.8%),and fetal intrauterine distress(9.0%)in the BWCT group was higher than that in the BWCT group,and the difference was statistically significant(P<0.01).There were no significant differences in mean age,adverse maternal history,mode of conception,Gestational diabetes mellitus,chorioamnionitis,thyroid dysfunction,cervical insufficiency,umbilical cord abnormalities,placental abnormalities,premature rupture of membranes for≥18 hours,and chorionic type.(2)The basic situation of newborns in BWDT group and BWCT group was compared:the average birth weight of heavy infants in BWDT group was 2106±512g,and the average birth weight of light infants was 1580±431 g;The average birth weight of heavy infants in the BWCT group was 2009±483 g,and the average birth weight of light infants was 1874±450g.The weight of heavy infants in the BWDT group was higher than that of the BWCT group,and the weight of light infants was lower than that of the BWCT group.The neonatal weight of BWDT group and BWCT group was mainly concentrated between 1500-2499g,and the proportion of heavy births in the BWDT group was higher than that in the BWCT group,while the proportion of heavy births in the BWDT group was smaller than that in the BWCT group.SGA accounted for 51%of the BWDT group,and the incidence of SGA was significantly higher than that in the BWCT group.The length of hospital stay[38.50(24.00,64.00)]and hospital cost[51340.00(24452.75,109217.75)]were higher in the BWCT group than in the BWCT group,and the difference was statistically significant(P<0.01).There were no significant differences in gender,gestational age at birth,and classification of gestational age between the two groups.(3)Comparison of some interventions and complications during hospitalization of newborns in BWDT group and BWCT group:The incidence of neonatal surfactant(PS)utilization rate(47.7%),neonatal respiratory distress syndrome(52.9%),noninvasive positive pressure ventilation time≥24 hours(40.5%),high-flow warm and humidified oxygen(HFNC)time≥24 hours(22.8%),bronchopulmonary dysplasia(15.6%),anemia,and persistent pulmonary hypertension(3.1%)in preterm infants were higher than in the BWCT group(P<0.05).There was no significant difference in the incidence of Apgar score ≤7 points at 1 minute and 5 minutes of birth,invasive mechanical ventilation,pulmonary hemorrhage,NEC,PDA of drug or surgical intervention,ROP,PIVH,PVL and sepsis between the two groups(all P>0.05).3.Data on twin fetal mothers with different degrees of birth weight differences and the occurrence of complications during hospitalization:the incidence rate of elderly women(22.5%,28.9%,15.3%,25.8%),cesarean section(75.4%,83.7%,82.9%,87.2%),hypertensive diseases during pregnancy(16.1%,24.4%,15.8%,group was higher than that in the heavy infant group,the difference was statistically significant(P<0.05).The incidence of Neonatal asphyxia,PS usage,invasive mechanical ventilation,positive pressure ventilation≥24 hours,HFNC time≥24 hours,NRDS,BPD,pulmonary hemorrhage,PAD,PIVH,and PPHN were similar in both groups.Conclusion1.The incidence of some complications during hospitalization of twins in the BWDT group was significantly higher than that in the BWCT group,and the former had a higher incidence of respiratory diseases and respiratory support.2.The risk of complications during neonatal hospitalization did not increase with the increase of ΔBW,but the risk of some diseases was related to the twins with discordant birth weights.It is necessary to pay attention to the early observation and timely diagnosis and treatment of twins with discordant birth weights to improve the clinical prognosis of their children.3.The birth weight discordance>15%of the light infants in the twins has a higher complication rate than that of heavy babies,and the light babies in the twins with discordant birth weight need to pay close attention to timely diagnosis and treatment to reduce the occurrence of complications.