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Birth weight discordance in very low birth weight twins: mortality, morbidity, and neurodevelopment.

ABSTRACT: OBJECTIVE:Examine outcomes among birth weight concordant and discordant 401-1500?g twins. STUDY DESIGN:Twins (n?=?8,114) at NICHD Neonatal Research Network (1994-2011) were studied. Discordance (birth weight difference/larger twin birth weight x 100%) was categorized into:???14,?>?14-20,?>?20-30, and?>?30%. Separate logistic regression models for the smaller and larger infants assessed the adjusted association between discordance and outcomes. RESULTS:Compared with the smaller twin with???14% discordance, mortality, necrotizing enterocolitis, severe retinopathy of prematurity, bronchopulmonary dysplasia, and neurodevelopmental impairment or death were highest among the smaller twins with discordance?>?30%. The larger twins with discordance?>?30% had higher odds of patent ductus arteriosus, moderate-to-severe cerebral palsy, blindness, cognitive and motor scores??14-20%. CONCLUSIONS:Discordance?>?30% was associated with higher mortality in the smaller twin and higher morbidities among the smaller and larger twins.

SUBMITTER: Boghossian NS

PROVIDER: S-EPMC6713585 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Birth weight discordance in very low birth weight twins: mortality, morbidity, and neurodevelopment.

Boghossian Nansi S NS Saha Shampa S Bell Edward F EF Brumbaugh Jane E JE Shankaran Seetha S Carlo Waldemar A WA Das Abhik A

Journal of perinatology : official journal of the California Perinatal Association 20190716 9

<h4>Objective</h4>Examine outcomes among birth weight concordant and discordant 401-1500 g twins.<h4>Study design</h4>Twins (n = 8,114) at NICHD Neonatal Research Network (1994-2011) were studied. Discordance (birth weight difference/larger twin birth weight x 100%) was categorized into: ≤ 14, > 14-20, > 20-30, and > 30%. Separate logistic regression models for the smaller and larger infants assessed the adjusted association between discordance and outcomes.<h4>Results</h4>Compared with the smal ...[more]

PMID: 31312035

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Project description:BACKGROUND:Invasive fungal infection is an important cause of mortality and morbidity in very preterm and very low birth weight infants. Early diagnosis is difficult and treatment is often delayed. Systemically absorbed antifungal agents (usually azoles) are increasingly used as prophylaxis against invasive fungal infection in this population. OBJECTIVES:To assess the effect of prophylactic systemic antifungal therapy on mortality and morbidity in very preterm or very low birth weight infants. SEARCH METHODS:We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 8), MEDLINE, EMBASE, and CINAHL (to May 2015), conference proceedings, and previous reviews. SELECTION CRITERIA:Randomised controlled trials or quasi-randomised controlled trials that compared the effect of prophylactic systemic antifungal therapy versus placebo or no drug or another antifungal agent or dose regimen in very low birth weight infants. DATA COLLECTION AND ANALYSIS:We extracted data using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by two review authors. MAIN RESULTS:We identified 15 eligible trials enrolling a total of 1690 infants. Ten trials (1371 infants) compared systemic antifungal prophylaxis versus placebo or no drug. These trials were generally of good methodological quality. Meta-analysis found a statistically significant reduction in the incidence of invasive fungal infection (typical risk ratio (RR) 0.43, 95% confidence interval (CI) 0.31 to 0.59; risk difference (RD) -0.09, 95% CI -0.12 to -0.06). The average incidence of invasive fungal infection in the control groups of the trials (16%) was much higher than that generally reported from large cohort studies. Meta-analysis did not find a statistically significant difference in the risk of death prior to hospital discharge (typical RR 0.79, 95% CI 0.61 to 1.02; typical RD -0.04, 95% CI -0.07 to 0.00). Very limited data on long-term neurodevelopmental outcomes were available. Three trials that compared systemic versus oral or topical non-absorbed antifungal prophylaxis did not detect any statistically significant effects on invasive fungal infection or mortality. Two trials that compared different dose regimens of prophylactic intravenous fluconazole did not detect any significant differences in infection rates or mortality. AUTHORS' CONCLUSIONS:Prophylactic systemic antifungal therapy reduces the incidence of invasive fungal infection in very preterm or very low birth weight infants. This finding should be interpreted and applied cautiously since the incidence of invasive fungal infection was very high in the control groups of many of the included trials. Meta-analysis does not demonstrate a statistically significant effect on mortality. There are currently only limited data on the long-term neurodevelopmental consequences for infants exposed to this intervention. In addition, there is a need for further data on the effect of the intervention on the emergence of organisms with antifungal resistance.

Dataset Information

Birth weight discordance in very low birth weight twins: mortality, morbidity, and neurodevelopment.

Publications

Birth weight discordance in very low birth weight twins: mortality, morbidity, and neurodevelopment.

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