63 - Short- and long- term outcomes of surviving infants following intrauterine co-twin or co-triplet fetal death among Very- Low- Birth- Weight Infants in Korea neonatal network

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 63
Publication Number: 63.429

Sumin Kim, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, seoul, Seoul-t'ukpyolsi, Republic of Korea; Jieun Hwang, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul-t'ukpyolsi, Republic of Korea; yunsil chang, Department of Pediatrics, Samsung Medical Center Sungkyunkwan University School of Medicine, seoul, Seoul-t'ukpyolsi, Republic of Korea; soyoon ahn, Samsung Medical Center, SEOUL, Seoul-t'ukpyolsi, Republic of Korea; Se In Sung, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul-t'ukpyolsi, Republic of Korea; Misun Yang, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul-t'ukpyolsi, Republic of Korea

Presenting Author(s)

Sumin Kim, Master (she/her/hers)

PhD candidate
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine
seoul, Seoul-t'ukpyolsi, Republic of Korea

Background: Recently, the number of multiple pregnancies has increased significantly due to advance in vitro fertilization(IVF). Compared to singleton pregnancies, most multiple pregnancies are linked to a greater risk of perinatal mortality and might be associated with increasing the likelihood of miscarriage related to preterm birth. In addition, recently IVF was suggested to be a factor related with increasing still birth. Nonetheless, little has been known about the outcomes of prematurely delivered surviving left infants following intrauterine co-twin or co-triplet fetal death.

Objective:

We aimed to investigate the outcomes of these surviving infants.

Design/Methods: This cohort study was conducted in twins or triplets with 21-27 weeks’ gestation in very-low-birth-weight infants enrolled in Korea neonatal network from January 2013 to December 2021. We categorized infants into group1, twin or triplet infants all survived and delivered, and group2, survived infants following intrauterine co-twin or co-triplet fetal death. The demographic factors and major outcomes were analyzed with logistic regression. In addition, we performed subgroup analysis according to the IVF pregnancy. The long-term neurodevelopmental outcomes including Bayley scale, Korean developmental screening test for infants and child, and growth profiles at 18-24 month at 3 years was assessed.

Results: In total 2018 infants, 1847(91.5%) were twins and 171(8.5%) were triplets. Of them, group1 infants were 1744(86.4%) and group2 infants were 274(13.6%). In characteristics, group2 showed lower gestational age(GA) with lower birth weight and lower Apgar score at 5 min, pathologically confirmed chorioamnionitis, and lower rate of antenatal steroid use, cesarean section, and gestational diabetes mellitus. In major outcomes, group2 displayed higher incidence of bronchopulmonary dysplasia(BPD) ≥moderate, necrotizing enterocolitis(NEC) ≥stage2 and mortality at neonatal intensive care unit discharge. After adjusting GA, antenatal steroid, cesarean section, chorioamnionitis, maternal diabetes, and IVF, Group2 presented significantly higher odds ratio of mortality compared to Group1(aOR 1.43; p=0.034). After subgroup analysis, in IVF group, group2 persistently showed increased mortality rate (aOR 1.7; p=0.025), in non-IVF group, no difference was observed. Growth profiles and development delay rate showed no difference between groups.

Conclusion(s): Prematurely delivered living infants following intrauterine co-twin or co-triplet fetal death displayed significantly higher mortality rate than twin or triplet preterm infants all survived until delivery.