Multiple Pregnancy: The Experience of A Level III Neonatology Unit

Background: The incidence of multiple gestations (MG) has increased over the last decades, with a consequent increase in the risk of fetal/neonatal morbidity/mortality.

Objective: Evaluate the approach, clinical evolution, complications and follow-up of newborns from MG.

Methods: Retrospective analysis of newborns admitted to the Perinatology Sector (PS) and Neonatal Unit (NU), resulted from MG, between January 2016 and December 2017.

Results: Ninety-eight gestations were identified, 3 triple, and 95 twin. 70.5% were bicorionic/biamniotic. 71% of the pregnancies were older than 31 years and 41% had medically assisted production techniques (APT).

Of the 197 newborns, 52% were female, 73.5% premature (2.7% extreme preterm), and the mean birth weight (BW) was 2062g. 4.5% presented extreme low birth weight (ELBW). 58.4% were admitted directly in NU, 41.6% in PS.

Mean gestational age (GA) of PS group was 36.8 weeks, and BW mean 2569.7g. 52.9% had hospitalization longer than protocolated.

Median length hospitalization`s in NU was 19 days, with 77.2% requiring intensive care. Mortality rate was 2.5%, with 80% being extreme premature.

83.7% had a follow-up visit, with a poor staturo-ponderal evolution in 2% and inadequate psychomotor development in 6%.

Extreme prematurity was associated with mortality (p<0.001), and intraperiventricular hemorrhage (IPVH) (p<0.001). Need for surfactant and mechanical ventilation were correlated with low birth weight (p<0.001,p=0.002), very low birth weight (VLW) (p<0.001,p=0.027) and ELBW (p<0.001,p<0.001).

Need for intensive care was associated with ELBW (p=0.006) and VLW (p<0.001). Inadequate psychomotor development was associated with VLW (p=0.036), and inadequate staturo-ponderal development with intrauterine growth restriction (p=0.001).

Conclusion: As described in the literature, maternal age was high and there was a high percentage of APT use.

In addition to complications inherent to prematurity, we found an extension of PS hospitalization time.

BW and GA are important risk factors for neonatal IPVH, respiratory morbidity, inadequate psychomotor development and mortality.