Cerebral palsy in the surviving twin associated with infant death of the co-twin
P O D Pharoah
FSID Unit of
Perinatal and Paediatric Epidemiology, Muspratt Building, Department of
Public Health, University of Liverpool, Liverpool L69 3GB, UK
Correspondence to: Professor Pharoah p.o.d.pharoah{at}liv.ac.uk
Accepted 15 November
2000
BACKGROUND
Monozygotic
twins are at greater risk of dying and of serious morbidity than
dizygotic twins, and both are at greater risk than singletons. This is
only partly explained by the higher proportion of low birthweight
infants among twins.
AIMTo compare, in
same sex and different sex twins, birth weight specific neonatal death
rates and cerebral palsy prevalence rates in the surviving twin when
the co-twin has died in infancy.
METHODSAnalysis of
birth and death registration data for same sex and different sex twins
for England and Wales 1993-1995 where both were live births. Death
certificates of all liveborn twins who died were obtained from the
Office for National Statistics. A questionnaire was sent to the general
practitioners of all surviving co-twins to determine if the child had
any disability.
RESULTSThe neonatal
death rate in same sex twins was 25.4 and in different sex twins 18.0 per 1000 live births (death rate difference 7.4; 95% confidence
interval 4.7 to 10.1; p < 0.001). The higher neonatal death rate in
same sex compared with different sex twins is attributable to the
higher proportion of same sex twins with low birth weight. Prevalence
of cerebral palsy in the low birthweight group (< 1000 g) was
marginally higher in same sex (224 per 1000) than different sex (200 per 1000) twin survivors. In the birth weight group 1000-1999 g, same
sex twin survivors were at a significantly higher risk of cerebral
palsy than those of different sex: 167 v 21 per 1000; difference 145 (95% confidence interval 44 to 231; p < 0.01) per 1000 infant survivors.
CONCLUSIONThere are
two components to the cause of cerebral palsy in twins. Immaturity per
se predisposes to cerebral damage. Also, same sex twins may sustain
cerebral damage that is in excess of that due to immaturity.
Keywords: twins; monozygotic; dizygotic; death rate; cerebral palsy; birth weight
© 2001 by Archives of Disease in Childhood
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