ORIGINAL ARTICLE

Effect of birth order on neonatal morbidity and mortality among very low birthweight twins: a population based study

E S Shinwell¹, I Blickstein², A Lusky³ and B Reichman^3,4

¹ Department of Neonatology, Kaplan Medical Center, Rehovot, and Hadassah Medical School, Hebrew University, Jerusalem Israel
² Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, and Hadassah Medical School, Hebrew University, Jerusalem Israel
³ Women and Children’s Health Research Unit, Gertner Institute, Sheba Medical Center, Tel Hashomer, Israel
⁴ Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

Correspondence to:
Correspondence to:
Dr Shinwell
Department of Neonatology, Kaplan Medical Center, Rehovot, Israel; eric_s{at}clalit.org.il

Objective: To study the effect of birth order on the risk for respiratory distress syndrome (RDS), chronic lung disease (CLD), adverse neurological findings, and death in very low birthweight (VLBW; < 1500 g) twins.

Methods: A population based study of VLBW infants from the Israel National VLBW Infant Database. The sample included all complete sets of VLBW twin pairs admitted to all 28 neonatal intensive care units between 1995 and 1999. Outcome variables were compared by birth order and stratified by mode of delivery and gestational age, using General Estimating Equation models, with results expressed as odds ratio (OR) with 95% confidence interval (CI).

Results: Second twins were at increased risk for RDS (OR 1.51, 95% CI 1.29 to 1.76), CLD (OR 1.36, 95% CI 1.11 to 1.66), and death (OR 1.24, 95% CI 1.02 to 1.51) but not for adverse neurological findings (OR 1.20, 95% CI 0.91 to 1.60). Mode of delivery did not significantly influence outcome. The odds ratio for RDS in the second twin was inversely related to gestational age, and the increased risk for RDS and CLD was found in both vaginal and caesarean deliveries.

Conclusions: VLBW second twins are at increased risk for acute and chronic lung disease and neonatal mortality, irrespective of mode of delivery.

Keywords: chronic lung disease; multiple birth; preterm; respiratory distress syndrome; twins

Abbreviations: CLD, chronic lung disease; RDS, respiratory distress syndrome; VLBW, very low birthweight

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