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Respiratory morbidity in late preterm twin infants.

Abstract：

PURPOSE:Antenatal corticosteroids have been shown to decrease neonatal respiratory morbidity in singleton pregnancies when given during the late-preterm period (340/7-366/7 weeks). Whether these findings also apply to late-preterm twins, who account for approximately one-third of infants born at 340/7-356/7 weeks, is currently unclear. The answer to this question depends, in part, on whether the risk of respiratory morbidity among late-preterm twin infants is similar to that observed in late-preterm singletons. We aimed to assess the rate of respiratory morbidity among late-preterm twin infants using a secondary analysis of prospectively collected data from a large international multicenter trial, and to compare that rate with previous studies that used the same definition of respiratory morbidity. STUDY DESIGN:This was a secondary analysis of the twin birth study. In the current study, we limited the analysis to women who gave birth during the late preterm period. The primary outcomes were the same primary composite respiratory morbidity variables that were used in the randomized controlled trial of Gyamfi-Bannerman et al., on the administration of betamethasone during the late preterm period in singletons (ALPS trial). The risk of respiratory morbidity among late preterm twins was stratified by gestational week at birth. RESULTS:A total of 1163 women who gave birth to 2324 late preterm twin infants met the inclusion criteria. The rates of respiratory morbidity and severe respiratory morbidity were 16.5% and 8.9%, respectively. The risk of respiratory morbidity was highly dependent on gestational week at birth, being more than fourfold for infants born at 340/7-346/7 weeks (aOR 4.30, 95%-CI 3.01-6.14) and more than twofold for infants born at 350/7-356/7 weeks (aOR 2.12, 95%-CI 1.51-2.98) compared with infants born at 360/7-366/7 weeks. The rate of respiratory morbidity and the theoretical number of women needed to be treated with betamethasone to prevent a single case of respiratory morbidity in the current study were similar to those reported in the APLS trial (16.5% vs. 14.4%, p = 0.103, and NNT 31 vs. 34, respectively). CONCLUSIONS:The risk-benefit ratio of betamethasone with regard to neonatal respiratory morbidity in women with twins at risk of late-preterm birth is expected to be similar to that observed in singletons.

journal_name

Arch Gynecol Obstet

journal_title

Archives of gynecology and obstetrics

authors

Martinka D,Barrett J,Mei-Dan E,Zaltz A,Melamed N

doi

10.1007/s00404-019-05191-z

subject

Has Abstract

pub_date

2019-08-01 00:00:00

pages

337-345

issue

eissn

0932-0067

issn

1432-0711

pii

10.1007/s00404-019-05191-z

journal_volume

300

pub_type

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Respiratory morbidity in late preterm twin infants.