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Developmental outcome of discordant premature twins at 3 years
Traci Anne Goyen1, Marina Veddovi, Kei Lui
1Department of Neonatology, Westmead Hospital, NSW, Westmead, Australia.
Insights
Intrauterine growth restriction (IUGR) in premature twins significantly impacts development, with smaller twins showing lower developmental quotients. Common genetic and environmental factors also influence outcomes, but IUGR has a small, significant effect.
Area of Science:
- Neonatal development
- Twin studies
- Growth restriction
Background:
- Maternal, fetal, and intrauterine conditions can cause growth restriction.
- Prematurity and growth restriction, alongside genetic and environmental factors, influence developmental outcomes.
Purpose of the Study:
- To investigate the developmental impact of intrauterine growth restriction (IUGR) in premature, discordant twins.
Main Methods:
- Utilized an intra-pair control comparison design.
- Assessed developmental outcomes at 3 years in 21 pairs of very low birth weight (VLBW) premature twins with >15% birth weight discordance.
Main Results:
- Smaller twins were somatically smaller and had lower Griffiths' quotients (GQ) compared to their co-twins.
- A significant difference in GQ was observed, particularly in the locomotor subscale.
- Gestation and percentage of birth weight discordance were key factors influencing developmental quotients.
Conclusions:
- Common intrauterine, genetic, and environmental factors strongly influence developmental outcomes.
- While severe adverse outcomes were rare in smaller twins, growth restriction showed a small but significant negative impact on development.
Background:
There are numerous known or unknown maternal, fetal and intrauterine conditions that may lead to growth restriction. In addition to prematurity and growth restriction, developmental outcome may also be influenced by many genetic and environmental factors.
Aim:
To examine the impact of intrauterine growth restriction on development in premature discordant twins.
Study Design:
Intra-pair control comparison.
Methods:
Developmental outcome at age 3 years was examined in 21 pairs of discordant (>15% birth weight discordance) very low birth weight (VLBW) premature twins.
Results:
None of the smaller twins had cerebral palsy and one larger twin had a mild diplegia. In paired comparisons, the smaller twins were somatically smaller and had a slight lower Griffiths' developmental quotient (GQ) than the co-twins without cerebral palsy [mean+/-S.D. 100+/-13, range 73-117, versus 104+/-12, 80-124, p=0.002]. The largest difference was in the locomotor subscale. There was a greater intra-pair GQ difference in the 12 twin pairs who had a discordance of greater than 30% (mean GQ=98 versus 105, p<0.001). The intra-pair GQ correlated well (r=0.90), a finding similar to that of a comparative group of 26 nondiscordant VLBW twin pairs (r=0.87). A multivariate analysis confirmed that gestation and percentage discordance were the important factors influencing GQ.
Conclusion:
There exists a strong influence of common intrauterine, genetic and environmental factors on developmental outcome. Despite an overall lack of adverse outcome in smaller twins, results indicated a small but significant influence of growth restriction.