Infant and perinatal outcomes of triplet pregnancy in Auckland: better than expected?
Malcolm Battin1, Michelle Wise, Anne DeZoete
1Newborn Services, National Women's Health, Auckland City Hospital, Private Bag 92024, Auckland, New Zealand. malcolmb@adhb.govt.nz
Insights
Outcomes for triplet infants, including those under 1500g, are favorable. This study provides crucial data for counseling parents on triplet pregnancy risks and infant neurodevelopmental outcomes.
Area of Science:
- Perinatology
- Neonatology
- Developmental Pediatrics
Background:
- Triplet pregnancies present unique challenges for neonatal intensive care units (NICUs).
- Accurate contemporary data on neurodevelopmental outcomes for low birth weight infants is limited.
Purpose of the Study:
- To offer local outcome data for counseling prospective parents of triplets.
- To address the need for contemporary data on neurodevelopmental outcomes and neonatal morbidity in infants weighing less than 1500 grams.
Main Methods:
- A retrospective review of triplet pregnancies at National Women's Hospital / Auckland City Hospital from 1995-2005.
- Definition of triplet pregnancy: beyond 20 weeks gestation with at least one registered birth.
Main Results:
- 55 triplet pregnancies identified; 45% conceived spontaneously, 60% had no major complications besides prematurity.
- Median gestational age: 32 weeks; median birth weight: 1620g. For infants <1500g, 66% had normal outcomes, 17% mild, 15% moderate, and 2% severe abnormalities.
- Cerebral palsy in 3 infants, one with hearing impairment; median Bayley II scores were within the normal range.
Conclusions:
- Triplet outcomes, including those weighing <1500g, compare favorably to reported data.
- Despite the burden on NICUs, the neurodevelopmental results for triplets are encouraging.
Aim:
There were two aims to the study: (1) to provide local outcome data that would be useful in counselling prospective parents of triplets; and (2) to address the deficit in accurate contemporary data on neurodevelopmental outcome and neonatal morbidity for those infants weighing less than 1500 g at birth.
Methods:
We reviewed the outcome of triplet pregnancies born at National Women's Hospital / Auckland City Hospital (Auckland, New Zealand) for 1995-2005 inclusive. For this study triplet pregnancy was defined as a pregnancy beyond 20 weeks leading to registration of at least one birth.
Results:
For the study period, 55 triplet pregnancies were identified. Forty-five percent of the pregnancies were reported as spontaneously conceived and 60% had no major complications other than premature delivery. One pregnancy spontaneously aborted; three fetuses from one pregnancy were stillborn, and four infants died in delivery suite. The median gestational age at birth was 32 (23-37) weeks and birth weight 1620 (530-2780) g. The median (range) Apgar score, for liveborns, was 8 (2-10) and 10 (4-10) for 1 and 5 minutes respectively. There were five neonatal deaths. Fifty-three infants, <1500g at birth, underwent formal developmental assessment. Three had cerebral palsy (2 hemiplegia and 1 spastic diplegia); one had marked motor delay and one hearing impairment requiring aids. The median Bayley II MDI was 95 (71-105) and PDI 94 (65-110). Outcomes were categorised in surviving triplets <1500 g as normal in 66%, mild abnormality in 17%, moderate abnormality in 15% and severely abnormal in only 2%.
Conclusion:
Although triplets represent a significant burden on the regional NICUs the outcome, including those <1500 g at birth, compares favourably with that reported.
