The Association between the Intertwin Interval and Adverse Neonatal Outcomes

Area of Science:

• Perinatal Medicine
• Neonatal Outcomes
• Twin Gestation

Background:

• Conflicting data exists on the association between intertwin interval and adverse neonatal outcomes.
• Evaluating this association in a contemporary U.S. cohort is crucial for clinical practice.

Purpose of the Study:

• To determine if the interval between twin deliveries impacts adverse neonatal outcomes for the second twin.
• To assess the association between intertwin interval (≥10 minutes vs. <10 minutes) and specific neonatal morbidities.

Main Methods:

• Cohort study of 171 twin deliveries from 2006-2014, with the first twin delivered vaginally vertex at ≥32 weeks gestation.
• Intertwin interval dichotomized as <10 minutes or ≥10 minutes.
• Adverse outcomes included low umbilical cord arterial pH, NICU admission, respiratory distress, intraventricular hemorrhage, and death.

Main Results:

• 61% of deliveries had an intertwin interval of ≥10 minutes; maternal characteristics were similar.
• An intertwin interval of ≥10 minutes was associated with a higher frequency of arterial pH ≤7.1 (22.0% vs. 8.2%, p=0.03).
• This association persisted after adjusting for confounders (aOR, 2.94; 95% CI, 1.04-8.33); no other adverse outcomes differed.

Conclusions:

• An intertwin interval of ≥10 minutes is linked to an increased risk of low umbilical cord arterial pH in the second twin.
• No significant association was found between prolonged intertwin interval and other adverse neonatal outcomes studied.
• These findings suggest careful consideration of delivery timing for the second twin when the intertwin interval is prolonged.