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Mortality in Multiple versus Singleton Very Low Birth Weight Infants in Germany: A Population-Based Study

Fabienne Kühne1, Vinzenz Boos2, Christoph Bührer3

  • 1Department of Neonatology, Charité-Universitätsmedizin Berlin, Berlin, Germany, fabienne.kuehne@charite.de.

Neonatology
|August 3, 2026
PubMed

Insights

Multiple births in very low birth weight infants show higher survival rates than singletons, except for extremely preterm infants born before 25 weeks gestation. This finding impacts neonatal care strategies for high-risk pregnancies.

Area of Science:

  • Neonatalogy
  • Perinatology
  • Public Health

Background:

  • Conflicting international data exist on mortality rates for multiple births versus singleton births.
  • Previous studies suggest multiple births are associated with increased mortality, but European data are inconsistent.
  • Gestational age is a critical factor in preterm infant survival.

Purpose of the Study:

  • To investigate the association between birth plurality and survival rates in very low birth weight infants.
  • To analyze survival differences between singletons and multiples in relation to gestational age.
  • To provide evidence for optimizing care for preterm infants.

Main Methods:

  • Analysis of a large German population-based cohort of preterm infants (<1500g birth weight) from 2010-2017 and 2019-2024.
  • Mandatory quality improvement data from all German hospitals were used.
  • Comparison of mortality rates between singleton and multiple births, stratified by gestational age.

Main Results:

  • Multiples constituted a significant proportion (28.2% twins, 3.9% triplets) of infants <1500g birth weight.
  • Overall mortality was lower for twins (7.3%) and triplets (6.2%) compared to singletons (9.0%).
  • However, infants born before 25 weeks gestation had higher mortality if they were multiples (40.5%) versus singletons (37.6%). Survival improved for multiples in later gestational age groups (25-27, 28-30, >30 weeks).

Conclusions:

  • In very low birth weight infants, multiple births are associated with higher survival rates than singletons.
  • This survival advantage for multiples is not observed in extremely preterm infants born before 25 weeks gestation.
  • Gestational age is a crucial determinant of survival differences between singleton and multiple births in the neonatal period.
Abstract

Keywords:
MortalityMultiplesPreterm infantsSurvivalVery low birth weight infants

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