Characterizing discordant discharge in late preterm and term twin pairs: a retrospective cohort study
Sara Khan1, Prisca C Diala2, Jared M Duldulao3
1Department of Pediatrics, Division of Neonatology, University of California Los Angeles, Los Angeles, USA.
Objectives:
Twin pairs are at risk for discordant hospital discharge, which may lead to postnatal co-twin separation. This study evaluated the prevalence of discordant discharge in late preterm and term twin pairs and identified clinical characteristics associated with this outcome.
Methods:
We conducted a retrospective cohort study of live, nonanomalous, inborn twin pairs ≥ 34 weeks at two urban delivery hospitals in the United States from 2016 to 2024. The primary outcome was discordant discharge between co-twins (inter-twin discharge date ≥ 1 day). Secondary outcomes included discordant neonatal intensive care unit admission and common neonatal morbidities. Clinical characteristics were compared between twin pairs with discordant versus concordant discharge. Cochran-Armitage test was used to assess for a linear trend in the primary outcome across gestational age. Multivariable logistic regression was used to identify factors associated with discordant discharge.
Results:
Among 359 twin pairs included, 84 (23.4%) had discordant discharge and 275 (76.6%) had concordant discharge. Twin pairs with discordant discharge had lower median gestational age (GA) and birthweight and were more likely to have mild (≥ 18 to < 30%) or severe (≥ 30%) birthweight discordance (BWD) than those with concordant discharge (p < 0.0001). The prevalence of discordant discharge was highest at 34 weeks (60.9%) with an overall trend toward lower prevalence with advancing GA (p < 0.0001). For the 84 twin pairs with discordant discharge, the inter-twin discharge interval ranged from 1 to 46 days with a median (IQR) of 5.0 (2.0, 9.0) days. In our adjusted model, late prematurity (aOR 14.54, 95% CI: 6.68, 31.65) and BWD ≥ 18% (aOR 2.99, 95% CI: 1.41, 6.33) were independently associated with discordant discharge. Sensitivity analyses using alternate definitions of discordant discharge (≥ 2, ≥ 3, and ≥ 5 days) and BWD (≥ 20% and ≥ 25%) demonstrated consistent results.
Conclusion:
Late prematurity and BWD ≥ 18% were independently associated with higher odds of discordant discharge. These findings may facilitate anticipatory counseling and discharge planning of this patient population.
