Neonatal neurologic characteristics of preterm twin infants <1,250 gm birth weight

The study objectives were to determine the incidence, time of onset, and clinical characteristics of neonatal neurologic injury in preterm twin infants <1,250 gm birth weight. Forty-one twin infants of birth weight 929 gm +/- 160 and 27.3 +/- 1.96 weeks gestation were evaluated and compared to 225 singleton infants <1,250 gm. Seventeen infants were monozygotic and 24 dizygotic. Six of the 9 monozygotic pregnancies were complicated by the polyhydramnios/oligohydramnios syndrome; a weight discordancy of >20% was observed in 8 of the monozygotic twin sets and polycythemia (hematocrit >65%) in 3 infants. Nine (22%) of the 41 infants died. Periventricular-intraventricular hemorrhage (PV-IVH) developed in 11 (27%) of 41 infants and was severe in 9 (22%) infants. IVH was noted on day 1 (n = 2), day 2 (n = 3), and day 3 (n = 6). IVH developed in 69 (30%) of the 225 singletons and was severe in 28 (12%) infants. Twin infants were more likely to have been delivered via cesarean section, to have required intubation in the delivery room, and to have been administered surfactant as compared with singletons (P < .01). It was concluded that preterm twin infants <1,250 gm are at high risk for developing severe IVH, and that the onset of IVH was within the first 3 postnatal days in all cases.