DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20181435

Analysis of clinical profile, growth and developmental pattern of twin babies in a tertiary care hospital of central India

Pawan K. Ghanghoriya, Avyact Agrawal, Uthara Mohan, Keerthi K., Shivraj Singh

Abstract


Background: Twin birth is associated with increased risk of neonatal morbidity and mortality and disadvantages in growth and neurodevelopmental status than singletons. Objective of present study was to analyze the clinical profile, growth pattern and neurodevelopmental outcome of twin babies on follow up for 6 months corrected gestational age.

Methods: A prospective observational study was done in a tertiary care NICU in 81 pairs of twins (162 neonates). Initial assessment in terms of morbidities and mortality was followed by growth pattern and neurodevelopmental assesment using DDSTII of survived infants upto 6 months corrected gestational age.

Results: Prematurity was present in 75% of twin gestation. 95.1% were LBW, 4.9% were normal birthweight. 38.9% were AGA babies and 61.1% were SGA babies. Moderate to severe growth discordancy, was identified in 17.2% of the twins. Mortality was inversely proportional to birth weight and gestational maturity and directly proportional to birth weight discordance. Most of the complications were attributed to prematurity and low birth weight. RDS, hypoglycemia (16%), Perinatal asphyxia (19%), NEC, shock, hyperbilirubinemia were major complications. Feeding difficulties need special attention. Group I (28-32 weeks) lagged behind group I (32-37 weeks) and group III (>37weeks) in all anthropometric parameters like weight, height and head circumference at all the ages. Growth velocity was in the order group I (28-32 weeks) >group II (32-37) >group III (>37). At 6 months of there was high incidence of abnormal neurodevelopmental outcome among twins according to gestational age. Hypoglycemia, Perinatal asphyxia, RDS, and NEC were risk factors of NDD.

Conclusions: There is higher incidence adverse outcomes in terms of morbidity, mortality, growth and development among twins.

Keywords


Complications, Growth pattern, Low birth weight, Neurodevelopment, Prematurity, Twins

Full Text:

PDF

References


Meherbansingh. Care of the new born-eighth edition. P:548-550.

Cloherty JP, Eichenwald EC, Hansen AR, Stark AR. Manual of neonatal care. 7th ed. SEA edition. 2015:129-133.

Chauhan SP, Scardo JA, Hayes E, Abuhamad AZ, Berghella V. Twins: prevalence, problems, and preterm births. Am J Obstet Gynecol. 2010;203(4):305-15.

Akinboro A, Azeez MA, Bakare AA. Frequency of twinning in Southwest Nigeria. Indian J Hum Genet. 2008;14(2):41-7.

Chaudhari S, Bhalerao MR, Vaidya U, Pandit A, Nene U.. Growth and development of twins compared with singletons at ages one and four years. Indian Pediatr. 1997;34:1081-5.

Refuerzo JS, Momirova V, Peaceman AM, Sciscione A, Rouse DJ, Caritis SN et al. Neonatal outcomes in twin pregnancies delivered moderately preterm, late preterm and term. Am J Perinatol. 2010 Aug;27(7):537.

Patil S, Utture A, Mondkar J, Goel S. Outcome in twin gestations: A prospective observational study. Indian J Child Health. 2017 Nov;4(2):239-42.

Assunção RA, Liao AW, Brizot MD, Krebs VL, Zugaib M. Perinatal outcome of twin pregnancies delivered in a teaching hospital. Rev Assoc Med Bras. 2010;56(4):447-51.

Morrison J. Twin gestation and premature birth. J Perinatol. 2005;25(1):13.

Manlan G, Scott KE. Contribution of twin pregnancy to perinatal mortality and fetal growth retardation; Reversal of growth retardation after birth. Can Med Assoc J. 1978;118(4):365-8.

Kyriakidou M, Karagianni P, Iliodromiti Z, Chatziioannidis I, Papaioannou E, Exadaktilou S et al. Comparison of 24 months neurodevelopmental outcome in twins and singletons ≤34 weeks gestation at birth. JPNIM. 2013 Jan 15;2(1):48-54.

Singh D, Devi N, Raman TR. Exclusive breast feeding in low birth weight babies. Med J Armed Forces India. 2009 Jul 1;65(3):208-12.

Wilson RS. Twin growth: initial deficit, recovery, and trends inconcordance from birth till nine years. Ann Hum Biol. 1979;6:205-20.

Thorpe K. Twin children's language development. Early Hum Dev. 2006;82(6):387-95.

Wadhawan R, Oh W, Perritt RL, McDonald SA, Das A, Poole WK et al. Twin gestation and neurodevelopmental outcome in extremely low birth weight infants. Pediatrics. 2009 Feb 1;123(2):e220-7.