Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-26T20:04:56.107Z Has data issue: false hasContentIssue false
  • English
  • Français

Factors Associated with Neonatal Hypoglycemia in Premature Twins and Singletons

Published online by Cambridge University Press:  01 August 2014

V. Zanardo ,
S. Cagdas  and
F. Marzari
V. Zanardo*
Affiliation:
Department of Pediatrics
S. Cagdas
Affiliation:
Department of Pediatrics
F. Marzari
Affiliation:
Physics, Padua University, Italy
*
Department of Pediatrics, Padua University, Via Giustiniani, 3-35100 Padova, Italy

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Twin gestation is associated with higher rate of neonatal hypoglycemia than do singletons. We examined the role of specific risk factors associated with neonatal hypoglycemia of 216 premature twins and 1284 premature singletons, consecutively born in the years 1994-1996 in the Department of Pediatrics of Padua University, Italy. Significantly higher risk of hypoglycemia (Dextrostix <40 and <20 mg%) was found in twins vs singletons (54% vs 32%, OR 2.49, CI 1.77-3.56; 19% vs 8%, OR 2.65, CI 1.59-4.19, respectively). Gestational age of 34-37 weeks increased hypoglycemia risk for the premature twins (77% vs 51%, OR 3.20 CI 1.49-6.88). Twin deliveries statistically differed from those of singletons in several perinatal characteristics. More twins were born by cesarean section (85% vs 55%, OR 4.15, CI 2.48-6.95), and the birth weight of twins was much lower related to prematures with BW < 1.0 kg (12% vs 6%, OR 2.06, CI 1.11-3.82) and SGA (20% vs 10%, OR 2.41, CI 1.46-3.98). The risk of twin deliveries was increased at 30-33 weeks gestational age (25% vs 15%, OR 1.84; CI 1.17-2.90). Twins were found to have higher rates of hospitalization (50% vs 40%, OR 1.52, CI 1.04-2.23) and showed an increased risk of cardiorespiratory resuscitation (51% vs 31%, OR 2.36, CI 1.61-3.47), hypothermia (11% vs 4%, OR 3.02, CI 2.333.91), BPD (25% vs 19%, OR 2.55, CI 1.10-5.91), and PVL (4% vs 1%, OR 4.08, CI 1.23-13.5). Mortality was found more often (not significant) in premature twins. The risk for intrapartum and early neonatal morbidity was however, mostly reduced in hypoglycemic twins, while it was comparable between smaller or smaller weight discordant twins and larger twins. Similarly, SGA twins, and smaller or smaller weight-discordant twins did not show increased hypoglycemia risk. In conclusion, our findings suggest that the multiple gestation per se is the single most important relative risk factor of hypoglycemia in premature twins.

Keywords

HypoglycemiaPrematureSingletonTwin
Type
Research Article
Information
Acta geneticae medicae et gemellologiae: twin research , Volume 46 , Issue 1 , January 1997 , pp. 69 - 77
Copyright
Copyright © The International Society for Twin Studies 1997

References

REFERENCES

1.Blickstein, I (1991): The definition, diagnosis, and management of growth-discordant twins: an international census Survey. Acta Genet Gemellol 40: 345–351.Google Scholar
2.Chen, SJ, Vohr, BR, Oh, W (1993): Effects of birth order, gender and intrauterine growth retardation on the outcome of very low birth weight in twins. J Pediatr 123: 132–136.CrossRefGoogle ScholarPubMed
3.Committee on Fetus and Newborn (1993): Routine evaluation of blood pressure, hematocrit, and glucose in newborns. Pediatrics 92: 474–476.CrossRefGoogle Scholar
4.Eberle, AM, Levesque, D, Vintzileos, AM, Egan, JF, Tsapanos, V, Salafia, CM (1993): Placental pathology in discordant twins. Am J Obstet Gynecol 169: 931–935.Google Scholar
5.Erkkolla, R, Ala-Mello, S, Piiroinen, O, Kero, P, Sillampaa, M (1991): Growth discordancy in twin pregnancies: a risk factor not detected by measurements of biparietal diameter. Obstet Gynecol 66: 203–206.Google Scholar
6.Fisk, NM, Borrel, A, Hubinont, C, Tannirandorn, Y, Nicolini, U, Rodeck, CH (1990): Fetofetal transfusion syndrome: do the neonatal criteria apply in utero? Arch Dis Child 65: 657–661.CrossRefGoogle ScholarPubMed
7.Fraser, D, Picard, R, Picard, E (1991): Factors associated with neonatal problems in twin gestation. Acta Genet Med Gemellol 40: 193–200.Google Scholar
8.Ghai, V, Vidyasagar, D (1988): Morbidity and mortality factors in twins. An epidemiologic approach. Clin Perinatol 15: 1234–1240.CrossRefGoogle ScholarPubMed
9.Ho, SK, Wu, PYK (1975): Perinatal factors and neonatal morbidity in twin pregnancy. Am J Obstet Gynecol 122: 979–987.Google Scholar
10.Lubchenco, LO, Bard, H (1971): Incidence of hypoglycemia in newborn infants classified by birth weight and gestational age. Pediatrics 47: 831–838.Google Scholar
11.Lubchenco, LO, Hansman, C, Dreesler, M, Boyd, E (1963): Intrauterine growth as estimated from liveborn birth-weight data at 24 to 42 weeks of gestation. Pediatrics 32: 793–800.CrossRefGoogle ScholarPubMed
12.Lucas, A, Morley, R, Cole, TJ (1988): Adverse neurodevelopmental outcome of moderate neonatal hypoglycemia. BMJ 297: 1304–1308.CrossRefGoogle Scholar
13.McCulloch, K (1988): Neonatal problems in twins. Clin Perinatol 15:141–158.CrossRefGoogle ScholarPubMed
14.Mordel, N, Benshushan, A, Zajicek, G, Laufer, N, Schenker, JG, Sadovsky, E (1993): Discordancy in triplet. Am J Perinatol 10: 224–225.Google Scholar
15.Rydhstrom, H (1990): Prognosis for twin discordant in birth weight of 1,0 kg or more: the impact cf cesarean section. J Perinat Med 18: 31–37.Google Scholar
16.Santer, R, Hoffmann, H, Suttorp, M, Simeoni, E, Schaub, J (1995): Discordance for hyprinsuline-mic hypoglycemia in monozygotic twins. J Pediatr 126(6): 1017.Google Scholar
17.Saunders, NJ, Snijders, PJM, Nicolaides, KH (1992): Therapeutic amniocentesis in twin-twin transfusion syndrome appearing in the second trimester of pregnancy. Am J Obstet Gynecol 166: 820–824.Google Scholar
18.Sonntag, J, Watz, S, Schollmeyer, T, Schuppler, U, Schroder, H, Weisner, D (1996): Morbidity and mortality of discordant twins up to 34 weeks of gestational age. Eur J Pediatr 155: 224–229.Google ScholarPubMed
19.Vetter, K (1993): Considerations on growth discordant twins. J Perinat Med 21: 267–272CrossRefGoogle ScholarPubMed
20.Volpe, J (1987): Hypoglycemia. In Neurology of the newborn: major problems in clinical pediatrics, vol 22. WB Saunders, Philadelphia.Google Scholar
21.Wenstrom, KD, Gall, SA (1988): Incidence, morbidity and mortality, and diagnosis of twin gestations. Clin Perinatol 15: 1–11.CrossRefGoogle ScholarPubMed