Morbidity and Mortality of Very-Low-Birthweight Twin Infants according to Their Sex and the Sex of the Co-Twin: A Retrospective Cohort Study.

IF 2.6 3区医学 Q1 PEDIATRICS Neonatology Pub Date : 2023-01-01 Epub Date: 2023-08-24 DOI:10.1159/000531106

Fermin García-Muñoz Rodrigo, Lourdes Urquía Martí, Carlos Zozaya Nieto, Gloria Galán Henríquez, Desiderio Reyes Suárez, Alejandro Avila-Alvarez, Josep Figueras Aloy, Maximo Vento

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Abstract

Introduction: The concept of male disadvantage regarding the prognosis of premature newborns was introduced more than half a century ago, and it has been corroborated over time. However, the influence of the sex of one twin on the outcomes of the other has yielded contradictory results.

Objective: The aim of the study was to determine if, in twin pregnancies of VLBW infants, the outcomes of one twin are modified by the sex of the co-twin.

Methods: A multicentre retrospective study of a cohort of infants admitted to the collaborating units of the Spanish SEN1500 neonatal network was conducted. Liveborn VLBW twin infants, from 23+0 to 31+6 weeks of gestational age (GA), admitted from 2011 to 2020 were included. Outborn patients, infants with major congenital anomalies, and cases with only one twin admitted were excluded. The main outcomes were survival until first hospital discharge, survival without moderate or severe bronchopulmonary dysplasia (BPD), survival without major brain damage (MBD), and survival without major morbidity. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were calculated.

Results: 2,111 twin pairs were included. Male infants exhibited worse outcomes than females (IRR; 95% CI) regarding survival (0.96; 0.94, 0.98), survival without moderate or severe BPD (0.89; 0.86, 0.93), survival without MBD (0.94; 0.91, 0.97), and survival without major morbidity (0.87; 0.81, 0.93). Differences disappeared when the co-twin was a female infant: survival (1.00; 0.97, 1.03), survival without moderate or severe BPD (0.96; 0.91, 1.01), survival without MBD (0.99; 0.95, 1.04), and survival without major morbidity (0.94; 0.85, 1.03). Results for female infants did not change significantly with co-twin sex.

Conclusions: Among VLBW twins from 23+0 to 31+6 weeks of GA, male infants have higher risk of morbidity and mortality overall. In cases of pregnancies with different-sex foetuses, males seem to improve their results, while these do not change for females. The underlying mechanism of this influence deserves further investigation.

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极低出生体重双胞胎婴儿的发病率和死亡率与性别和同卵双胞胎性别的关系:一项回顾性队列研究。

关于早产新生儿预后的男性劣势概念早在半个多世纪前就提出了，并且随着时间的推移得到了证实。然而，双胞胎中一方的性别对另一方的影响却产生了相互矛盾的结果。目的:本研究的目的是确定在VLBW婴儿的双胎妊娠中，双胞胎中的一个的结局是否会受到双胞胎性别的影响。方法:对西班牙SEN1500新生儿网络合作单位收治的一组婴儿进行多中心回顾性研究。纳入2011 ~ 2020年住院的23+0 ~ 31+6周胎龄(GA)的活产VLBW双胎婴儿。排除外生患者、有重大先天性异常的婴儿和只有一个双胞胎入院的病例。主要结局是存活至首次出院，存活无中度或重度支气管肺发育不良(BPD)，存活无严重脑损伤(MBD)，存活无主要发病率。计算发病率比(IRR)和95%置信区间(CI)。结果:共纳入2111对双胞胎。男婴的预后比女婴差(IRR;95% CI)，生存率(0.96;0.94, 0.98)，无中度或重度BPD的生存率(0.89;0.86, 0.93)，无MBD生存期(0.94;0.91, 0.97)，无重大发病的生存率(0.87;0.81, 0.93)。当同卵双胞胎是女婴时，差异消失:存活率(1.00;0.97, 1.03)，无中度或重度BPD的生存率(0.96;0.91, 1.01)，无MBD生存期(0.99;0.95, 1.04)，无重大发病的生存率(0.94;0.85, 1.03)。女婴的结果与同卵双胞胎的性别没有显著变化。结论:在孕龄23+0 ~ 31+6周的VLBW双胞胎中，男婴总体发病率和死亡率较高。在不同性别胎儿怀孕的情况下，男性似乎可以改善他们的结果，而女性则没有变化。这种影响的潜在机制值得进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neonatology 医学-小儿科

CiteScore

0.60

自引率

4.00%

发文量

审稿时长

6-12 weeks

期刊介绍： This highly respected and frequently cited journal is a prime source of information in the area of fetal and neonatal research. Original papers present research on all aspects of neonatology, fetal medicine and developmental biology. These papers encompass both basic science and clinical research including randomized trials, observational studies and epidemiology. Basic science research covers molecular biology, molecular genetics, physiology, biochemistry and pharmacology in fetal and neonatal life. In addition to the classic features the journal accepts papers for the sections Research Briefings and Sources of Neonatal Medicine (historical pieces). Papers reporting results of animal studies should be based upon hypotheses that relate to developmental processes or disorders in the human fetus or neonate.

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