Neonatal and Two-Year Prognosis of Eutrophic Newborns from Monochorionic Diamniotic Twin Pregnancies Complicated by Selective Intrauterine Growth Restriction
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Study Objectives
2.3. Perinatal and Neonatal Data
2.4. Development at 2 Years
2.5. Statistical Analysis
3. Results
3.1. Perinatal Characteristics of the Population
3.2. Neonatal Assessment
3.3. Neurodevelopmental Assessment at 2 Years
3.4. Comparison Between the Eutrophic Twin and the IUGR Co-Twin
Neonatal Data
3.5. ASQ at 2 Years
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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sIUGR Group | Uncomplicated Group | p Value | |
---|---|---|---|
Number of pregnancies, n | 57 | 135 | |
Age, years, median (min–max) | 30.9 (20.2–44.3) | 29.9 (18.7–44.3) | 0.75 |
Gravidity, n, median (min–max) | 2 (1–10) | 2 (1–10) | 0.92 |
Parity, n, median (min–max) | 1 (0–4) | 1 (0–8) | 0.26 |
BMI, kg/m2, median (min–max) | 22.4 (16.4–43.0) | 24.1 (16.3–45.0) | 0.08 |
Fetal sex, n (%) | |||
Male | 28 (49%) | 75 (56%) | 0.27 |
Female | 29 (51%) | 60 (44%) | |
Antenatal corticosteroid therapy, n (%) | |||
Not administered | 11 (19%) | 70 (52%) | <0.001 |
Incomplete | 0 (0%) | 4 (3%) | |
Complete | 46 (81%) | 61 (45%) | |
Mode of delivery, n (%) | |||
Vaginal delivery | 9 (16%) | 68 (50%) | <0.001 |
Cesarean section | 48 (84%) | 67 (50%) | |
Indication for delivery, n (%) | |||
Spontaneous | 13 | 62 | |
Abnormal fetal heart rate | 24 | 3 | |
Doppler abnormalities | 15 | 3 | |
Growth restriction | 12 | 7 | |
Other | 5 | 41 | |
Gestational age at birth, weeks of amenorrhea, median (min–max) | 33 (25–38) | 36 (24–39) | <0.001 |
Number of newborns, n | 114 | 270 | |
Birth weight, grams, mean ± SD | 1914 ± 473 | 2306 ± 576 | <0.001 |
Head circumference at birth, centimeters, mean ± SD | 29 ± 2 | 31 ± 3 | 0.001 |
Birth length, centimeters, mean ± SD | 42 ± 3 | 44 ± 4 | 0.001 |
Growth discordance at birth, %, mean ± SD | 26 ± 10.4 | 7.8 ± 5.3 | <0.001 |
Birth weight percentile, %, mean ± SD | 44.3 ± 32 | 38.3 ± 25 | 0.69 |
Apgar score, median, (min–max) | |||
1 min | 9 (0–10) | 10 (0–10) | 0.24 |
5 min | 9 (5–10) | 10 (3–10) | 0.06 |
10 min | 10 (8–10) | 10 (5–10) | 0.003 |
Apgar score < 7, n/N (%) | |||
1 min | 8/57 (14%) | 41/270 (15%) | 0.7 |
5 min | 4/57 (7%) | 14/270 (5%) | 0.7 |
10 min | 0/57 (0%) | 1/270 (0.3%) | 0.25 |
pH at birth, median, (min–max) | 7.34 (7.2–7.4) | 7.31 (7.0–7.5) | 0.003 |
pH < 7.15, n/N (%) | 0/49 | 16/258 (6%) | 0.06 |
Lactate levels at birth, mmol/L, median, (min–max) | 2.3 (1.3–6.5) | 2.9 (1.0–10.0) | 0.06 |
sIUGR Group | Uncomplicated Group | p Value Adjusted * | |
---|---|---|---|
Hospitalization in intensive care, n/N (%) | 36/57 (63%) | 66/270 (24%) | <0.001 |
Length of hospital stay, days, median (min–max) | 4.5 (1–70) | 4 (1–39) | 0.51 |
Death, n/N (%) | 2/57 (4%) | 7/270 (3%) | 0.81 |
Age at death, days, median (min–max) | 14 (3–25) | 7 (4–13) | |
Respiratory complications: | |||
Need for ventilatory support, n/N (%) | 39/57 (68%) | 69/270 (26%) | <0.001 |
Duration of ventilatory support, days, median (min–max) | 6 (1–71) | 5.5 (1–55) | 0.99 |
Hyaline membrane disease, n/N (%) | 33/57 (58%) | 64/270 (24%) | 0.02 |
Bronchopulmonary dysplasia, n/N (%) | 3/57 (5%) | 7/270 (3%) | 0.34 |
Sepsis, n/N (%) | 5/55 (9%) | 9/187 (5%) | 0.29 |
Early-onset sepsis, n/N (%) | 0/55 (0%) | 5/187 (3%) | |
Late-onset sepsis, n/N (%) | 5/55 (9 %) | 4/185 (2%) | |
Necrotizing enterocolitis, n/N (%) | 4/57 (7%) | 6/270 (2%) | 0.22 |
Abnormal Auditory Evoked Potentials, n/N (%) | 1/31 (3%) | 6/95 (6%) | 0.34 |
Abnormal indirect ophthalmoscopy, n/N (%) | 3/19 (16%) | 6/35 (17%) | 0.92 |
Abnormal electroencephalogram, n/N (%) | 6/43 (14%) | 3/67 (4%) | 0.23 |
Abnormal brain MRI, n/N (%) | 9/16 (56%) | 9/23 (39%) | 0.32 |
Grade III or IV IVH, n/N (%) | 1/16 (6%) | 1/23 (4%) | 0.52 |
PVL, n/N (%) | 2/16 (13%) | 0/23 (0%) | 0.05 |
Ventricular dilation, n/N (%) | 2/16 (13%) | 1/23 (4%) | 0.52 |
Breastfeeding at discharge, n/N (%) | 34/53 (64%) | 98/179 (55%) | 0.22 |
Composite morbidity and mortality criterion, n/N (%) (including neonatal death, grade III or IV IVH, PVL, BPD, and stage II or III NEC) | 6/57 (11%) | 14/270 (5%) | 0.18 |
sIUGR Group N = 38 | Uncomplicated Group N = 67 | p Value | |
---|---|---|---|
Age, years, median (min–max) | 31 (22–40) | 30 (19–44) | 0.60 |
Gravidity, n, median (min–max) | 2 (1–5) | 3 (1–7) | 0.04 |
Parity, n, median (min–max) | 1 (0–4) | 1 (0–3) | 0.19 |
BMI, kg/m2, median (min–max) | 21.3 (17.4–43) | 24 (16.3–45) | 0.02 |
Fetal sex, n (%) | 0.12 | ||
Male | 18 | 40 | |
Female | 20 | 27 | |
Antenatal corticosteroid therapy, n (%) | |||
Not administered | 8 | 36 | 0.002 |
Incomplete | 0 | 0 | |
Complete | 30 | 31 | |
Mode delivery, n (%) | <0.001 | ||
Vaginal delivery | 6/38 (16%) | 37/67 (55%) | |
Cesarean section | 32/38 (84%) | 30/67 (45%) | |
Indication for birth, n (%) | |||
Spontaneous | 9 | 30 | |
Abnormal fetal heart rate | 16 | 1 | |
Doppler abnormalities | 12 | 3 | |
Growth restriction | 8 | 3 | |
Other | 3 | 24 | |
Gestational age at birth, weeks of amenorrhea, median (min–max) | 34 (26–35) | 36 (27–37) | <0.001 |
Birth weight, grams, mean SD | 1986 ± 456 | 2384 ± 519 | <0.001 |
Number of newborns, n | 38 | 134 | |
Head circumference at birth, centimeters, mean SD | 30 ± 1.8 | 31.4 ± 2.3 | 0.002 |
Length at birth, centimeters, mean SD | 42.5 ± 3.2 | 44.7 ± 3.5 | 0.006 |
Growth discordance at birth, %, mean SD | 25 ± 27 | 6 ± 7 | <0.001 |
Birth weight percentile, %, mean SD | 26.5 ± 12 | 36.7 ± 24.5 | 0.55 |
Apgar score, median, (min–max) | |||
1 min | 9 (0–10) | 9.5 (0–10) | 0.12 |
5 min | 10 (5–10) | 10 (6–10) | 0.11 |
10 min | 10 (8–10) | 10 (7–10) | 0.004 |
Apgar score < 7, n/N (%) | |||
1 min | 3 | 18 | 0.3 |
5 min | 3 | 5 | 0.23 |
10 min | 0 | 0 | 1 |
pH at birth, median, (min–max) | 7.34 (7.19–7.4) | 7.3 (7.03–7.5) | 0.002 |
PH < 7.15, n/N (%) | 0 | 11 | 0.06 |
Lactate at birth, mmol/L, median, (min–max) | 2.3 (1.3–5.5) | 2.9 (1–6.9) | 0.15 |
sIUGR Group | Uncomplicated Group | Adjusted p Value ** | |
---|---|---|---|
ASQ score | |||
Median (IQR) | 252 (226–264) | 240 (220–260) | 0.26 |
ASQ < 220, n (%) | 8/38 (21%) | 33/134 (25%) | 0.65 |
ASQ < threshold, n (%) * | 11/38 (29%) | 47/134 (35%) | 0.51 |
Number of impaired domains, n (%) | 0.32 | ||
0 | 32 (80%) | 92 (69%) | |
1 | 6 (15%) | 30 (22%) | |
2 | 1 (3%) | 12 (9%) | |
3 | 1 (3%) | 0 (0%) | |
4 or 5 | 0 | 0 | |
At least one impaired domain, n (%) | 8/38 (21%) | 42/134 (31%) | 0.21 |
By domain, n (%) | |||
Communication | 4/38 (11%) | 19/134 (14%) | 0.59 |
Gross motor skills | 1/38 (3%) | 5/134 (4%) | 0.68 |
Fine motor skills | 1/38 (3%) | 6/134 (4%) | 0.44 |
Problem solving | 1/38 (3%) | 0/134 (0%) | 0.21 |
Social skills | 4/38 (11%) | 24/134 (18%) | 0.30 |
26–31 Weeks GA | 32–34 Weeks GA | >35 Weeks GA | |||||||
---|---|---|---|---|---|---|---|---|---|
sIUGR Group | Uncomplicated Group | p Value | sIUGR Group | Uncomplicated Group | p Value | sIUGR Group | Uncomplicated Group | p Value | |
ASQ score, median (IQR) | 250 (220–264) | 240 (230–250) | 0.37 | 245 (219–262) | 232 (209–245) | 0.5 | 260 (242–265) | 240 (220–261) | 0.09 |
ASQ < 220, n (%) | 3/10 (30%) | 2/10 (20%) | 0.84 | 4/16 (25%) | 7/24 (29%) | 0.92 | 1/12 (8 %) | 24/100 (24%) | 0.17 |
ASQ < threshold, n (%) | 3/10 (30%) | 2/10 (20%) | 0.84 | 5/16 (31%) | 13/24 (54%) | 0.15 | 1/11 (8%) | 24/100 (24%) | 0.17 |
Number of impaired domains, n (%) | |||||||||
0 | 9 (90%) | 10 (100%) | 1 | 12 (75%) | 13 (54%) | 0.78 | 9 (75%) | 69 (69%) | 0.38 |
1 | 1 (10%) | 0 | 2 (13%) | 9 (38%) | 3 (25%) | 21 (21%) | |||
2 | 0 | 0 | 1 (6%) | 2 (8%) | 0 | 10 (10%) | |||
3 | 0 | 0 | 0 | 0 | 0 | 0 | |||
4 or 5 | 0 | 0 | 0 | 0 | 0 | 0 | |||
At least one impaired domain, n (%) | 1/10 (10%) | 0/10 (0%) | 0.49 | 4/16 (25%) | 11/24 (46%) | 0.15 | 3/12 (25%) | 31/100 (31%) | 0.57 |
Communication | 1 | 0 | 0.49 | 2/16 (13%) | 4/24 | 0.68 | 1/12 | 15/100 | 0.66 |
Gross motor skills | 0 | 0 | 1 | 1/16 (6%) | 3/24 | 0.64 | 0/12 | 2/100 | 0.88 |
Fine motor skills | 0 | 0 | 1 | 0/16 | 1/24 | 1 | 1/12 | 6/100 | 0.94 |
Problem-solving | 0 | 0 | 1 | 1/16 (6%) | 0/24 | 0.36 | 1/12 | 1/100 | 1 |
Social and individual aptitudes | 0 | 0 | 1 | 3/16 (19%) | 6/24 | 0.71 | 1/12 | 18/100 | 0.37 |
Eutrophic Twin | IUGR Twin | p Value | |
---|---|---|---|
Hospitalization in intensive care, n/N (%) | 36/57 (63%) | 30/57 (53%) | 0.35 |
Duration in intensive care, days, median (min–max) | 4.5 (1–70) | 5 (1–63) | 0.75 |
Duration of hospitalization, days, median (min–max) | 25 (0–113) | 23 (3–113) | 0.96 |
Death, n/N (%) | 2/57 (4%) | 4/57 (7%) | 0.24 |
Age at death, days, median (min–max) | 14 (3–25) | 14.5 (6–100) | |
Respiratory complications: | |||
Need for ventilatory support, n/N (%) | 39/57 (68%) | 34/57 (60%) | 0.44 |
Duration of ventilatory support, days, median (min–max) | 6 (1–71) | 6 (1–86) | 0.46 |
Hyaline membrane disease, n/N (%) | 33/57 (58%) | 26/57 (46%) | 0.18 |
Bronchopulmonary dysplasia, n/N (%) | 3/57 (5%) | 4/57 (7%) | 0.85 |
Infectious complications | |||
Sepsis, n/N (%) | 5/55 (9%) | 7/54 (13%) | 0.5 |
Early-onset, n/N (%) | 0 | 0 | |
Late-onset, n/N (%) | 5 | 7 | |
Necrotizing enterocolitis, n/N (%) | 0.37 | ||
Stage I, n/N (%) | 4/57 (7%) | 8/57 (14%) | |
Stage II, n/N (%) | 1 | 3 | |
Stage III, n/N (%) | 3 | 3 | |
Stage IV, n/N (%) | 0 | 2 | |
Neurosensory complications: | |||
Auditory evoked potential abnormalities, n/N (%) | 1/31 (3%) | 1/34 (3%) | 0.71 |
Fundus abnormalities, n/N (%) | 3/19 (16%) | 2/17 (12%) | 0.72 |
Electroencephalogram abnormalities, n/N (%) | 6/43 (13%) | 2/46 (4%) | 0.12 |
Abnormalities on brain MRI, n/N (%) | 9/16 (56%) | 3/18 (17%) | 0.001 |
IVH grade III or IV, n/N (%) | 1/16 (6%) | 0/18 (0%) | 0.17 |
PVL, n/N (%) | 2/16 (13%) | 1/18 (6%) | 0.47 |
Ventricular dilation, n/N (%) | 2/16 (13%) | 0/18 (0%) | 0.09 |
Composite morbidity–mortality criterion, n/N (%) (including neonatal death, grade III or IV IVH, PVL, BPD and stage II or III NEC) | 6/57 (11%) | 9/57 (16%) | 0.58 |
Eutrophic N = 38 | IUGR N = 19 | p Value | |
---|---|---|---|
ASQ score | |||
Median (IQR) | 255 (229–270) | 245 (212–260) | 0.53 |
ASQ < 220, n (%) | 8/38 (21%) | 6/19 (32%) | 0.70 |
ASQ < threshold, n (%) | 11/38 (29%) | 8/19 (42%) | 0.60 |
Number of impaired domains, n (%) | 0.55 | ||
0 | 30 | 12 (6%) | |
1 | 6 | 5 (26%) | |
2 | 1 | 2 (11%) | |
3 | 1 | 0 | |
4 or 5 | 0 | 0 | |
At least one altered domain, n (%) | 8/38 (21%) | 7/19 (37%) | 0.38 |
By domain, n (%) | |||
Communication | 4 | 5 | |
Gross motor skills | 1 | 1 | |
Fine motor skills | 1 | 0 | |
Problem-solving | 1 | 0 | |
Social and individual aptitudes | 4 | 3 |
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Jarry, M.-A.; Topalian, N.; Cosnard, L.; D’Ercole, C.; Chau, C.; Tosello, B. Neonatal and Two-Year Prognosis of Eutrophic Newborns from Monochorionic Diamniotic Twin Pregnancies Complicated by Selective Intrauterine Growth Restriction. Children 2025, 12, 615. https://doi.org/10.3390/children12050615
Jarry M-A, Topalian N, Cosnard L, D’Ercole C, Chau C, Tosello B. Neonatal and Two-Year Prognosis of Eutrophic Newborns from Monochorionic Diamniotic Twin Pregnancies Complicated by Selective Intrauterine Growth Restriction. Children. 2025; 12(5):615. https://doi.org/10.3390/children12050615
Chicago/Turabian StyleJarry, Marie-Anne, Nayri Topalian, Lauréline Cosnard, Claude D’Ercole, Cécile Chau, and Barthélémy Tosello. 2025. "Neonatal and Two-Year Prognosis of Eutrophic Newborns from Monochorionic Diamniotic Twin Pregnancies Complicated by Selective Intrauterine Growth Restriction" Children 12, no. 5: 615. https://doi.org/10.3390/children12050615
APA StyleJarry, M.-A., Topalian, N., Cosnard, L., D’Ercole, C., Chau, C., & Tosello, B. (2025). Neonatal and Two-Year Prognosis of Eutrophic Newborns from Monochorionic Diamniotic Twin Pregnancies Complicated by Selective Intrauterine Growth Restriction. Children, 12(5), 615. https://doi.org/10.3390/children12050615